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Health Care Reform: Measuring its impact in 33 States with IHS funded health programs American Indians & Alaska Natives July 26, 2012. Review of New Data from the 2008-2010 American Community Survey on rates of insurance and income distribution for Alaska Natives and American Indians - PowerPoint PPT Presentation
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R E V I E W O F N E W D A T A F R O M T H E 2 0 0 8 - 2 0 1 0 A M E R I C A N C O M M U N I T Y S U R V E Y O N R A T E S O F I N S U R A N C E A N D I N C O M E
D I S T R I B U T I O N F O R A L A S K A N A T I V E S A N D A M E R I C A N I N D I A N S
3 3 S T A T E A C A A I A N D A T A P R O J E C T A C A / A I A N 1 2
W W W . E D F O X P H D . C O M
Health Care Reform: Measuring its impactin 33 States with IHS funded health programs
American Indians & Alaska Natives
July 26, 2012
33 State level impact analysis
1st step: How many AIANs are there?
4,095,371 (33 states) estimated AIAN alone & in combination4, 900,000 in all 50 states
2nd step: What is rate of private insurance?
45.6% 1.9 million AIANs have private insurance30% 1.2 million report access to IHS paid services27% 1.1. million have Medicaid
3rd step: What is number and rate of uninsured?
27% 1.1 million uninsured 4th step: Determine income distribution of uninsured across 3 income categories.*
36% under 138% of Federal Poverty Level (FPL), ** 42% 138 to 400% of FPL 21% over 400% of FPL
5th step: Use estimates to provide information needed for planning outreach & education, workforce, facilities, budgets for all.
6th step: Remember these are estimates, check with reality as it becomes known, make no assumptions, remember error rates.
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The American Community Survey
Three-year data2008-2010 surveys pooled data released 10/27/11, w/ add’l releases Dec.
’11
State, County, and Metropolitan Area data for areas w/ ≥ 20,000 AIAN alone & in comb.
Health Insurance data partially available
(most reliable data thus far for AIANs – question on health insurance first asked in 2008, allowing 1st time 3-yr data is avail.)
Current release does not report Medicaid or Medicare separately, but as public coverage
In addition it includes, for the first time, information on the perception of IHS ‘coverage’ and Income distribution for AIANs:
Questions on the ACS
The health insurance question asks the respondent to give a separate answer for each member of household regarding health insurance coverage, including:
1. Employer Sponsored Insurance (ESI)2. Private, paid by individual3. Medicare4. Medicaid 5. Tricare, Health care insure for military and families6. VA, Veteran’s Administration 7. IHS coverage-not used to compute rates of insurance
Question on insurance is ‘point in time’ or ‘current coverage’ not the coverage in the ‘past year’ asked in some surveys.
It is generally believed that Medicaid is underreported.
Limitations of ACS data
Estimates are based on survey samples: do not have calculated error rates to inform the range of uncertainty in
the estimates However, three years of data for Oklahoma have over 10,000 responses
and Washington’s data includes more than 6300 responses from self-identified AIANs
As the first set of 3-year estimates, it is relatively new and little research has examined its relative accuracy.Example: there is some evidence that it underestimates Medicaid coverage by a couple points
Uninsured is calculated when a respondent answers: no to all 6 types of health insurance coverage Note: IHS is not considered coverage
ACS and Urban Indians
Arizona, Alaska, California, Oregon, Oklahoma, Minnesota, New Mexico, and Washington all have very large Urban Indian populations.
ACS has income and insurance data for metropolitan areas in each of these states. In addition, County level, data is available for Arizona, California, Oklahoma, New Mexico, and Washington.
% of All Respondents IHS Uninsured Medicaid Medicare Private InsAlabama 3% 21% 20% 15% 59%Alaska 81% 36% 29% 8% 35%Arizona 53% 30% 38% 9% 32%California 9% 20% 26% 11% 54%Colorado 9% 23% 22% 9% 54%Connecticutt 13% 26% 13% 61%Florida 4% 28% 21% 13% 50%Idaho 33% 30% 24% 13% 44%Iowa 11% 26% 21% 10% 55%Kansas 18% 23% 24% 9% 54%Louisiana 4% 24% 27% 11% 49%Maine 21% 18% 42% 15% 43%Massachusetts 2% 8% 34% 13% 61%Michigan 17% 16% 30% 11% 56%Minnesota 28% 22% 37% 8% 43%Mississippi 28% 32% 25% 12% 45%Montana 68% 40% 29% 9% 28%Nebraska 19% 21% 25% 11% 52%Nevada 33% 28% 16% 10% 55%New Mexico 63% 39% 29% 9% 30%New York 10% 19% 30% 12% 52%North Carolina 6% 25% 28% 11% 45%North Dakota 69% 33% 26% 6% 41%Oklahoma 59% 28% 24% 10% 48%Oregon 20% 27% 26% 9% 48%Rhode Island 28% 32% 25% 12% 45%South Carolina 4% 24% 25% 12% 51%South Dakota 77% 38% 39% 7% 22%Texas 5% 27% 18% 11% 55%Utah 19% 27% 28% 21% 47%Washington 26% 22% 29% 10% 50%Wisconsin 31% 20% 33% 12% 48%Wyoming 40% 31% 28% 8% 41%
MassachusettsAlabama
LouisianaSouth Carolina
FloridaTexas
North CarolinaColorado
CaliforniaNew York
IowaMichigan
KansasUtah
NebraskaOregonMaine
WashingtonMinnesota
Rhode IslandMississippiWisconsin
IdahoNevada
WyomingArizona
OklahomaNew Mexico
MontanaNorth DakotaSouth Dakota
Alaska
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
2%3%4%4%4%5%6%
9%9%10%11%
17%18%19%19%20%21%
26%28%28%28%
31%33%33%
40%53%
59%63%
68%69%
77%81%
Access to IHS
MassachusettsConnecticutt
MichiganMaine
New YorkCaliforniaWisconsinNebraskaAlabama
MinnesotaWashington
KansasColoradoLouisiana
South CarolinaNorth Carolina
IowaTexas
OregonUtah
OklahomaFloridaNevada
IdahoArizona
WyomingMississippi
Rhode IslandNorth Dakota
AlaskaSouth DakotaNew Mexico
Montana
0% 5% 10% 15% 20% 25% 30% 35% 40%
8%13%
16%18%
19%20%20%21%21%
22%22%23%23%
24%24%25%
26%27%27%27%
28%28%28%
30%30%
31%32%32%33%
36%38%39%40%
Uninsured
NevadaTexas
AlabamaFlorida
IowaColorado
OklahomaIdaho
KansasMississippi
Rhode IslandSouth Carolina
NebraskaOregon
CaliforniaConnecticutt
North DakotaLouisiana
UtahNorth Carolina
WyomingWashingtonNew Mexico
AlaskaMontana
New YorkMichigan
WisconsinMassachusetts
MinnesotaArizona
South DakotaMaine
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
16%18%
20%21%21%
22%24%24%24%25%25%25%25%26%26%26%26%
27%28%28%28%29%29%29%29%30%30%
33%34%
37%38%
39%42%
Medicaid
North DakotaSouth Dakota
MinnesotaAlaska
WyomingColorado
ArizonaMontana
OregonKansas
New MexicoWashington
NevadaOklahoma
IowaNebraska
TexasCaliforniaMichigan
North CarolinaLouisianaNew YorkWisconsin
Rhode IslandMississippi
South CarolinaConnecticutt
MassachusettsIdaho
FloridaMaine
AlabamaUtah
0% 5% 10% 15% 20% 25%
6%7%8%8%8%9%9%9%9%9%9%10%10%10%10%11%11%11%11%11%11%12%12%
12%12%12%13%13%13%13%
15%15%
21%
Medicare
South DakotaMontana
New MexicoArizonaAlaska
North DakotaWyoming
MaineMinnesota
IdahoNorth Carolina
MississippiRhode Island
UtahOklahoma
OregonWisconsinLouisiana
FloridaWashington
South CarolinaNebraskaNew YorkColorado
CaliforniaKansas
TexasIowa
NevadaMichiganAlabama
ConnecticuttMassachusetts
0% 10% 20% 30% 40% 50% 60% 70%
22%28%
30%32%
35%41%41%
43%43%44%45%45%45%
47%48%48%48%49%50%50%
51%52%52%
54%54%54%55%55%55%56%
59%61%61%
Private Insurance
Income Categories and Insurance Status
Source: American Community Survey 2008-2010
33 state Average Total
1,494,529 36% under 138 1,738,858 42% 138-400 861,984 21% over 400 4,095,371 100% Total IHS Access 30% 495,893 41% under 138 532,423 44% 138-400 186,626 15% over 400 1,218,539 100% Total % Uninsured 27% of Total 487,641 45% under 138 463,275 43% 138-400 151,286 14% over 400 1,102,202 101% Total
Medicaid 27%
% of Total
742,621 66% under 138 326,250 29% 138-400 48,820 4% over 400 1,117,691 100% Total % of Total Medicare 11% 158,043 37% under 138 190,131 44% 138-400 78,336 18% over 400 430,437 99% Total % of Total Private 47% 270,342 14% under 138 949,506 49% 138-400 703,054 37% over 400 1,922,902 100% Total