Health Insurance Decision Tools for States

Steven B. Cohen, Ph.D.Steven B. Cohen, Ph.D.

Agency for Healthcare Research and Agency for Healthcare Research and QualityQuality

Current CapacityCurrent Capacity

AHRQ’s MEPS data and research findings provide national and state AHRQ’s MEPS data and research findings provide national and state specific estimates of: specific estimates of:

the uninsured population – by length of time, availability of offers, the uninsured population – by length of time, availability of offers, income levelincome level

the characteristics of employer sponsored coverage – availability, the characteristics of employer sponsored coverage – availability, employee take up, premium costs (employer/employee) employee take up, premium costs (employer/employee)

health care utilization, expenditures, source of payment, and health care utilization, expenditures, source of payment, and health status profiles by insurance coverage statushealth status profiles by insurance coverage status

Medical Expenditure Panel Medical Expenditure Panel Survey (MEPS)Survey (MEPS)

Annual Survey of 15,000 households:Annual Survey of 15,000 households: provides national estimates of health care use, expenditures, provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and insurance coverage, sources of payment, access to care and health care qualityhealth care quality

Permits studies of:Permits studies of: Distribution of expenditures and sources of paymentDistribution of expenditures and sources of payment Role of demographics, family structure, insuranceRole of demographics, family structure, insurance Expenditures for specific conditionsExpenditures for specific conditions Trends over timeTrends over time

MEPS Household ComponentMEPS Household ComponentSample DesignSample Design

Oversampling of policy relevant domainsOversampling of policy relevant domains

19961996 Minorities (Blacks & Hispanics)Minorities (Blacks & Hispanics)

19971997 MinoritiesMinoritiesLow income Low income

Children with activity limitationsChildren with activity limitations

Adults with functional limitationsAdults with functional limitations

Predicted high expenditure casesPredicted high expenditure cases

ElderlyElderly

1998-20011998-2001 MinoritiesMinorities

2002+2002+ Minorities, Asians, Low IncomeMinorities, Asians, Low Income

15,000 households; ~35,000 persons15,000 households; ~35,000 persons

Key Features of MEPS-HCKey Features of MEPS-HC

Survey of U.S. civilian noninstitutionalized populationSurvey of U.S. civilian noninstitutionalized population Sub-sample of respondents to the National Health Interview Survey (NHIS)Sub-sample of respondents to the National Health Interview Survey (NHIS) Oversample of minorities and other target groupsOversample of minorities and other target groups Panel Survey – new panel introduced each yearPanel Survey – new panel introduced each year

– Continuous data collection over 2 ½ year periodContinuous data collection over 2 ½ year period– 5 in-person interviews (CAPI) 5 in-person interviews (CAPI) – Data from 1st year of new panel combined with data from 2nd year of Data from 1st year of new panel combined with data from 2nd year of

previous panelprevious panel

Published Estimates from the Published Estimates from the MEPS-Household ComponentMEPS-Household Component

The MEPS-HC survey produces State-level estimates of: The MEPS-HC survey produces State-level estimates of: – Percent of persons with an expense, Percent of persons with an expense,

– Mean expense per person with an expense, andMean expense per person with an expense, and

– Percent of total expenses paid out-of-pocket for: Percent of total expenses paid out-of-pocket for: Total Health Services,Total Health Services, Dental Services,Dental Services, Prescription Drugs, and Prescription Drugs, and Office-Based Medical Provider Services.Office-Based Medical Provider Services.

Estimates are available for the 29 largest StatesEstimates are available for the 29 largest States

MEPS Insurance Component MEPS Insurance Component

Annual survey of 40,000 establishmentsAnnual survey of 40,000 establishmentsNational and State Level estimates of employer National and State Level estimates of employer

sponsored coverage:sponsored coverage: Availability of health insuranceAvailability of health insurance Access to health insuranceAccess to health insurance Cost of health insuranceCost of health insurance Benefit and payment provisions of private health Benefit and payment provisions of private health

insuranceinsurance

Published Estimates from the Published Estimates from the MEPS-Insurance ComponentMEPS-Insurance Component

Each year the MEPS-IC produces 280 tables of State-level estimates for private-sector Each year the MEPS-IC produces 280 tables of State-level estimates for private-sector employers: employers:

– Premiums, Premiums,

– Contributions, Contributions,

– Enrollments, Enrollments,

– Take-up rates, andTake-up rates, and

– Other (i.e., percent of employees with a choice of plans)Other (i.e., percent of employees with a choice of plans) Survey began in 1996 with estimates for 40 StatesSurvey began in 1996 with estimates for 40 States Since 2003, estimates are available for all StatesSince 2003, estimates are available for all States

Published Estimates from the Published Estimates from the MEPS-Insurance ComponentMEPS-Insurance Component

State-level estimates are broken out by:State-level estimates are broken out by:

– Firm Size Firm Size

– Industry GroupingsIndustry Groupings

– Ownership Type Ownership Type

– Age of FirmAge of Firm

– Proportion of Employees Who Are Full-time Proportion of Employees Who Are Full-time

– Proportion of Employees Who Are Low-wageProportion of Employees Who Are Low-wage

– Average Wage QuartilesAverage Wage Quartiles

Published Estimates from the Published Estimates from the MEPS-Insurance ComponentMEPS-Insurance Component

Starting in 2005, MEPS-IC produces a smaller set of private-sector Starting in 2005, MEPS-IC produces a smaller set of private-sector estimates for:estimates for:– 20 largest Metro Areas in the United States (by small/large firms) 20 largest Metro Areas in the United States (by small/large firms) – The largest Metro Areas in each State (at least one per State) The largest Metro Areas in each State (at least one per State)

and the Remainder of the State.and the Remainder of the State. All State and Metro Area estimates are available on-line in Excel All State and Metro Area estimates are available on-line in Excel

and CSV spreadsheet formats in addition to HTML and PDF tables.and CSV spreadsheet formats in addition to HTML and PDF tables.

Special State-level Estimates from the Special State-level Estimates from the MEPS-ICMEPS-IC

Spreadsheets with State-level estimates for self-insured and fully-insured Spreadsheets with State-level estimates for self-insured and fully-insured plans are distributed to a mailing list of 90+ State-level data users (most plans are distributed to a mailing list of 90+ State-level data users (most States are represented)States are represented)

Special requests from State governments and Federal agencies for more Special requests from State governments and Federal agencies for more detailed breakouts are handled on an individual basisdetailed breakouts are handled on an individual basis– Estimates often tied to proposed or pending legislationEstimates often tied to proposed or pending legislation– Distributional estimatesDistributional estimates– Estimates for specific sub-categories (i.e., geographic areas within Estimates for specific sub-categories (i.e., geographic areas within

State)State)

Special State-level Estimates from the Special State-level Estimates from the MEPS-ICMEPS-IC

AHRQ has partnered in years past with State and Federal agencies AHRQ has partnered in years past with State and Federal agencies to allow the purchase of additional sample to improve estimates for to allow the purchase of additional sample to improve estimates for specific States:specific States:– Through the HRSA State-Planning Grant ProgramThrough the HRSA State-Planning Grant Program

Increased samples in selected years for 32 States and a special Increased samples in selected years for 32 States and a special collection for the U.S. Virgin Islandscollection for the U.S. Virgin Islands

– Through Contract or GrantThrough Contract or Grant Arkansas, Massachusetts, Wisconsin, and the Robert Wood Johnson Arkansas, Massachusetts, Wisconsin, and the Robert Wood Johnson

Foundation Foundation

MEPSnet/ICMEPSnet/IC

Interactive Web-based tool provides national, and State-by-State, and public sector Interactive Web-based tool provides national, and State-by-State, and public sector insurance data in tabular formatinsurance data in tabular format

Health Insurance Decision ToolsHealth Insurance Decision Tools

Identification of affordable benefit designsIdentification of affordable benefit designs

Nationally representative data on:Nationally representative data on: health plan benefit provisionshealth plan benefit provisions, deductibles and co-pays, , deductibles and co-pays,

Consumer Driven Health Plans Consumer Driven Health Plans consumer behaviorconsumer behavior in response to coverage decisions in response to coverage decisions

and choice of plansand choice of plans linkageslinkages between MEPS household and policy booklet between MEPS household and policy booklet

data, and MEPS employer data on coverage offers, take data, and MEPS employer data on coverage offers, take up and premium costsup and premium costs

MEPS Informs Consumers’ Checkbook Guide to MEPS Informs Consumers’ Checkbook Guide to Health PlansHealth Plans

Annual Annual publicationpublication

Rates every plan Rates every plan available to available to federal federal employees and employees and retireesretirees

Compares likely Compares likely cost of various cost of various plan options to plan options to employeeemployee

Example: Example: Estimated 2007 Estimated 2007 cost to average cost to average family of 4 with family of 4 with head of head of household under household under 55 years of age55 years of age

Approximate Yearly Cost to You ($)

Plan Code

Plan Name Yearly Premium

($)

If Your Health Care Usage

were Low

If Your Health Care Usage

were Average

If Your Health Care Usage were

High

Yearly Limit on Cost to You

Excluding Dental ($)

Local Plans

E35 Kaiser-St 1210 1420 2670 4800 8880

E32 Kaiser-Hi 2480 2590 3340 4680 7230

JP2 M.D. IPA 2190 2340 3300 5170 7990

JN5 Aetna Open Access-Basic

1420 1630 3090 5900 8880

JN2 Aetna Open Access-Hi

3080 3260 4570 7100 10540

222 Aetna HealthFund CDHP

1310 1310 3770 7700 13260

2G2 CareFirst BlueChoice

2250 2480 3680 6030 10510

Components of ProgramComponents of Program Data collection and analysisData collection and analysis

– Health plan benefit provisions and costsHealth plan benefit provisions and costs– Consumer behaviorConsumer behavior

Modelling effort Modelling effort – coverage benefits, costs and take upcoverage benefits, costs and take up

Produce user friendly decision toolsProduce user friendly decision tools– Estimate impact of specific proposed state plans (cost of plan, Estimate impact of specific proposed state plans (cost of plan,

take up, expected service use and expenditures of take up, expected service use and expenditures of beneficiaries)beneficiaries)

Technical assistance on design issues and use of toolTechnical assistance on design issues and use of tool

Short Term OutputsShort Term Outputs

Number of uninsured (6+ month); socio-economic characteristics Number of uninsured (6+ month); socio-economic characteristics Classifications by income/poverty status; age; eligibility for offers Classifications by income/poverty status; age; eligibility for offers

of coverageof coverage Medical Expenditures: mean; median, total;Medical Expenditures: mean; median, total;

% with $ above X; total expenditures above X% with $ above X; total expenditures above X Comparisons with full year insuredComparisons with full year insured National, regional and state estimatesNational, regional and state estimates

OutputsOutputs

Target populationTarget population Number of uninsuredNumber of uninsured Additional persons coveredAdditional persons covered Plan benefitsPlan benefits Estimated premiumsEstimated premiums Estimated state costEstimated state cost Covered families cost Covered families cost

– Premiums plus out-of-pocketPremiums plus out-of-pocket

Greater Access to AHRQ Greater Access to AHRQ Restricted Data Restricted Data

Use of Census Bureau Research DataUse of Census Bureau Research DataCenters (Centers (RDCRDC) to improve accessibility of) to improve accessibility ofnon-public AHRQ datanon-public AHRQ dataExamples of off-site approved projects in RDC’s:Examples of off-site approved projects in RDC’s:Columbia University - Department of Health Policy and Management - Sherry Glied – “The Tax Columbia University - Department of Health Policy and Management - Sherry Glied – “The Tax

Treatment of Health Insurance Revisited”Treatment of Health Insurance Revisited”

University of Michigan - Economic Research Initiative on the Uninsured, – Matthew Rutledge – University of Michigan - Economic Research Initiative on the Uninsured, – Matthew Rutledge – “Estimation of Adverse Selection & Moral Hazard in Health Insurance”“Estimation of Adverse Selection & Moral Hazard in Health Insurance”

Growing utility of Growing utility of AHRQ Data CenterAHRQ Data Center