Health care policy
O
n Jan. 1, 2014, Minnesotans gained access to new health insurance coverage options through the Affordable Care Act (ACA). These options included an expansion of Medicaid coverage for adults with annual incomes of up to 138 percent of the federal poverty level (or up to $16,105 for a single-person household) and new premium tax credits and cost-sharing subsidies for the purchase of private coverage through Minnesota’s new health insurance marketplace, MNsure. These new options, along with an in-
Coverage impacts of the ACA Implications for our health-care delivery system By Julie Sonier, MPA, and Elizabeth Lukanen, MPH dividual mandate to have health insurance coverage, have led to shifts in Minnesota’s health insurance coverage landscape. These shifts have implications
Party Fabulous! Holiday Events at
651-292-9292 | saintpaulhotel.com | 800-292-9292
32
Minnesota Physician October 2014
for all sectors of the health care market, including physicians and other health care providers. Changes in the size and composition of the insured population have the potential to change the composition of providers’ typical patient population (e.g., age and health status), alter demand for services, and transform the system capacity needs. There is great interest in having timely information to understand how the ACA has affected Minnesota so far. Historically, population surveys have been used to monitor state-level changes in health insurance coverage. However, given lags in data collection, relevant estimates from these surveys will not be available until the fall of 2015. Information on national-level impacts is beginning to be available, but there are many reasons to believe that the law’s impacts on health insurance coverage will vary by state: different policy choices that states have made about implementing the law, variation in prior uninsurance rates across states, and variations in state demographic and economic characteristics. To assess the state-level impacts of the ACA in a more timely way, the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota published an analysis using a unique method to estimate how patterns of health insurance coverage in Minnesota have shifted since the fall of 2013. The analysis and report were prepared at the request of MNsure, Minnesota’s state-based health insurance exchange, and the work was funded through a grant from the Robert Wood Johnson Foundation’s State Health Re-
form Assistance Network. This article provides a brief summary of the SHADAC research and discusses its implications for the health care system. The full report is available at (www. shadac.org/MinnesotaCoverag e Report). Methods and data Although some piecemeal information has been available about the ACA’s impacts in Minnesota, such as the number of people who have enrolled in coverage through MNsure, this information only tells part of the story. An accurate assessment of the ACA’s impacts needs to account for shifts between coverage sources—for example, some people who signed up for coverage through MNsure may have previously had other coverage. To accurately assess the statewide impacts of the ACA, SHADAC measured the health insurance coverage status of the entire population of Minnesota at two points in time: Sept. 30, 2013, and May 1, 2014 (see Fig. 1 on page 33). We chose these dates to provide a snapshot of coverage in the state immediately before MNsure’s first open enrollment period and one month after the end of open enrollment. This allowed us to account for enrollments that had been started but not completed prior to the official end of open enrollment on March 31. This method of measuring population-wide changes in the number of people with each type of coverage provided a complete picture of how health insurance coverage in Minnesota has changed, rather than the partial picture based on the limited data that were previously available. We gathered information from private and public payers on the number of Minnesota residents enrolled in their health plans on these two dates. The data for our study came from the following sources: U.S. Census Bureau (for population totals); the Minnesota Council of Health Plans (reporting for private health plans); MNsure; the Minnesota Department of Human Ser-