2017 oregon health insurance survey (ohis) · 2018. 3. 28. · 2017 ohis survey. 5. 25 regions with...

2017 Oregon Health Insurance Survey (OHIS)

Summary and Results

HEALTH POLICY & ANALYTICS DIVISION

Jeremy Vandehey, Jon Collins

Presentation Today

• Background on the OHIS• Insurance coverage • Coverage transitions and gaps • Focus on the uninsured• Cost, out of pocket, medical bills/debt, premium

and deductibles• Underinsurance


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History of OHIS Surveys


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2011

2013

2015

OHIS has been fielded in…

2017New vendor, Slight methodology changes

2017 OHIS Survey


4

9,007Households

21,329People

11,239Families

Collects information at the individual, family and

household levels

2017 OHIS Survey

5

25 regions with at least 20,000 people in each• 20 regions are a single

county• 5 regions are multi-

county

Pre-screened sample for racial/ethnic groups:• Hispanic/Latino,

Black/African American, Native American, and Asian


2017 OHIS Survey

6

29.6minutes average length

Random

DialingDigit

ENGLISH and

SPANISH

Dual Telephone Frame


64%cell

36%landline

2017 OHIS Question Topics

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TopicsInsurance Status Coverage Changes

Why Remain Uninsured** Program Eligibility*

Health Status Mental Health**

Access Dental Care**

Utilization Demographics

Costs Underinsurance*


* - new topic in 2017 ** - expanded topic in 2017

Overall insurance coverage dropped slightly in 2017.Point in time insurance rates

2011 85.4%

2013 85.5%

2015 94.7%

2017 93.8%

Nearly 94% of Oregonians were insured in 2017.

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14.6%

14.5%

5.3%

6.2%4.9% 4.9% 6.0%

5.2%

52.2%49.3%

47.9% 47.5%

13.7%

15.9%

24.9%26.0%

13.9%14.7% 15.9% 15.1%

2011 2013 2015 2017

Group

MedicareUninsured

Individual

OHP/ Healthy Kids

Health insurance coverage was lowest among 26-34 year olds.

Less than 3% of children and teens ages 0-18 were uninsured.

Less than 1% of Oregonians age 65 and older were uninsured.

Insurance Coverage by Age

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93.8%

97.1%

88.7%

88.0%

89.2%

92.6%

95.1%

99.6%

Statewide

0-18

19-25

26-34

35-44

45-54

55-64

65+

Uninsurance by Race and Ethnicity

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Uninsurance was highest among Hispanic Oregonians in 2017.

18.7%

17.7%

9.6%

8.8%

7.3%

6.2%

5.9%

5.4%

2.3%

Hispanic

Other

Black or African American

American Indian or Alaska Native

Pacific Islander

STATEWIDE

Two or more races

White

Asian

Uninsured Population

Total Population

3,300 145,100

178,400 3,297,600

10,800 181,900

245,600 3,993,100

2,000 27,500

4,600 52,600

7,100 74,400

10,200 57,700

29,200 156,200

Coverage Transitions

Were you without insurance at some time during the last 12 months?

For how long were you without health insurance coverage?

(Avg = 2 mo)

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5.3%3.9%

14.0%7.9%

2.2%

OVERALLGroup

IndividualOHP

Medicare

21.0%50.2%

9.6%2.9%5.1%4.4%6.8%

Up to 1 monthUp to 6 months

Up to 1 yearUp to 2 yearsUp to 5 years

More than 5 yearsNever had coverage before

For those with health insurance coverage…

Coverage Transitions

Did you have a major change in your health insurance in the past 12 months?

Why did your coverage change? Top 5 reasons

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For Oregonians who were insured for all of the previous 12 months…

8.3%

8.6%

29.3%

4.7%

6.9%

OVERALL

Group

Individual

OHP

Medicare

19.7% Person with health insurance lost job or changed employers

14.0% Cost is too high, cost increased, cost of premium, cannot afford

10.5% Employer changed insurance providers

8.1% Switched insurance providers

6.2% Insurance company refused coverage, terminated coverage

41.4% Other reasons (27)

Coverage Gaps

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88.9% 11.1%

Insured all of the past year

Currently uninsured or had a coverage gap in the past year

Focus on the Uninsured

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35 years oldMale White

Lives in Urban areaMultnomah County

187% FPL (median)High school or less

Employed

23 months uninsuredPaid $780 out of pocket for

medical costs in the past year(more detail on later slide)

Focus on the UninsuredOf the group, what percent are uninsured?

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7.3%

5.0%

Male

Female

2.9%

11.7%

10.0%

5.4%

0.4%

0 to 18

19 to 34

35 to 49

50 to 64

65+

5.4%

9.6%

2.3%

7.3%

8.8%

18.7%

17.7%

5.9%

White

Black or African American

Asian

Pacific Islander

American Indian or Alaska Native

Hispanic

Other

Two or more races

Focus on the Uninsured Of the group, what percent are uninsured?

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18.3%

9.3%

6.2%

6.7%

3.6%

2.1%

Less than high school

High school or GED

Some college

Associate's degree

Bachelor's degree

Graduate degree

Focus on the UninsuredOf the group, what percent are uninsured?

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6.9%

10.5%

9.9%

7.4%

5.6%

2.7%

0% to 100%

101% to 138%

139% to 200%

201% to 300%

301% to 400%

401% or more

7.9%

11.7%

18.9%

3.0%

Employed

Self-employed

Unemployed

Out of the labor force


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17.4%

17.9%

6.6%

11.5%

4.3%

5.2%

30.2%

6.8%

< 3 months

3 to 6 months

7 to 9 months

10 to 12 months

13 to 18 months

19 to 24 months

25+ months

DK-REF

How long has the person been uninsured?


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Percent uninsured by region

2.4 – 4.9%

5.0 – 6.2%

6.3 – 7.9%

8.0 – 9.0%

10.0 – 13.6%

Uninsurance ratesHighest 13.6% Hood RiverLowest 2.4% Benton

WallowaMultnomah

ClackamasMarion

Linn

Lane

Douglas

KlamathJackson

Wheeler

Crook

Lake

Deschutes

Jefferson

Wasco

ShermanHood River

Union

Baker

MalheurHarney

Grant

Umatilla

Morrow

Gilliam

Josephine

Curry

Coos

Benton

LincolnPolk

YamhillTillamook

ClatsopColumbia

Washington

Focus on the UninsuredReasons a person is uninsured - each question is a Yes/No question in the survey

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32.2%

29.2%

25.3%

22.6%

10.2%

9.7%

Lost OHP coverage

Not interested in health insurance

Premiums too expensive on employer coverage

Lost a job

Employer stopped offering coverage

Reduced work hours, no longer eligible for coverage

Focus on the UninsuredReasons a person is uninsured- Open-ended answers were combined into seven themes

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31.4%

22.6%

16.1%

10.4%

9.0%

6.6%

3.8%

Cost

Job related

OHP related

Other

Insurance related

Don't need insurance

Personal reasons

Focus on the UninsuredWhat percent of people without health coverage are eligible for Medicaid or financial assistance through the Exchange?

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14.2%

12.6%

49.7%

13.2%

36.1%

74.2%

Adults19-64

Children0-18

Likely eligible for Medicaid

Likely eligible for financial assistance (Exchange)Not eligible for financial assistance

= 87.4%Likely eligible for some coverage or

assistance

= 85.8%Likely eligible for some coverage or

assistance

Delaying Care due to Cost

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During the past 12 months, did the person need but not get a certain type of care because they couldn't afford it?

Overall Group Individual

2.1%

3.2%

3.3%

3.8%

4.1%

4.3%

9.4%

1.7%

2.3%

2.3%

2.0%

2.5%

2.9%

6.4%

2.8%

9.1%

6.9%

7.5%

2.9%

8.8%

15.2%

Mental health care or counseling

A diagnostic test

Specialist care

Routine medical care

Prescription medicines

Medical care from a doctor or a surgery

Any type of dental care

Delaying Care due to Cost

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During the past 12 months, did the person need but not get a certain type of care because they couldn't afford it?

Overall OHP Medicare Uninsured

2.1%

3.2%

3.3%

3.8%

4.1%

4.3%

9.4%

2.3%

3.2%

4.2%

3.6%

5.6%

5.2%

9.6%

1.2%

2.5%

2.4%

3.1%

5.9%

2.8%

10.9%

6.3%

6.8%

7.2%

16.8%

7.5%

11.6%

24.0%

Mental health care or counseling

A diagnostic test

Specialist care

Routine medical care

Prescription medicines

Medical care from a doctor or a surgery

Any type of dental care

Out of Pocket Expenses

In the past year, how much has your family paid out of pocket for all medical expenses?

Includes: - Prescription drugs- dental, vision, and mental

health care- All other expenses (doctors,

hospitals, tests, over-the-counter medications, first aid supplies)

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Median annual out of pocket expenses per family by coverage type

- Excludes premiums & deductibles -

$400

$780

$1,700

$1,990

$2,470

OHP/Healthy Kids

Uninsured

Group

Medicare

Individual

Medical Bills and Medical Debt

During the last 12 months, were there times that there were problems paying for medical bills?

26


8.4%

7.4%

15.8%

5.9%

9.5%

17.1%

OverallGroup

IndividualOHP

MedicareUninsured

Medical Bills and Medical Debt

Does person currently have any medical bills which the household is paying off over time?

27


10.3%

11.0%

12.8%

6.6%

9.8%

18.9%

OverallGroup

IndividualOHP

MedicareUninsured

Monthly Family Premiums

What is the median monthly health insurance premium paid by a family?

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$300

$350

$600

Medicare

Group

Individual

Annual Family Deductibles

What is the median annual health insurance deductible paid by a family?

29


$760

$1,500

$3,500

Medicare

Group

Individual

What is Underinsurance?

The Commonwealth Fund (CF), a national health policy research organization, developed a definition and methodology to measure underinsurance.

Essentially, underinsurance is a relationship between a family’s annual income and their annual medical expenses.

Under the CF model, a person is underinsured if:

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A family’s annual deductible is greater than 5% of their annual household income, or

If a family’s income is 200% of the federal poverty level (FPL) or lower and their out-of-pocket medical expenses exceed 5% of their annual income, or

If a family’s income is above 200% FPL and their out-of-pocket medical expenses exceed 10% of their annual income.

What is Underinsurance?

OHA’s partner on the 2017 OHIS, Market Decisions Research (MDR), expanded upon CF’s definition of underinsurance by including measures of a family’s experience paying for healthcare.

The MDR definition adds: • One or more family members deferred

health care due to cost. This includes deferring:

– Medical care from a doctor or surgery– Routine medical care that that was

needed

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– Mental health care or counseling– Any type of dental care– A diagnostic test such as a CAT scan,

MRI, lab work, or x-ray that was recommended

– Specialist care– Prescription Medicines– Skipping doses or taking smaller

amounts of prescription drugs to make them last longer

• If the family experienced difficulties paying for medical bills.

Focus on the Underinsured

Commonwealth Fund Model- Income in relation to premium

or deductible

MDR Model- Includes CF criteria- Adds personal experience of

difficulty paying for health care

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35.3%

51.6%

58.6%

42.3%

*

*

CFModel

MDRModel

Underinsured Not Underinsured

* Uninsured 6.2%

Summary

• Overall, uninsurance is low.• By race and ethnicity,

Oregonians who are Hispanic are the most likely to be uninsured.

• By age, Oregonians who are 26 to 34 are the most likely to be uninsured.

• Having no health insurance is related to difficulty paying for health care.

• About 30% of the uninsured say they don’t want coverage.

• Around 50% of people with health insurance were underinsured.

• Over 80% of uninsured Oregonians are likely eligible for OHP or financial assistance through the exchange.

• People with Individual coverage paid the most out of pocket for care in the past year.

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Upcoming Fact Sheets

Regional Coverage Rates The Uninsured

Access to Care Trends Prescription Usage and Cost

Underinsurance Medical Debt, bills, and expenses

Mental Health Barriers to Care and Providers

Doctor Visits, Usual Place of Care Care Coordination and Telehealth

Race and Ethnicity Coverage Rates Health Insurance Exchange

Dental Coverage and Utilization Emergency Room Utilization

Gaps and Changes in Coverage Employment and Coverage

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Contact and Further Information

Stacey Schubert, [email protected]

[email protected]

Jon Collins, [email protected]

2017 OHIS data reports will be posted as available on our website:http://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Insurance-Data.aspx

Topics will include coverage, access, utilization, demographics, and more to come.


mailto:[email protected]:[email protected]:[email protected]://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Insurance-Data.aspx

2017 Oregon Health Insurance Survey (OHIS)Presentation TodayHistory of OHIS Surveys2017 OHIS Survey2017 OHIS Survey2017 OHIS Survey2017 OHIS Question TopicsNearly 94% of Oregonians were insured in 2017.Insurance Coverage by Age�Uninsurance by Race and Ethnicity �Coverage TransitionsCoverage TransitionsCoverage GapsFocus on the UninsuredFocus on the UninsuredFocus on the Uninsured Focus on the UninsuredFocus on the UninsuredFocus on the UninsuredFocus on the UninsuredFocus on the UninsuredFocus on the UninsuredDelaying Care due to CostDelaying Care due to CostOut of Pocket ExpensesMedical Bills and Medical DebtMedical Bills and Medical DebtMonthly Family PremiumsAnnual Family DeductiblesWhat is Underinsurance?What is Underinsurance?Focus on the UnderinsuredSummaryUpcoming Fact SheetsContact and Further Information

2017 oregon health insurance survey (ohis) · 2018. 3. 28. · 2017 ohis survey. 5. 25 regions with...

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