Pres mnhsr2011 mar1_landry

The Impact of the Patient Protection and Affordable Care Act (ACA) on Low-Income Enrollees of the Minnesota Comprehensive Health Association (MCHA)

Kerry LandryMPH Candidate: Public Health Administration & Policy

Minnesota Health Services Research Conference

St. Paul, Minnesota

March 1st, 2011

www.shadac.org

Acknowledgements

• Minnesota Comprehensive Health Association (MCHA)

• Halleland Habicht Consulting• State Health Access Data Assistance Center

(SHADAC)• University of Minnesota School of Public Health

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What are the new coverage options available to MCHA enrollees under the Affordable Care Act?

• In 2014 there will be new coverage options for low-income Minnesotans

• The new coverage options will be based on income eligibility with no asset test

• Assuming that health reform is fully implemented, what coverage options will be available for current MCHA enrollees?

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Overview of Presentation

1. Affordable Care Act coverage expansions

2. Overview of MCHA and the Low-Income Subsidy Program

3. What we know about Low-Income Subsidy recipients

4. Estimate of MCHA enrollees eligible for new coverage options

5. Policy Implications

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1. Affordable Care Act Coverage Expansions

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Affordable Care Act (ACA)Coverage Expansions

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Income Level ACA Provision

0-138% FPL Medicaid Expansion for ALL

139-200% FPL Basic Health Plan (State opt-in)

201-400% FPLTax credit for premium assistance in the

Exchange

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2. Overview of MCHA and Low-Income Subsidy Program

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High-Risk Pools

• State health coverage mechanism for:– Medically uninsurable– HIPAA eligible– Health Care Tax Credit (HCTC) eligible

• 35 states• Financing

– Mostly through enrollee premiums and insurer assessments

– CMS grants

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Minnesota Comprehensive Health Association (MCHA)

• MCHA– Largest high-risk pool in the country

(~27,000 enrollees)– 2nd oldest – in operation since 1976– Currently administered by Medica– ‘Presumptive conditions’ also eligible

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Low-Income Subsidy Programs

• Approximately 15 states offer a subsidy• Financing through CMS grants

– Annual application for federal grant money; some years not offered

• Most states distribute as monthly premium discount

• High variation across programs

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Minnesota’s Low-Income Subsidy Program

2010

Amount Distributed $1,674,608

Income Eligibility Up to 220% FPL

Distribution Method Total $ divided by # of qualified members

Subsidy Recipients 2,774

Subsidy Amount per member $610.28 one-time check

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3. What we know about low-income subsidy recipients

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MCHA and Low-Income Subsidy Program Participants: Age

0-5 6-18 19-25 26-34 35-44 45-54 55-64 65+0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0% 2%5%

9%

13%

25%

45%

0%2%6% 6%

8%

12%

24%

42%

0%

Percentage of LISP recipients Percent of MCHA population

Age

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MCHA and Low-Income Subsidy Program Participants: Deductible Level

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$500 $1,000 $2,000 HDHP $5,000 $10,000 0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

5.9%

19.3%

33.7%

6.7%

19.1%

15.3%

7.6%

19.7%

31.6%

13.9%16.2%

10.9%

Percentage of LISP recipients Percent of MCHA population

Deductible Level

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Low-Income Subsidy Recipients

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Percent of Federal Poverty Level

Estimate of Subsidy Program Recipients

0-138% 1,362

139-200% 959

201-220% 453

Total 2,774

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What can we say about ALL MCHA enrollees from the Subsidy Program data?

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• At a minimum,

• 5.3% potentially eligible for Medicaid

• 3.7% potentially eligible for Basic Health Plan

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4. Estimate of MCHA enrollees eligible for new coverage options

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www.shadac.org 19

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Estimating income for all MCHA enrollees• Income information not available for all

enrollees – only those who applied for the subsidy program

• Do have zip code information for all enrollees

• Use zip code to determine community level income

• Estimate MCHA enrollee income using community level income

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American Community Survey (ACS)

• Annual survey conducted by the US Census Bureau

• Information on demographics, income, education, employment, health insurance, etc.

• Sub-state (community-level) analysis possible

• Public use file available

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Estimating income for all MCHA enrollees

1. Find the % of people in different income categories for each community from the ACS

– 0-138%FPL– 139-200%FPL– 201-400%FPL– 401%+FPL

2. Imputation of income for MCHA enrollees based on community level income

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Estimate of income level for all MCHA enrollees

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16.7%

9.3%

32.0%

42.0%

0-138%

139-200%

201-400%

401%FPL+

Subsidies in the exchange

Basic Health PlanNo subsidy

Medicaid

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5. Policy Implications

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Policy Implications

• 58% of MCHA enrollees potentially eligible for some form of subsidized health insurance

(n = 14,179)

• There are likely more low-income enrollees than what we estimate from the subsidy program

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Policy Implications (2)

• Potential for many individuals with chronic conditions moving to Medicaid and the individual market – Increase in risk profile of these groups– Added costs– Potential increase in premiums for private coverage– Risk adjustment in the exchange and individual

market

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Limitations

• These results are estimates • Could improve estimate through:

– Income information on all MCHA members through an enrollee survey

• Further research needed to assess affordability of new options compared with MCHA coverage

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Contact information

Kerry [email protected]

State Health Access Data Assistance Center (SHADAC)

www.shadac.org

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