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Health Insurance Data

Dianne Rucinski, PhD

Naomi Morris Collaborative for <= /i>= Health Assessment and Evaluation
and
Institute for Health Research and Policy
School of Public Health <= /div>
University of Illinois - Chicago

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Health Insurance Data Sources

<= span style=3D'font-size:88%'>•Current Population Survey

<= span style=3D'font-size:88%'>•Behavioral Risk Factor Surveillance System

<= span style=3D'font-size:88%'>•Survey of Income and Program Participation

<= span style=3D'font-size:88%'>•National Health Interview Survey

<= span style=3D'font-size:88%'>•Medical Expenditures Survey
•Small Area Health Insurance Estimates <= /span>

<= span style=3D'font-size:88%;visibility:hidden'>•

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Health Insurance Data Sources

<= span style=3D'font-size:88%'>•Scope

<= span style=3D'font-size:88%'>•Sample size

<= span style=3D'font-size:88%'>•Content

<= span style=3D'font-size:88%'>•Mode of data collection

<= span style=3D'font-size:88%'>•Analytic approach

<= span style=3D'font-size:88%'>•CONTINUITY

Strengths and Weaknesses of Existing Ongoing Surv= eys

(CPS, BRFSS, SIPP, NHIS, MEPS,SAHIE)

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Why use multiple data sources?

•Each source has its advantages and disadvantages

•A range of estimates is more realistic for policy and planning discussions
•The “uninsured” is a dynamic population, BUT there are characteristics of the uninsured that can help us create policy

•Multiple methods increa= se our confidence when we do find a significant relationship

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Illin= ois Data for Policy Consideration

•A population survey of= the low-income families conducted by UIC for the Illinois Department of Public Aid (now Health Care and Family Services);

•A population survey of= the uninsured conducted by Health Research by UIC under State Planning Grant, and;

•A population survey of caregivers of children enrolled in KidCare by UIC for = Illinois Department of Public Aid.

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Population Survey of Low-Income Families

•Purpose of survey to determine the number of children who would be eligible for S-CHIP
•Survey of families with children
•Adjusted family income at or below 250% Federal Poverty Guideline (1998) •Funded by the Illinois Department of Public Aid
•

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Methodo= logy-Sample Disposition&= #13;

<= span class=3DBB style=3D'position:absolute;left:-4.08%'>•Mixed mode (in-person and telephone)

<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Screened = for low-income families

<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Response = rates

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Uninsured Children

<= span style=3D'font-size:88%;visibility:hidden'>•
•In 1998-1999, approximately 18.4% of children = in families with income at or below 250% of the FPL were uninsured

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Most uninsured children in Cook
•A disproportionate = number of uninsured children live in Cook County = = •Southern Illinois has the smallest percentage of uninsured children

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Both families with insured and uninsured children are working families

UIC-Kidcare

Percent = of families with at least working adult

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Latino Children least likel= y to have health insurance

UIC-Kidcare

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Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

Income of Low-Income Families with Uninsured member: Uninsured have lower incomes
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UIC-Kidcare

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Uninsured parents with uninsured children and uninsured parents with insured children are twice as likely to work in firms employing less than 50 peo= ple

UIC-Kidcare

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file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0035.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

Population Survey of Uninsured and Newly Insured

•Purpose of survey to= get a more in-depth picture of uninsured and newly insured in Illinois in 2001
•RDD Surve= y
•Screened for people without health insurance coverage and people who h= ad been without coverage within the last six months
<= span class=3DBB style=3D'position:absolute;left:-3.88%'>•Funded by= HRSA through planning grant

•

------=_NextPart_01C621D0.C243DF60 Content-Location: file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0050.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

State Planning Grant
Steering Committee

Illinois Assembly

on the Uninsured

= Data Collection

= and Analysis

= Policy Development

= and Consensus

= Building

= Illinois Plan to Expand

= Health Insurance Coverage

= Policy

= Recommendations

= for Coverage

= Expansion

The Illinois State Planning Grant Process

Illinois Department of Pub= lic Health, Division of Health Policy

March 2001<= span style=3D'mso-special-format:lastCR;display:none'>

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= SIU-C Qualitative Research

<= span style=3D'font-family:Arial;font-size:75%;color:#6699FF;mso-color-index:0'>= •<= /span>= focus groups

<= span style=3D'font-family:Arial;font-size:75%;color:#6699FF;mso-color-index:0'>= •<= /span>= key informant interviews =

<= span style=3D'font-family:Arial;font-size:75%;color:#6699FF;mso-color-index:0'>= •<= /span>= literature review

State Planning Grant
Steering Committee

UIC Survey of the Uninsu= red

IDPH BRFSS Enhancement

Illinois Assembly

on the Uninsured

= Data Collection

= and Analysis

= Policy Development

= and Consensus

= Building

= Illinois Plan to Expand

= Health Insurance Coverage

= Policy

= Recommendations

= for Coverage

= Expansion

The Illinois State Planning Grant Process

Illinois Department of Pub= lic Health, Division of Health Policy

March 2001<= span style=3D'mso-special-format:lastCR;display:none'>

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Methodo= logy-Sample Disposition&= #13;

= 226;25,735 calls made over a five month period

&#= 8226;Response rate =3D 51.9%

&#= 8226;Estimated survey eligibility - 8.9% - 15.7%

&= #8211;8.9% assuming noncontacts were insured

–15.7% assuming noncontacts were proportionately insured and uninsured.

&#= 8226; Estimated 9.7% uninsured

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Latinos and African American= s disproportionately uninsured

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Newly insured were less likely to be without coverage for longer periods of time

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Uninsured were somewhat less likely to be employed than the newly insured

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Newly insured were more likely to be employed by a new employer than the uninsured

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Uninsured in Service Sector

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Uninsured cross occupations

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Less than half of the employers of uninsured workers offer of health insurance to respondents or to workers in the same position as respondent

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Reason for declining employment-based plan

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file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0039.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

Just over 10% of uninsured had applied for health insurance directly to insurance company

•Of that group, only = 22% were able to get coverage. •Most no longer had coverage because the premiums were too high or because they had a pre-existing condition •None of t= he respondents dropped the direct purchase policy because they were able to get other coverage
<= span style=3D'visibility:hidden'>•

------=_NextPart_01C621D0.C243DF60 Content-Location: file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0062.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

What are people willing to= pay for individual coverage?

About $77 a month-- median

($93 mean)

------=_NextPart_01C621D0.C243DF60 Content-Location: file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

What are people willing to pay for individual coverage?

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tyMJAAA7 ------=_NextPart_01C621D0.C243DF60 Content-Location: file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0037.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

What are people willing to= pay for family coverage?

About $100 a month-- median

($131 mean)

------=_NextPart_01C621D0.C243DF60 Content-Location: file:///C:/A769C636/IllinoisHRSA_DianneRucinski_01252006_files/slide0063.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Health Insurance Data

What are people willing to <= /span>pay for family coverage?

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Health Insurance Data

I-CHIP Awareness

About 11% of uninsured h= ad heard or read about I-CHIP

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Reasons for not using I-CHIP

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Preliminary Conclusions

•<= /span>Increasing access through employment-based plans has the potential to help some of the uninsured

•<= /span>Employer sponsored coverage continues to erode

•<= /span>A substantial minority (about 40%) of working people DO NOT ha= ve access through employment

•<= /span>Cost remains a significant impediment to joining employer’= ;s plan

•<= /span>

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Preliminary Conclusions

•75% of uninsured were uninsur= ed for over 6 months

•64% were uninsured for over 1= 2 months

• The uninsured are poorer than the = insured.

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Preliminary Conclusions

•With total average mo= nthly premiums in 2005 at $318 for individuals, and $869 for = families, direct purchase of policies is untenable
<= span style=3D'visibility:hidden'>•

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Preliminary Conclusions

•<= /span>Increasing access through employment-based plans has the potential to help some of the uninsured

•<= /span>Employer sponsored coverage continues to erode

•<= /span>A substantial minority (about 40%) of working people DO NOT ha= ve access through employment

•<= /span>Cost remains a significant impediment to joining employer’= ;s plan

•<= /span>

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Preliminary Conclusions

•“Lifestyle choice” does not appear to play a significant role in decisions to <= span style=3D'position:absolute;top:38.5%;left:11.04%;width:79.02%;height:6.75%= '>decline coverage.

•Awareness of and participation= in public programs remains a serious challenge

•<= /span>

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KidCare Caregiver Study

•Secondary Analysis of Current Population Survey Annual Demographic Supplement 1998-2000
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Caregiver= Survey 2002

•

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KidCare Caregiver Survey

<= span class=3DBB style=3D'position:absolute;left:-4.14%'>•List samp= le from IDPA enrollment files
•Sample Ki= dCare Share, Premium and Rebate
<= span class=3DBB style=3D'position:absolute;left:-4.43%'>•Very low = refusal rates – 3-7%
•17.1% could not be contacted because the phone numbers were not working
•
•

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Estimates from CPS

&#= 8226;At or below 200% FPL

&= #8211;738,434 families

&= #8211;809,686 individuals

&#= 8226;At or below 185% FPL

&= #8211;654,978 families

&= #8211;725,676 individuals

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Estimat= es from Caregiver Survey

&#= 8226;At or below 200% FPL

&= #8211;293,299 families

&= #8211;393,177 individuals

&#= 8226;At or below 185% FPL

&= #8211;282,593 families

&= #8211;378,900 individuals

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Of 393,177 with adjusted income less than 200%= 3;

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Content-Type: text/html; charset="us-ascii" Health Insurance Data

Caregiver Survey: Demographics

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Access to and use of
employer-based cove= rage

&#= 8226;Employer Coverage Available

&= #8211;Individual coverage - 72.8%

&= #8211;Family coverage – 63.9%

&#= 8226;Enrolled in Employer-based coverage

&= #8211;67.8%

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What are people willing to <= /span>pay for FamilyCare?

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