Author: Lyndsey Nolan


AskCHIS Reveals New Categories on Industry and Occupation Indicators

Last week, the UCLA Center for Health Policy Research announced that the Center’s AskCHIS online database now allows for review of health data by industry and occupation. AskCHIS – an online query system that provides health statistics at the county, regional, and state level – relies on the responses of more than 50,000 Californians interviewed annually by the California Health Interview Survey.

AskCHIS already features a variety of data points, such as access and utilization, health insurance status, public program participation, and health behaviors.

Using the new functionality, UCLA highlighted differences in insurance rates between specific industries in California. According to 2014 data, while more than 90 percent of workers in education, health care, and social assistance had health insurance, by contrast, nearly 40 percent of workers in agriculture, forestry, fishing, hunting, and mining lacked health insurance. The new AskCHIS categories offer an additional tool to evaluate health reform implementation and remaining challenges.

The 14 industry and 13 occupation categories are listed below.

Industry categories:

  • Agriculture, Forestry, Fishing, Hunting, Mining
  • Construction
  • Manufacturing
  • Wholesale Trade
  • Retail Trade
  • Transportation, Warehousing, Utilities
  • Information
  • Finance and Insurance, Real Estate, Rental, Leasing
  • Professional, Scientific, Management
  • Educational Services, Health Care, Social Assistance
  • Arts, Entertainment, Recreation, Accommodation, Food Services
  • Other Services, Except Public Administration
  • Public Administration
  • Military
Occupation categories:

  • Management, Business, and Financial
  • Computer, Engineering, and Science
  • Education, Legal, Community Service, Arts, and Media
  • Healthcare Practitioners and Technical
  • Service
  • Sales and Related Occupations
  • Office and Administrative Support
  • Farming, Fishing, and Forestry
  • Construction and Extraction
  • Installation, Maintenance, and Repair
  • Production
  • Transportation and Material Moving
  • Military Specific

California Leads Nation in Reducing Uninsured: Highlights from New U.S. Census Report

California ranks number one among states in reducing the ranks of the medically uninsured according to a new report released on Tuesday by the U.S. Census Bureau. The report, “Health Insurance Coverage in the United States: 2015” features data from two of the Census Bureau’s annual surveys, the Current Population Survey Annual Social and the Economic Supplement (CPS ASEC) and the American Community Survey (ACS), and includes 2014 and 2013 data for comparison.

Although the report shows improvement across the country, California stands above all of the other states.

  • California had the greatest decrease in the uninsured rate between 2014 and 2015, 3.9 percentage points. The difference between 2013 and 2015 was (unsurprisingly) even greater, dropping by an additional 8.6 percentage points.
  • Nationally, the uninsured rate decreased by 1.3 percentage points between 2014 and 2015 across the country, bringing the number of uninsured from 33 million people down to 29 million.
  • Between 2014 and 2015, the greatest change in coverage was the rise in direct-purchase health insurance (coverage bought by individuals such as California’s health exchange, Covered California), which jumped from 14.6% to 16.3% – an increase of about 1.7 percentage points.
  • The uninsured rate decreased in 47 states (plus the District of Columbia) from 2014 to 2015; the only states that did not have a statistically significant change were North and South Dakota and Wyoming.
  • Although foreign-born noncitizens experienced a greater increase in coverage (4.8 percentage points) than did naturalized citizens (1.5 percentage points), noncitizens still had the lowest coverage rate at 73.6%.
  • In both 2014 and 2015, the uninsured rate was higher in states that did not expand Medicaid than in the states that did expand (see Figure 5 from the report below).

California’s success in getting more people into health coverage reflects its early and robust implementation of the federal Affordable Care Act (ACA).

Within months of passage of the ACA, California adopted state legislation establishing the first state-run ACA exchange, Covered California, and strategically invested federal exchange funds in getting the exchange ready for the first enrollment year in 2014. Covered California funded and worked with state and local organizations to conduct aggressive statewide marketing and outreach. Nearly 1.3 million Californians now have coverage through Covered California.

California also implemented the full expansion of Medi-Cal eligibility allowed under the ACA, taking advantage of higher federal matching funds for states expanding Medicaid. Medi-Cal enrollment has increased from 7.9 million in 2012-13 prior to ACA implementation to over 14 million Californians in 2016-17, and now covers more than one-third of Californians. Nationally, states that expanded Medicaid had the highest reductions in the number of uninsured as illustrated below.

US Census Bureau Uninsured Rate Report

Medicaid expansion states experienced the greatest decreases in uninsured rates.

Be sure to check out the full census report for more details!

Children’s Health Insurance Coverage: 4 California Stats

In light of the upcoming Medi-Cal expansion for undocumented children on May 16, ITUP continues to put a spotlight on children’s health insurance coverage during this historic month.

Children's Health Insurance Coverage Trends

State-Level Changes in Uninsurance Among Low-Income Children, 2013-2014 (Source: SHADAC).

In February of this year, the State Health Access Data Assistance Center (SHADAC) released a new report, “State Level Trends in Children’s Health Insurance Coverage.” SHADAC, a program of the Robert Wood Johnson Foundation, analyzed data from the American Community Survey (ACS) to show coverage trends nationwide and at the state level. In this post, ITUP highlights key findings about the Golden State.

By the Numbers: Children’s Health Insurance Coverage in California

  • -209,796: California had the greatest decline in the number of uninsured children between 2013 and 2014, with a drop of nearly 210,000.
  • 553,725: Despite gains in coverage, California still had the second largest count of uninsured children in 2014, after Texas.
  • 3.1%: California saw a statistically significant drop in uninsured Hispanic children, with more gains in private coverage (1.9%) than public (1.2%).
  • 7.3%: Despite improvement Hispanic children in California still had the highest rate of uninsurance in 2014 compared to white children (4.0%) and non-white children (4.1%).
Children's Health Insurance Coverage

Largest Decreases in the Number of Uninsured Children, 2013-2014 (Source: SHADAC).

 

SHADAC noted that even though the primary target of the coverage provisions of the ACA is the adult uninsured population, ACA implementation has affected children as well through (a) general enhanced awareness of public coverage options due to broad-based ACA outreach initiatives and (b) direct outreach to the families of children who are eligible for Medicaid/CHIP or subsidies through a health insurance marketplace.

The SHADAC report compares coverage for children from 2013 to 2014—before and after full implementation of the ACA’s coverage provisions—and documents five-year coverage trends at the state level using data from 2010 through 2014.

Read more about the report and SHADAC here.

Marketplaces and Medicaid Enrollment: Highlights from The Commonwealth Fund’s New Issue Brief

Last week The Commonwealth Fund published a new issue brief on the role of health insurance marketplaces in Medicaid enrollment. ITUP took a closer look, broke down some of the key takeaways, and outlined what’s true for California.

Background

Under the ACA, states that have a state-based marketplace (SBM) must enable their marketplace to make final Medicaid eligibility determinations. But states that have a federally facilitated marketplace (FFM) – or at least use the FFM IT platform – can either have the FFM make final determinations or have the FFM simply assess and refer to the state Medicaid agency to make final determinations.

Rusty on health insurance marketplaces and all their acronyms? Here’s a quick refresher based on Kaiser Family Foundation’s definitions:

  • Federally-Facilitated Marketplace (FFM): HHS performs all marketplace functions. Consumers apply for and enroll in coverage through healthcare.gov.
  • State-Partnership Marketplace (Partnership): These states may administer in-person consumer assistance functions while HHS performs the remaining marketplace functions. Consumers apply for and enroll in coverage through healthcare.gov. Think of these as hybrids.
  • Federally-Supported State-Based Marketplace: These states are considered to have a state-based marketplace, and are responsible for performing all marketplace functions, except that the state relies on the FFM IT platform. Consumers apply for and enroll in coverage through heatlhcare.gov. Think of these as essentially SBMs, except for the IT part.
  • State-Based Marketplace (SBM): These states are responsible for performing all marketplace functions. Consumers apply for and enroll in coverage through marketplace websites established and maintained by the states. Here in the Golden State, Covered California is an SBM.

ITUP developed the table below using Kaiser Family Foundation’s review of marketplace models by state. The table is organized by Medicaid expansion status, and shows what type of marketplace each state uses, as well as how Medicaid eligibility is determined. (Note that SBMs do not rely on the FFM IT platform in any way and are required to enable Medicaid eligibility determinations as shown in the far right column.)

expansion vs nonexpansion 5

 

Highlights from The Commonwealth Fund’s Issue Brief

  • Most states that use the FFM or FFM IT platform (i.e., FFMs, Partnerships, or Federally Supported SBMs) choose to limit the FFM role to assessment and referral, instead of determination. As you will see in Commonwealth’s Figure 5 below, FFMs that determine eligibility tend to have higher Medicaid enrollment compared to those that only assess and refer to Medicaid agencies.
  • Among Medicaid expansion states, SBMs tend to have higher Medicaid enrollment growth, possibly because they must integrate Medicaid eligibility determination into the marketplace. (See Commonwealth Exhibit 4.)
  • Among expansion states, Federally Supported SBMs (NV, NM, OR) also had high Medicaid enrollment growth, suggesting that regardless of whether a state or federal IT enrollment platform is used, a state-based marketplace can establish better  communication and coordination between the state’s Medicaid program and the marketplace. (See Commonwealth Exhibit 4.)

Rosenbaum_medicaid_expansion_exhibit_04

  • Among expansion states that are either full FFMs or hybrid FFM Partnerships, those that determine eligibility have higher Medicaid enrollment rates. (See Commonwealth Exhibit 5.)

Rosenbaum_medicaid_expansion_exhibit_05

 

Enrollment in California’s SBM

California’s state-based exchange, Covered California, works with the state and counties to determine eligibility and facilitate enrollment for individuals eligible for Medi-Cal. Covered California is one single entry point – consumers can apply online and get a determination of whether they are eligible for exchange coverage and related federal assistance (tax credits and cost-sharing reductions) or eligible for Medi-Cal based on income. CalHEERS, a system jointly developed by Covered California and the state Medicaid agency, Department of Health Care Services, supports the calculations of eligibility through the exchange, and at other entry points, including county social service agencies. County social services agencies evaluate Medi-Cal eligibility for individuals with eligibility factors other than income, such as disabled and elderly persons, and are ultimately responsible for final verification of Medi-Cal eligibility.