1. Putting Out the Welcome Mat: Targeting
Outreach Under the Affordable Care Act
Profile of Minnesota’s Uninsured
Jessie Kemmick Pintor, MPH
MN Health Services Research Conference
March 5th, 2013
Funded by a grant from the Robert Wood Johnson Foundation

2. Purpose/Overview
• To provide an in-depth profile of the
uninsured in Minnesota in order to inform
targeted outreach to non-elderly adults who
will be newly eligible for Medicaid coverage
or subsidies through the exchange:
– Overall uninsured
– Potentially Medicaid-eligible non-elderly adults:
<138% FPG
– Potentially subsidy-eligible non-elderly adults :
139-400% FPG
2

3. 2011 MN Health Access Survey
• Conducted by MDH and SHADAC (Sep to Dec 2011)
• Purpose:
– Document trends in health insurance coverage and access to
insurance and health care
– Describe characteristics of the uninsured, and economic and
demographic factors associated with lack of coverage
– Establish baseline data for evaluating health reform
• Dual frame survey targeting 11,000 completes
– 62% landline, 38% cell
• Stratified sampling to produce reliable estimates for:
– Regions of the state
– Most populous racial/ethnic groups
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4. Uninsured Minnesotans, 2011
• 489,000, or 9.1% of, Minnesotans uninsured
– 675,000, or 12.6% uninsured at some time in 2011
• Uninsurance rates highest among:
– 26-34 year olds, individuals with lower education/income
levels, Hispanics/Latinos, and foreign-born
• Uninsured as likely to be employed as overall
– However, more likely to be self employed or work for
smaller employers, work part-time, hold more than one job,
and hold temporary or seasonal jobs
• Most report lack of coverage due to cost, and
loss of coverage due to job termination
4

5. Nearly half of Medicaid-eligible already have
public coverage, most subsidy-eligible have ESI
Insurance coverage among non-elderly adults at or below 138%
and 139-400% FPG, 2011
Public
Uninsured 15%
Uninsured 17%
23% Individual
Public 6%
Individual 45%
5%
Group Group
27% 62%
Source: 2011 Minnesota Health Access Survey
5

6. Uninsured Medicaid- and subsidy-eligible
much younger than non-elderly adults overall
Age distribution of non-elderly adults, 2011
50%
46%
45% 41%
40%
35% 31%
29%* 30%*
30% 26%
25%
19% 19%
20% 18%
16%
15% 13%
11%
10%
5%
0%
18-25 26-34 35-54 55-64
Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall
*Indicates statistically significant difference (95% level) from overall non-elderly population
Source: 2011 Minnesota Health Access Survey
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7. Latinos greatly overrepresented among Medicaid-
eligible; Blacks overrepresented among subsidy-eligible
Race/ethnicity among non-elderly adults, 2011
100%
90% 84%
80% 75%
70%
59%
60%
50%
40%
30%
20% 17%*
12%*
10%
10% 5% 6% 4% 4% 7% 5%
4% 1% 1% 4% ƚ 2%
0%
White Black Asian American Hispanic/Latino Other
Indian
Uninsured Medicaid-eligible Uninsured subsidy-eligible Overall
*Indicates statistically significant difference (95% level) from overall non-elderly population
ƚ Less than 1%
Source: 2011 Minnesota Health Access Survey
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8. Three in ten Medicaid-eligible have less than
a high school education
Level of education among non-elderly adults, 2011
100%
8%
90% 19%
80% 34%
29%
70%
32%
60% College grad
50% 34% Some college
33%
40% HS grad
30% 37%
Less than HS
20% 25%
30%*
10%
13% 8%
0%
Uninsured Medicaid- Uninsured subsidy- Overall
eligible eligible
*Indicates statistically significant difference (95% level) from overall non-elderly population
Source: 2011 Minnesota Health Access Survey
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9. What else do we know about Medicaid- and
subsidy-eligible non-elderly adults?
• Males slightly overrepresented
• Less likely to be in excellent/very good health
• Similar distribution across TC metro/Greater MN
• Just over half of Medicaid-eligible employed,
compared to 76% of nonelderly overall
• 11% of Medicaid-eligible and 19% of subsidy-eligible
have access to ESI
• Over half of Medicaid-eligible and 1/3 of subsidy-
eligible have children under 21 in household
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10. Interaction of uninsured non-elderly adults with
Minnesota Public Health Care Programs, 2011
100%
90%
80%
70%
60%
50%
40% Uninsured Medicaid-elgible
30% Uninsured subsidy-eligble
20%
10%
0%
Asked/given Would enroll if Of those who say Would
information eligible no: would enroll participate in a
about public if coverage was premium
programs free assistance
program
Source: 2011 Minnesota Health Access Survey
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11. Main reason for not enrolling in MN Health Care
Programs among uninsured non-elderly adults, 2011
Don't think the
care/benefits are good
3% Other
Other 11%
Don't think the Too much
14%
hassle/paperwork
care/benefits are
3%
good Applied but not
Too expensive Don't think eligible
4%
23% government should 23%
pay for my health care
Don't need or 4%
want insurance
Will get insurance
right now/rarely soon
sick 6%
10% Don't think I'm eligible
Do not know Don't need or want 14%
Will get insurance insurance right now
what to do/where
soon 11%
to go/how to
8%
enroll Do not know
Too much 21% what to
hassle/paperwork do/where to Too expensive
9% go/how to 14%
Applied but not enroll
eligible 11%
11%
Medicaid-eligible Subsidy-eligible
Source: 2011 Minnesota Health Access Survey
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12. Next steps/Potential analyses for MN Health
Insurance Exchange
• 3-year (2008-2010) pooled sample of the American
Community Survey (ACS) allows for geographic
specificity (PUMA) in answering a number of questions
• Characteristics of uninsured across PUMAs:
– Education levels across PUMAs
– Individuals in linguistically-isolated households across PUMAs
– Individuals in households where someone receives
TANF/SNAP benefits across PUMAs
• Potential to generate regions designed by the state
• Adding layer information such as location of schools,
community centers, libraries, etc.
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13. Percent uninsured nonelderly US citizens, <=138%
FPL and 139-400% FPL, 2008-2010, by PUMA
13

14. Conclusions/Implications for outreach to
Medicaid-eligible
• Medicaid outreach will need to target younger
Minnesotans with lower levels of education
• Over half of uninsured Medicaid-eligible have
inquired about MHCP and 4 in 5 report they
would enroll in Medicaid if they were eligible
– Still, many report that they do not know where to
go, how to apply and/or that the process is too
much of a hassle/too much paperwork
• Many live in households with children under 21,
which may be a potential avenue for outreach
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15. Conclusions/Implications for outreach to
subsidy-eligible
• Slightly younger and lower levels of education
compared to nonelderly overall
• Only 1 in 5 of the uninsured who are potentially
eligible for subsidies under the exchange have
access to employer-sponsored insurance
• Over half have inquired about MHCP and most
report they would enroll in a premium
assistance program if eligible
– Still, again, they report problems accessing MHCP
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16. Jessie Kemmick Pintor
kemm0018@umn.edu
612.624.2083
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