Post reform changes in health care access and affordability in MN

POST-REFORM CHANGES IN HEALTH CARE ACCESS AND

AFFORDABILITY IN MINNESOTA

Giovann Alarcón MN Health Services Research Conference March 1st, 2016

Purpose and overview

Provide an up-to-date and State specific overview of two important outcomes to monitor: health care access and affordability • How accessible and affordable is care in MN? • Has the situation changed post-ACA? • Does this depend on insurance type or income?

2

Analytic sample

• MNHA 2007, 2009, 2011, 2013, and 2015 • Sample size

• 2007: 9,728 • 2009: 12,031 • 2011: 11,355 • 2013: 11,778 • 2015: 11,178

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Indicators on Health Care Access Access indicators in the Minnesota Health Access Survey include: • reports of having a usual source of care (2007-2015), • the ability –and confidence– in getting care when

needed (2013-2015), and • provider supply issues where potential patients are

told by a doctor’s office or clinic that they do not accept their health care coverage or they are not accepting new patients (2013-2015).

Other indicators available are: visit to a doctor’s office (2011-2015) and use of the emergency department (2009-2015).

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Indicators on Health Care Affordability Affordability indicators in the Minnesota Health Access Survey include: • forgone care due to costs (2011-2015), • having problems paying medical bills (2013-2015), • needing to establish a payment plan with a hospital

or doctor’s office (2013-2015), • having trouble paying other basic bills (e.g. food,

heat, or rent) due to care costs (2013-2015), and • being satisfied with the protection against high

medical bills provided by their insurance coverage (2015).

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ACCESS

Highlights

• Most Minnesotans have a (private) usual source of care and are confident in getting care when needed, but only about half of the uninsured report the same characteristics.

• One in ten Minnesotans could not get a doctor’s appointment as soon as needed, increasing for people with private coverage.

• Minnesotans with public coverage were more likely to face problems with providers than people with other types of insurance.

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Usual Source of Care by Insurance Type, 2007 - 2015

8

* Indicates statistically significant difference (p≤.05) from previous year shown

89.4% 88.3% 86.4% 85.5% 85.7%

40%

60%

80%

100%

2007 2009 2011 2013 2015

Total Public Group Non-group Uninsured

Confidence in Getting Care When Needed by Insurance Type, 2013 - 2015

9

* Indicates statistically significant difference (p≤.05) from 2013 estimates

91.7% 92.8% 96.1% 90.0%

58.2%

93.2%* 91.7% 96.3% 89.8%

67.2%

0%

20%

40%

60%

80%

100%

Total Public Group Non-group Uninsured

2013 2015

Level of Confidence in Getting Care When Needed by Insurance Type, 2015

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^ Indicates statistically significant difference (p≤.05) from Total estimates

TotalVery confident 75.8% 82.0% ^ 64.6% ^ 70.6% ^ 48.3% ^Somewhat confident 17.4% 14.3% ^ 25.1% ^ 21.1% ^ 18.9%A little confident 3.9% 2.3% ^ 5.2% 5.7% ^ 10.9% ^Not confident at all 2.9% 1.5% ^ 5.0% 2.6% 21.9% ^

Group Non-group Public Uninsured

Could Not Get an Appointment When Needed by Insurance Type, 2013 - 2015

11

* Indicates statistically significant difference (p≤.05) from 2013 estimates

9.7%

12.2%

8.9%

5.6%

7.9%

12.1%* 13.2%

11.5%* 12.3%*

11.5%

0%

2%

4%

6%

8%

10%

12%

14%

Total Public Group Non-group Uninsured

2013 2015

Doctor Did Not Accept Their Health Coverage by Insurance Type, 2013-2015

12

* Indicates statistically significant difference (p≤.05) from 2013 estimates

2.7%

4.8%

1.3%

2.1%

5.4%

3.7%*

6.2%

2.1%*

3.7%

6.6%

0%

2%

4%

6%

8%

Total Public Group Non-group Uninsured

2013 2015

Doctor Was Not Accepting New Patients by Insurance Type, 2013 - 2015

13

* Indicates statistically significant difference (p≤.05) from 2013 estimates

2.9%

4.1%

2.2% 2.0%

3.9% 3.7%*

5.4%

2.3%

6.6%*

5.6%

0%

2%

4%

6%

8%

10%

Total Public Group Non-group Uninsured

2013 2015

AFFORDABILITY

Highlights

• About one in five people were likely to forgo care due to costs, although this has decreased for patients seeking routine or mental care.

• One in five insured Minnesotans who used some form of care reported having financial burdens related to these services. This doubles for uninsured Minnesotans.

• Financial Burden affects 1 in 3 Minnesotans with income between 138-250% FPG.

• Four in five people reported being satisfied with the protection against high medical bills provided by their insurance.

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Forgone Care Due to Cost, 2013 - 2015

16

* Indicates statistically significant difference (p≤.05) from 2013 estimates

18.6%

7.0%

12.4%

6.3%

3.7% 4.4%

18.4%

6.2%

12.4%

4.6%*

2.7%*

4.4%

0%

4%

8%

12%

16%

20%

Any forgonecare

Prescriptiondrugs

Dental care Routine care Mental care Specialist care

2013 2015

Forgone Care Due to Cost by Income Group, 2015

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Any forgone care

Prescription drugs Dental care Routine

care Mental care Specialist care

Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%0 to <138%/275 FPG 22.5% 7.9% 14.8% 5.6% 3.2% 4.6%138-250% FPG 29.8% 9.3% 24.2% 7.3% 3.5% 8.3%<250-400% FPG 19.0% 6.2% 14.1% 4.5% 2.2% 4.4%<400% FPG 11.9% 4.0% 6.9% 3.2% 2.3% 3.0%

Forgone Care Due to Cost by Insurance Type, 2015

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Any forgone care

Prescription drugs Dental care Routine

care Mental care Specialist care

Total 18.4% 6.2% 12.4% 4.6% 2.7% 4.4%Public 20.1% 6.3% 16.5% 4.1% 2.0% 4.0%Group 14.7% 5.1% 9.0% 3.7% 2.3% 3.5%Non-group 29.4% 8.7% 21.8% 7.6% 5.1% 8.9%Uninsured 40.0% 16.4% 24.4% 17.4% 9.9% 14.0%

Type of Medical Financial Burden, 2013 - 2015

19

* Indicates statistically significant difference (p≤.05) from 2013 estimates

23.0%

14.8%

17.0%

8.7%

20.8%*

12.1%*

16.0%

6.5%*

0%

5%

10%

15%

20%

25%

Financial Burden Medical bills Payment Plan Basic Bills

2013 2015

Financial Burden by Income Group, 2013 - 2015

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* Indicates statistically significant difference (p≤.05) from 2013 estimates

23.0%

31.3% 32.1%

24.7%

14.0%

20.8%* 22.8%*

31.7%

24.3%

14.4%

0%

5%

10%

15%

20%

25%

30%

35%

Total 0 to <138%/275FPG

138-250% FPG <250-400% FPG <400% FPG

2013 2015

Financial Protection by Insurance Type, 2015

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82.3% 87.7%

80.9%

66.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Total Public Coverage Group Coverage Individual Coverage

Financial Protection by Insurance Type, 2015

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0%

10%

20%

30%

40%

50%

60%

70%

Verysatisfied

Somewhatsatisfied

Neutral Somewhatdissatisfied

Verydissatisfied

Public Group Non-group

Financial Protection by Insurance Type, 2015

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^ Indicates statistically significant difference (p≤.05) from Total estimates

Total

Very satisfied 50.6% 62.0% ^ 46.1% ^ 31.7% ^Somewhat satisfied 31.7% 25.8% ^ 34.8% ^ 35.3%Neither satisfied or dissatisfied 8.0% 5.9% ^ 8.9% 11.1%Somewhat dissatisfied 6.0% 4.0% ^ 6.6% 10.4% ^Very dissatisfied 3.7% 2.4% ^ 3.6% 11.6% ^

Public Group Non-group

CLOSING REMARKS

• Some access indicators show a clear improvement, including gains in coverage.

• Some issues related to providers have worsened, including the rate of people who reported not getting an appointment when they needed it.

• Forgone routine and mental care are less frequent. • Fewer Minnesotans had problems paying medical

bills or other basic bills due to medical costs. • Only low-income Minnesotans have experienced a

reduction in the financial burden they experience due to their health care costs.

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Acknowledgements

• Stefan Gildemeister • Alisha Simon • Sarah Hagge • Kendal Orgera

• Kathleen Call • Karen Turner • Jessie Kemmick-Pintor • Giovann Alarcon

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THANK YOU Giovann Alarcón alar0013@umn.edu