establishing a baseline for the affordable care act: how accessible and affordable has health care...
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How Accessible and Affordable has Health Care been in Minnesota
previous to the ACA?
Giovann Alarcón
MN Health Services Research Conference
March 4th, 2014
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Provide an up-to-date and State specific overview of two
important outcomes to monitor under the ACA: health
care access and affordability.
• How accessible is care in MN?
• How affordable is care in MN?
• How do the Uninsured compare to other groups?
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• MNHA 2007, 2009, 2011, and 2013
• Non-elderly population
• Sample size
• 2007: 7,316
• 2009: 9,749
• 2011: 9,499
• 2013: 9,935
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Access indicators that the ACA is expected to impact
include:
• reports of having a usual source of care (2007-2013),
• use of the emergency department (2009-2013),
• the ability -and confidence- in getting care when needed
(2011-2013), 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).
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• Most Minnesotans have a usual source of care and are
confident in getting care when needed, but only about half of
the uninsured report the same characteristics.
• Health Care Utilization is high for most (around 80% for
doctor’s visits) but the uninsured (47%).
• One out of ten Minnesotans could not get a doctor’s
appointment as soon as needed, with those enrolled in public
programs doubling the rates of others.
• Minnesotans with public coverage were more likely to face
problems with providers than people with other types of
insurance or the uninsured.
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90.4%
83.6%^*
88.5%
54.6%^
86.3%
50%
60%
70%
80%
90%
100%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
2007 2009 2011 2013
* Indicates statistically significant difference (p≤.05) from previous year shown
^ Indicates statistically significant difference (p≤.05) from Group within year
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* Indicates statistically significant difference (p≤.05) from previous year shown
^ Indicates statistically significant difference (p≤.05) from Group within year
96.1%
89.8%^ 90.6%^
58.4%^
91.1%
50%
60%
70%
80%
90%
100%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
2007 2009 2011 2013
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^ Indicates statistically significant difference (p≤.05) from Group within year
Total
Very confident 83.4% 73.1% ^ 67.5% ^ 30.0% ^ 74.5%
Somewhat confident 12.8% 16.7% 23.1% ^ 28.3% ^ 16.6%
A little confident 2.5% 5.4% ^ 5.0% ^ 23.0% ^ 5.1%
Not confident at all 1.4% 4.8% ^ 4.4% ^ 18.6% ^ 3.8%
PublicGroup Individual Uninsured
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^ Indicates statistically significant difference (p≤.05) from Group within year
83.0%
76.2%^
82.4%
47.3%^
79.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
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* Indicates statistically significant difference (p≤.05) from previous year shown
^ Indicates statistically significant difference (p≤.05) from Group within year
13.5%
11.7%
27.2%^
18.0%
16.7%
0%
5%
10%
15%
20%
25%
30%
35%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
2009 2011 2013
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^ Indicates statistically significant difference (p≤.05) from Group within year
8.9%
5.7%^
15.9%^
7.9%
10.1%
0%
3%
6%
9%
12%
15%
18%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
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^ Indicates statistically significant difference (p≤.05) from Group within year
1.3%
2.2%
7.2%^
5.2%^
2.9%
2.2% 2.1%
6.1%^
4.0%
3.2%
0%
2%
4%
6%
8%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
Doctor did not accept their health care coverage
Doctor was not accepting new patients
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Affordability indicators that the ACA is expected to impact
include:
• forgone and delayed care due to costs (2011 & 2013),
• problems paying medical bills (2013),
• needing to establish a payment plan with a hospital or
doctor’s office (2013), or
• having trouble paying other basic bills (e.g. food, heat, or
rent) due to care costs (2013).
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• Although, in 2013 Minnesotans were less likely to forgo
care due to costs than in 2011, about one out of five
people faced this situation.
• One out of four Minnesotans who used some form of
care reported having financial burdens related to these
services.
• Almost one out of two uninsured Minnesotans had
problems paying medical bills, and for 32% of the
uninsured these affected their ability to pay other basic
bills
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* Indicates statistically significant difference (p≤.05) from previous year shown
^ Indicates statistically significant difference (p≤.05) from Group within year
9.2%
17.4%
9.8% 9.2%
7.3%*
12.4%*
6.9%*
4.1% 4.9%*
0%
3%
6%
9%
12%
15%
18%
21%
Prescription Dental Care Routine Care Mental HealthCare
Specialist Care
2011 2013
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* Indicates statistically significant difference (p≤.05) from previous year shown
^ Indicates statistically significant difference (p≤.05) from Group within year
Group Coverage 4.5% * 8.3% * 3.7% * 2.4% 3.2% *
Individual Coverage 7.5% 15.1% ^ 7.8% ^ * 3.6% 4.4% *
Public Coverage 11.1% ^ 15.2% ^ * 5.5% ^ * 4.1% ^ 4.9% ^ *
Uninsured 17.7% ^ 32.4% ^ * 32.2% ^ 17.1% ^ 17.6% ^ *
Total 7.3% * 12.4% * 6.9% * 4.1% 4.9% *
Prescription Dental Care
Routine
Care
Mental
Health
Specialist
Care
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^ Indicates statistically significant difference (p≤.05) from Group within year
19.3% 19.3%
25.3%^
40.0%^
22.5% 21.3% 22.1%
28.1%^
60.6%^
25.1%
0%
10%
20%
30%
40%
50%
60%
70%
Group Coverage IndividualCoverage
Public Coverage Uninsured Total
Overall population Those who used health care
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^ Indicates statistically significant difference (p≤.05) from Group within year
12% 16%
20%^
48%^
16% 17% 16% 18%
46%^
19%
6% 7%
14%^
32%^
10%
0%
10%
20%
30%
40%
50%
60%
Group Coverage Individual Coverage Public Coverage Uninsured Total
Problems paying medical bills Set up a payment plan for medical bills
Had trouble with basic bills due to medical costs
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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year
83.0%
76.2% 82.4%
60.1%^ 54.9%^
40.6%^
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Group coverage Individual coverage Public coverage
Insured Uninsured
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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year
8.9%
5.7%
15.9%
7.6%
10.4%
7.2%^
0%
10%
20%
Group coverage Individual coverage Public coverage
Insured Uninsured
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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year
13.4%
22.3% 23.3%
44.0%^
49.7%^
43.6%^
0%
10%
20%
30%
40%
50%
60%
Group coverage Individual coverage Public coverage
Insured Uninsured
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^ Indicates statistically significant difference (p≤.05) from comparison group (Insured) within year
19.3% 19.3%
25.3%
43.2%^
34.7%^
43.0%^
0%
10%
20%
30%
40%
50%
Group coverage Individual coverage Public coverage
Insured Uninsured
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• Despite high insurance rates, some measures of
health care access and affordability are low.
• This especially affects Minnesotans with public
coverage and the uninsured.
• Under ACA, most changes are expected to occur in
the individual market and public programs.
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www.shadac.org
@shadac
Giovann Alarcón
alar0013@umn.edu
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