Profile of Minnesota's Uninsured: Summary of Key Findings

SUMMARY OF KEY FINDINGS
Funded by NASHP, MDH, DHS and the Robert Wood Johnson Foundation
PROFILE OF MINNESOTA’S
UNINSURED
Kathleen T. Call, Elizabeth Lukanen, Jessie Kemmick Pintor, Giovann Alarcón
April 29, 2014

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This profile is designed to provide information about uninsured Minnesotans that can aid
policy development as well as outreach and enrollment efforts. It includes information
about the characteristics of the uninsured, their access to insurance, access to and
affordability of health care, and reasons they lack insurance. We estimate their eligibility
for insurance options available through the Affordable Care Act (ACA), as well as those
who are not eligible for ACA expansions. We also provide a summary of the projected
impact of the ACA in Minnesota provided by Gruber and Gorman, followed by documented
results of health reform efforts in Massachusetts and Oregon to foreshadow what might be
expected in Minnesota. We close with a series of maps that indicate where rates of
uninsurance are highest in the state, estimated location of the uninsured eligible for
Medicaid, MinnesotaCare, and MNsure with a subsidy along with overlays of other
information that aid outreach efforts such as the location of schools, churches and
hospitals. We focus on the non-elderly population who are the primary target of ACA
provisions. We draw on a variety of data sources to tell this story. The compilation of the
information presented in this chart book was funded by the National Academy for State
Health Policy (NASHP).
2
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN
Overview

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Fifth level
• Slide 4 Data sources used
• Slides 5-24 Who are the uninsured in Minnesota?
• Slides 25-35 Access to and affordability of care for the uninsured
• Slides 36-46 ACA eligibility among the uninsured
• Slides 47-52 Estimates of populations not eligible for ACA expansions
• Slides 53-70 What we know about take-up from prior research
• Slides 71-126 Distribution of uninsured across Minnesota
3
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN
Table of Contents

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Data sources
• 2013 Minnesota Health Access Survey (MNHA)
• American Community Survey (ACS):
• 2011 Small Area Health Insurance Estimates (SAHIE)
• 2011 & 2012 1-year file
• 2010-2012 3-year file
• 2008-2012 5-year file
• Minnesota Gruber-Gorman simulation model
• 2011 MNHA, health plan data, and MEPS-HC
4
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
WHO ARE THE UNINSURED IN
MINNESOTA?
5

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Fifth level
Section overview
• Distribution of coverage among non-elderly (0-64)
• Summary characteristics of uninsured Minnesotans
• Measures of uninsurance (point-in-time, long- and
short-term uninsured)
• Uninsurance rates by demographic characteristics
• Demographic and employment characteristics of the
uninsured
• Reasons for uninsurance
6
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fourth level
Fifth level
Preview: Nonelderly uninsured, 2013
• 9.4% at time of survey, or 13.7% uninsured at some time in
2013
• Uninsurance rates highest among:
• 18-34 year-olds; Blacks, Hispanics, and American Indians; non
US-born, and those under 200% FPG
• Uninsured are less likely to be employed than MNs overall
• And were more likely to be self-employed, work fewer hours, and
work for smaller firms
• Most report lack of coverage due to cost, and loss of
coverage due to job termination
7
Source: 2013 Minnesota Health Access Survey
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Sources of insurance coverage among
nonelderly, 2013
8
63.2%
21.3%
6.1%
9.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Group Coverage Public Coverage Individual Coverage Uninsured
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Measures of uninsurance among non-
elderly, 2013
9
9.4%
7.0%
13.7%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%
Uninsurance, point in time
Uninsurance, all year
Some episode of uninsurance in year
NOTE: Unless
otherwise indicated,
estimates are based
on those uninsured at
the time of the survey
or a point in time
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Nonelderly Minnesotans with an episode of
uninsurance, 2013 (13.7%)
10
Long-term uninsured means uninsured for 12 months or longer
Uninsurednow(9.4%)
Uninsuredatsomepointintheyear(13.7%)
Uninsurednow,but
wasinsuredat
somepointinthe
year(short-term)
(2.4%)
Uninsured for 12
months or longer
(long-term)
(7.0%)
Insurednow
Insured now, but had episode of uninsurance
in past 12 months (4.3%)
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Age distribution of nonelderly long-term
uninsured and total nonelderly population, 2013
11
Long-term uninsured means uninsured for 12 months or longer
^Indicates statistically significant difference in the rates to the overall population (95% level)
5.3%^
8.7%^
21.0%^
24.2%^
30.2%
10.6%^
9.3%
19.0%
12.5% 13.2%
31.1%
15.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
0-5 6-17 18-25 26-34 35-54 55-64
Long-term uninsured Total
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Uninsurance rates by age among
nonelderly, 2013
12
7.4%
5.6%^
13.9%^
17.3%^
8.8%
6.2%^
9.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
0-5 6-17 18-25 26-34 35-54 55-64 Overall
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Uninsurance rates by race/ethnicity among
nonelderly, 2013
13
Respondents were able to choose more than one race/ethnicity
7.0%^
15.0%^
35.4%^
19.2%^
13.5%
10.6%
9.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
White Black Hispanic American Indian Asian Other Overall
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Uninsurance rates for nonelderly
Minnesotans born and not born in US, 2013
14
^Indicates statistically significant difference between US-born and non US-born (95% level)
Reported for individuals 3 years and older
27.3%^
7.7%^
9.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Not US born US born Overall
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Uninsurance rates by FPG* among
nonelderly, 2013
15
*2012 Federal Poverty Guidelines (FPG)
18.3%^
17.5%^
10.7%
5.3%^
2.0%^
9.4%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0%
FPG <= 100% FPG 101-200% FPG 201-300% FPG 301-400% FPG >400% Overall
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fifth level
Comparing demographic characteristics of the
nonelderly uninsured to overall population, 2013
16
• Compared to the nonelderly MN population overall
Minnesota’s uninsured were more likely to be:
• Male, between 18 and 34 years of age; African American,
American Indian, or Hispanic/Latino; not born in the U.S.
• Not married, lower-income (200% of FPG or less); in good or
fair/poor health (vs. excellent or very good)
• There were no regional differences (Twin Cities/Greater MN)
between the nonelderly uninsured and overall nonelderly
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Comparing employment characteristics of the
nonelderly uninsured to overall population, 2013
17
• The nonelderly uninsured were less likely to be employed
than the overall nonelderly population (74% compared with
82%)
• Minnesota’s nonelderly uninsured were more likely to:
• Be self employed
• Work between 11-20 hours (as compared to fewer or more)
• Work for firms with fewer than 100 employees, and
• Hold temporary or seasonal jobs
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

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Fourth level
Fifth level
Potential sources of coverage among
nonelderly uninsured, 2013
18
37.0%
19.7%
62.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Connection to employer that offers
coverage
Eligible for employer coverage Potentially eligible for public programs
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Measures of reasons for uninsurance
• Primary reasons for lack of coverage
• Main reasons for not enrolling in public health care
programs
• Interaction of the uninsured with public health care
programs
19
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Primary four reasons for lack of coverage
among non-elderly uninsured, 2013
20
Did not
take-up ESI
when
offered*
Did not
purchase
coverage
directly
Reason for loss of coverage
Among short-
term uninsured
Among long-
term uninsured
Too expensive/ could not afford 44.5% 60.5%
Not eligible for reason other than health 31.0% 7.6%
Expect to be covered shortly 15.5% 4.8%
Unemployed/not working 6.2%
Receives services through IHS 1.2%
Job that provided coverage ended 34.4% 40.7%
No longer eligible for public insurance 21.2% 18.8%
Did not provide info to stay on public program 10.2%
Could no longer afford employer coverage/COBRA 5.2% 8.1%
No longer eligible for parents’ policy 7.9%
Could no longer afford to buy own coverage
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Primary reasons for lack of coverage by
age group, 2013
• Sample size does not support separate analysis for
adults and children, yet it appears that:
• The most common reason for not taking up ESI for non-
elderly adults is not being eligible for reasons unrelated to
health whereas cost and affordability of coverage is most
important for children
• Loss of coverage is tied to job loss for non-elderly adults,
whereas for children, not providing information to stay on
a public program is most common
21
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Main reasons for not enrolling in public health
care programs among uninsured children*, 2013
22
*Reports by parents or guardians
Source: Minnesota Health Access Survey, 2013
1.2% 1.6%
9.4%
10.7%
18.4%
0.0%20.3%
3.7%0.9%
5.9%
0.1%
15.2%
0.0%
3.0% 9.7%
Do now need or want insurance right now
Rarely sick
Do not know what to do/where to go/how to enroll
Too much hassle/paperwork
Too expensive
Do not think the care or benefits through these programs
are good
Applied but is not eligible
Do not think is eligible
Is embarrased or do not want other to know
Do not think government should pay for their health care
Do not want government involved in their health care
Will get insurance soon or has applied and is waiting
Gets care through IHS
Never looked into it
Other
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Main reasons for not enrolling in public health care
programs among uninsured nonelderly adults, 2013
23
Source: Minnesota Health Access Survey, 2013
6.0%
2.7%
14.9%
6.4%
21.6%
0.2%
11.7%
14.1%
0.3%
3.3%
1.1%
7.0%
0.7%
4.5%
5.4%
Do now need or want insurance right now
Rarely sick
Do not know what to do/where to go/how to enroll
Too much hassle/paperwork
Too expensive
Do not think the care or benefits through these programs
are good
Applied but is not eligible
Do not think is eligible
Is embarrased or do not want other to know
Do not think government should pay for their health care
Do not want government involved in their health care
Will get insurance soon or has applied and is waiting
Gets care through IHS
Never looked into it
Other
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Interaction with public health care programs
among eligible nonelderly uninsured, 2013
24
*
*Insufficient sample for children
75.9%
88.1% 87.8%
52.4%
83.0%
73.6%
84.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Asked/given information
about public programs
Would enroll if eligible Of those who say no or
do not know: would enroll
if coverage was free
Would participate in a
premium assistance
program
Children
NE Adults
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
ACCESS TO AND
AFFORDABILITY OF CARE
FOR THE UNINSURED
25

Second level
Third level
Fourth level
Fifth level
Measures of access and affordability
• Usual source of care, and type of usual source of
care
• Confidence in care
• Forgone care due to cost
• Financial burden
• Problems paying medical bills
• Payment plan with clinic to cover medical bills
• Trouble paying for other living costs due to medical bills
26
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Preview: Access to care
• Most Minnesotans have a usual source of care; this is less
true for the uninsured, especially uninsured non-elderly
adults
• The most common source of care is a doctors office, however, the
uninsured also use safety net clinics and ED services
• Most Minnesotans are confident in getting care when
needed; this is less true for the uninsured, especially
uninsured non-elderly adults
27
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Preview: Affordability
• Compared to those with insurance, uninsured children and
non-elderly adults are significantly more likely to
• Report forgone care due to cost
• Experience financial burden
• Forgone care due to cost and experiences of financial
burden appear more prominent among uninsured non-elderly
adults than uninsured children
28
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of nonelderly uninsured without a usual
source of care, 2013
29
94.5%
87.2%
79.2%^
48.5%^
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Children NE Adults
Insured
Uninsured
^Indicates statistically significant difference between the nonelderly uninsured and insured population (95% level)
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Place of usual source of care among nonelderly
uninsured, 2013
30
90.0%
60.7%^
86.2%
57.7%^
7.6%
25.2%^
7.5%
21.4%^
0.0%
5.5%
0.0%
0.7%
0.0%
0.0%
3.6%
4.1%
1.5%
8.4%
2.2%
15.6%^
1.0%
0.1%^ 0.6% 0.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Insured - Children Uninsured - Children Insured - Adults Uninsured - Adults
Some place else
An emergency room or urgent care center
A VA hospital/clinic
A Indian Health Care provider
A sliding fee scale, public health, or free
clinic
A private clinic or doctor’s office
An Indian Health Care provider
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of nonelderly uninsured very or somewhat
confident they can get care when needed, 2013
31
96.8%
93.3%
77.6%^
53.6%^
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Children NE Adults
Insured
Uninsured
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of uninsured children* with forgone care
due to worry about cost, 2013
32
10.9%
4.3%
5.9%
2.0% 1.5% 1.7%
28.1%^
9.6%
16.6%^
21.8%^
8.0%^ 8.8%^
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Any Care Presciption Dental Care Routine Care Mental Health
Care
Specialist Care
Insured
Uninsured
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of uninsured nonelderly adults with
forgone care due to worry about cost, 2013
33
18.7%
7.1%
12.4%
5.4%
3.4%
4.5%
48.7%^
19.6%^
36.2%^
34.8%^
19.4%^ 19.7%^
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Any Care Presciption Dental Care Routine Care Mental Health
Care
Specialist Care
Insured
Uninsured
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of uninsured children* experiencing
financial burden, 2013
34
21.0%
12.6%
16.3%
7.7%
51.1%^
32.1%^
40.7%^
24.5%^
0%
10%
20%
30%
40%
50%
60%
70%
Any Financial Burden Problem paying medical
bills
Set up a payment plan
for medical bills
Had trouble with basic
bills due to medical costs
Insured
Uninsured
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Percent of uninsured nonelderly adults
experiencing financial burden, 2013
35
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN
23.8%
15.3%
17.5%
8.4%
63.4%^
52.4%^
48.1%^
34.1%^
0%
10%
20%
30%
40%
50%
60%
70%
Any Financial Burden Problem paying medical
bills
Set up a payment plan
for medical bills
Had trouble with basic
bills due to medical costs
Insured
Uninsured

Second level
Third level
Fourth level
Fifth level
ACA ELIGIBILITY AMONG THE
UNINSURED: APPLYING 2014
ELIGIBILITY CRITERIA TO 2013
MNHA DATA
36

Second level
Third level
Fourth level
Fifth level
Method for estimating 2014 ACA eligibility
• Medicaid eligible includes:
Adults (19 or older) with family income of 138% FPG or less
Children (18 or younger) with family income of 275% FPG or less
Infants (23 months or younger) with family income of 280% FPG or less
• MNCare/BHP eligibility includes:
Adults (19 or older) who are not eligible to get coverage through their employer (or
their spouse’s/parents’ employer) and report a family income between 139 – 200%
of FPG
• Exchange subsidy eligibility includes:
Everyone with family income of 400% FPG or lower who do not meet the eligibility
criteria presented above and are not eligible to get coverage through their employer
(or their spouse’s or parents’ employer)
37
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Insurance coverage among nonelderly by ACA
eligibility
38
40.3% 39.2% 41.8%
8.8%
37.7%
0.0%
0.0%
84.1%
5.4%
16.5%
24.5%
4.7%
16.7%
44.4%
33.7%
2.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MA-eligible MNCare/BHP-eligible Exchange-eligible Not eligible for ACA
Uninsured
Individual Coverage
Group Coverage
Public Coverage
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
ACA eligibility among nonelderly uninsured
39
58.0%
10.8%
16.2%
15.1%
Eligible for MA
Eligible for MinnesotaCare/BHP
Eligible for Exchange with
subsidies
Not eligible for ACA coverage
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
What do we know about Medicaid-eligible non-
elderly?
• Children are overrepresented among those eligible for
Medicaid, whereas we observe the opposite for
nonelderly adults 35 years of age or older
• MA-eligible are more likely to be Hispanic, and less
likely to be white, in comparison to the overall MN
nonelderly population
• MA-eligible are less likely to live in non-core rural areas
and to have completed some years of college than the
overall MN nonelderly population
40
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
What do we know about MinnesotaCare/BHP-
eligible non-elderly?
• Those eligible for MNCare or BHP are less likely to be
college graduates or have completed postgraduate
studies than the overall MN nonelderly population
41
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
What do we know about MNSure subsidy-eligible
non-elderly?
• Children and young adults (18-25) are underrepresented
among people eligible for subsidies or tax credits, whereas
people 35 years of age or older are overrepresented
• Those eligible for subsidies or tax credits are more likely to be
white, and less likely to be black or Hispanic than the overall
MN nonelderly population
• Those eligible for subsidies or tax credits are less likely to live
in micropolitan rural areas
• People who do not have a high school diploma are
underrepresented among those eligible for subsidies
42
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Age distribution among nonelderly uninsured by
ACA eligibility
43
^Indicates that this estimate is statistically significantly higher than the estimate for the overall population (95% level)
*Indicates that this estimate is statistically significantly lower than the estimate for the overall population (95% level)
29.2%^
23.5%
21.7%
19.4%*
6.2%*
0.0%
10.6%
35.3%
39.1%
15.0%
3.8%*
8.5%*
17.9%
52.4%^
17.4%^
6.0%*
15.6%
32.6% 33.5%
12.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
0-17 18-25 26-34 35-54 55-64
MA-eligible
MNCare/BHP-eligible
Exchange-eligible
Not eligible for ACA
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Race/ethnicity among nonelderly uninsured by
ACA eligibility
44
Sample size is insufficient for reporting Asian and other race estimates
53.4%*
11.5%
27.8%^
3.6%
62.9%
15.1%
22.0%
4.0%
75.5%^
4.6%*
6.5%*
4.1%
73.7%^
13.4%
5.1%*
2.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
White Black Hispanic American Indian
MA-eligible
MNCare/BHP-eligible
Exchange-eligible
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Geographic distribution among nonelderly
uninsured by ACA eligibility
45
72.3%
16.7%
10.9%*
61.1%
16.2%
22.8%
64.8%
7.5%*
27.8%
75.5%
13.5%
11.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Metropolitan Urban Micropolitan Rural Non-core Rural
MA-eligible
MNCare/BHP-eligible
Exchange-eligible
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Level of education among nonelderly uninsured
by ACA eligibility
46
22.7%
34.8%
27.1%*
15.4%
21.2%
32.0%
36.3%
10.4%*
8.0%*
23.3%
41.1%
27.6%
3.1%*
29.9%
42.3%
24.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Less than HS HS Some college College grad/postgrad
MA-eligible
MNCare/BHP-eligible
Exchange-eligible
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
ESTIMATES OF POPULATIONS
NOT ELIGIBLE FOR ACA
EXPANSIONS
47

Second level
Third level
Fourth level
Fifth level
Low-income uninsured not eligible for
ACA expansions due to immigration status
• Medicaid eligibility by immigration status
• unauthorized immigrants and legal permanent residents
(LPRs) who have resided legally in the U.S. for < five
years are not eligible
• Exchange (tax credit) eligibility by immigration status
• unauthorized immigrants are not eligible
48
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Estimates of Medicaid eligibility by
immigration status
49
% unauthorized or legal permanent residents of <5 years
3%
7%
10%
NE Adults Low Income NE Adults Low Income Uninsured NE Adults
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Estimates of Exchange (tax credit)
eligibility by immigration status
• 10,170, or 5.9% of all uninsured non-elderly adults
with incomes between 139 and 400% FPG are
unauthorized
50
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
“Family glitch”
• Non-elderly adults (19-64) between 138-400% FPG
with an employed spouse and access to coverage
through that spouse, but not eligible for coverage
through own work
• Children (0-18) between 275-400% FPG with an
employed parent and access to coverage through
that parent
51
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Total number in the “glitch,” 2013 (uninsured
and those with individual coverage)
52
Current Coverage
Adults with Children Individual Uninsured
138-200% FPL 298 5,830
>200-275% FPL 4,277 0
>275-400% FPL 1,249 0
Adults without Children
138-200% FPL 0 1,323
>200-275% FPL 264 1,959
>275-400% FPL 1,791 2,660
All Adults
138-200% FPL 298 7,153
>200-275% FPL 4,541 1,959
>275-400% FPL 3,040 2,660
Adults (subtotal)
Children
>275-400% FPL 8,234 881
Total 16,113 12,653
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
WHAT WE KNOW ABOUT
TAKE-UP AND ACCESS TO
CARE FROM PRIOR RESEARCH
53

Second level
Third level
Fourth level
Fifth level
Take-up in Minnesota and other states
• 2011 Gruber-Gorman estimates of ACA impact in
2016 across markets (ESI, unreformed/reformed
individual market, MNCare, Medical Assistance,
BHP) and on number of remaining uninsured
• Take-up rates and the impact of coverage on access
to care: Lessons from other states (MA, OR)
54
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Estimate of ACA effect, 2016 (BHP/Wrap)
55
Source: Gruber and Gorman MNsure Analysis, 2011 as presented January 2013
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Estimated ACA effect on MNCare, 2016
56
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Predicting the size of MNsure, 2016
57
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Predicting remaining uninsured, 2016
58
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN
Source: Gruber and Gorman MNsure Analysis, 2011 as published April 2012
12%
9%
36%
43%
Undocumented
Newly Uninsured
Documented, Exempt from
Mandate
Subject to Mandage, Choose Not
to Insure
Projected number uninsured in 2016: 210,000

Second level
Third level
Fourth level
Fifth level
Massachusetts (MA) introduction
• MA Health Reform Initiative enacted in 2006
• Serves as an important benchmark for take-up,
access to care, and the “welcome mat effect”
because it was used as a “template for the structure
of the ACA”
59
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Preview: Lessons from Massachusetts
• Take-up increased for all types of insurance, though higher for
public programs
• Medicaid enrollment increased between 16 and 19 percentage points
among those previously eligible but not enrolled
• Access improved: having a usual source of care and utilization
increased and the inability to get care when needed and
forgone care decreased
• Use of inpatient and ED services decreased
• Catastrophic health expenditures decreased
60
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Take-up 2 years after MA reform enacted
(Long & Stockley, 2011)
• Among lower-income adults (<350% FPL):
• 6 to 10 percentage point (pp) increase in public coverage
• 4 to 6 pp increase for any coverage
• Among all adults:
• 2 to 4 pp increase in public coverage
• 2 to 3 pp increase for any coverage
61
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Access to care 4 Years after MA reform
enacted (Long et al., 2012)
62
Outcome Direction Magnitude
Usual source of care 5 percentage points
Preventive visit in past 12 months 6 percentage points
Multiple doctor visits in past 12 months 5 percentage points
Specialist visit in past 12 months 4 percentage points
Dental visit in past 12 months 5 percentage points
Any hospital stay 2 percentage points
Any ED visit in past 12 months 4 percentage points
3 or more ED visits 2 percentage points
Most recent ED visit was for non-
emergency condition
4 percentage points
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Access to care 4 years after MA reform
enacted (Long et al., 2012)
63
Did not get needed care in past 12 months
Doctor care 2 percentage points
Medical tests, treatment, follow-up care 2 percentage points
Preventive care screening 3 percentage points
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Affordability of care 4 years after MA
reform enacted (Long et al., 2012)
64
Out-of pocket spending over past 12 months
at >= 10% of family income
4 percentage points
Did not get needed care because of costs in
past 12 months
Any care 3 percentage points
Doctor care 3 percentage points
Specialist care 2 percentage points
Medical tests, treatment, follow-up care 2 percentage points
Preventive care screening 1 percentage points
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
MA reform and the “Welcome Mat ‘Effect’”
(Sonier et al., 2013)
• The “welcome mat effect” refers to an increase in
Medicaid participation for populations that were
previously eligible (prior to reform) but not enrolled
• Sonier et al. use MA as a case study to measure the
potential effect of the ACA on the previously eligible,
but not enrolled population
• They find an increase in Medicaid enrollment
between 16 and 19 percentage points among those
previously eligible but not enrolled
65
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Preview: Lessons from Oregon
• 2008 Medicaid experiment based Medicaid
expansion on a lottery from a waiting list of low-
income adults
• Baicker et al., 2013 evaluated the effect of Medicaid
coverage on a range of outcomes
• Findings:
• Improved clinical outcomes, access to care, self-reported
health, increased use of preventive care, and reduction of
costs and financial strain
66
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Effect of Medicaid enrollment after 2 years:
health care utilization (Baicker et al., 2013)
Usual source of care 24 percentage points
Office visit past month 3 percentage points
Received all needed care past 12 months 11 percentage points
High quality care in past months 10 percentage points
Cholesterol screening 15 percentage points
Pap smear (women) 14 percentage points
Mammography (women) 30 percentage points
PSA test (men) 19 percentage points
67
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Effect of Medicaid enrollment after 2 Years:
health outcomes (Baicker et al., 2013)
Self-reported health 8 percentage points
Self-reported depression 2 percentage points
Diagnosis of diabetes 4 percentage points
Prescription for management of
diabetes
5 percentage points
68
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Effect of Medicaid enrollment after 2 years:
financial strain (Baicker et al., 2013)
Any out-of-pocket (OOP) spending 12 percentage points
Amount of annual OOP spending $215
“Catastrophic expenditures” (OOP>30%
income)
4 percentage points
Any medical debt 13 percentage points
Borrowed $ to pay bills or skipped payment 14 percentage points
69
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Literature cited
• Baicker, K., Taubman, S.L., Allen, H.L., Bernstein, M., Gruber, J.H., Newhouse, J.P.,
et al. (2013). The Oregon Experiment — Effects of Medicaid on Clinical Outcomes.
The New England Journal of Medicine, 368: 1713-1722. doi:
10.1056/NEJMsa1212321
• Long, S.K. & Stockley, K. (2011). The Impacts of State Health Reform Initiatives on
Adults in New York and Massachusetts. Health Services Research, 46: 365–387.
doi: 10.1111/j.1475-6773.2010.01211.x
• Long, S.K., Stockley, K., & Dahlen, H. (2012). Massachusetts Health Reforms:
Uninsurance Remains Low, Self-Reported Health Status Improves As State Prepares
To Tackle Costs. Health Affairs, 31(2): 444-451. doi:10.1377/hlthaff.2011.0653
• Sonier, J., Boudreaux, M.H., & Blewett, L.A. (2013). Medicaid ‘Welcome-Mat’ Effect
Of Affordable Care Act Implementation Could Be Substantial. Health Affairs, 32(7):
1319-1325. doi:10.1377/hlthaff.2013.0360
70
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
DISTRIBUTION OF
UNINSURED ACROSS MN
71

Second level
Third level
Fourth level
Fifth level
Exploring the distribution of uninsured
• Mapping the geography of the uninsured provides useful
information to guide outreach efforts
• Identify concentrations of populations that are likely eligible for
various coverage options (e.g., MNCPs versus QHP subsidies)
• Comparing different geographies can confirm uniformity or
highlight hotspots not seen in geographic roll ups (e.g., should a
program be regional or county-based?)
• Layering on points of interest can inform potential outreach
approaches (e.g., hospitals, schools)
72
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Measures of the distribution of uninsured
• Distribution of uninsured across Minnesota counties
• Distribution of uninsured by zip code
• Estimates of uninsured eligible for Medicaid,
MinnesotaCare/BHP and the Exchange with a
subsidy, with overlays of cities, churches, hospitals,
Federally Qualified Health Centers (FQHCs), and
schools
73
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
74
DISTRIBUTION OF
UNINSURED ACROSS
MINNESOTA COUNTIES

Second level
Third level
Fourth level
Fifth level
Number of nonelderly uninsured, by county, 2011
75
Source: SHADAC Analysis of the US Census Bureau, “Model-
Based Small Area Health Insurance Estimates (SAHIE) for
Counties and States,”
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
Additional small area health
insurance estimates (SAHIE)
• U.S. Census Bureau’s interactive data/map tool allows
users to estimate uninsurance at the county-level by a
number of demographic groups, including:
• Age group (0-18, 18-64, 40-64, 50-64, 0-64)
• Sex
• Income (<=139% FPL*, <=200%, <=250%, <=400%)
• SAHIE Interactive Data Tool:
https://www.census.gov/did/www/sahie/data/interactive/
76
*Federal Poverty Level
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
77
DISTRIBUTION OF
UNINSURED BY ZIP CODE

Second level
Third level
Fourth level
Fifth level
Percent uninsured, by zip code tabulation area, 2008-
2012
78
Source: SHADAC Analysis of the 2008-
2012 American Community Survey.
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
79
ESTIMATES OF UNINSURED
ELIGIBLE FOR MEDICAID,
WITH OVERLAYS OF CITIES,
CHURCHES, HOSPITALS AND
SCHOOLS

Second level
Third level
Fourth level
Fifth level
Number of nonelderly citizens who are uninsured and
between 0-138% FPG, by region, 2011
80
Source: SHADAC analysis of 2011 American
Community Survey (ACS).
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by region, 2011 - cities
81
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by region, 2011 - churches
82
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by region, 2011 - hospitals
83
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by region, 2011 - schools
84
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by PUMA, 2011
85
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by PUMA, 2011 - cities
86
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by PUMA, 2011 - churches
87
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by PUMA, 2011 - hospitals
88
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, by PUMA, 2011 - schools
89
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, metro, 2011
90
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, metro, 2011 – cities
91
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, metro, 2011 - churches
92
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, metro, 2011 - hospitals
93
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 0-138% FPG, metro, 2011 - schools
94
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
95
ELIGIBLE FOR MNCARE/BHP,
WITH OVERLAYS OF CITIES,
SCHOOLS

Second level
Third level
Fourth level
Fifth level
96
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 139-250% FPG, by region, 2011 - cities
97
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
98
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
99
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
100
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
101
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
102
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
103
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
104
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
105
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
106
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 139-250% FPG, metro, 2011 - cities
107
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
108
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
109
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
110
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
111
ELIGIBLE FOR EXCHANGE
WITH SUBSIDY, WITH
OVERLAYS OF CITIES,
SCHOOLS

Second level
Third level
Fourth level
Fifth level
112
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 251-400% FPG, by region, 2011 – cities
113
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
114
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
115
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
116
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
117
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
118
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
119
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
120
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
121
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
122
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
between 251-400% FPG, metro, 2011 - cities
123
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
124
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
125
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
126
Overview
Who are the
uninsured?
Access and
affordability
ACA eligibility
Populations not
eligible for ACA
Take-up under
state reforms
Distribution
across MN

Second level
Third level
Fourth level
Fifth level
www.shadac.org
@shadac
shadac@umn.edu
612.624.4802
Kathleen Thiede Call
callx001@umn.edu
Contact information

Profile of Minnesota's Uninsured: Summary of Key Findings

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