Preliminary Results from the 2008 Oklahoma Health Care Insurance and Access Survey Presentation to the Oklahoma Health Care Authority Board November 13, 2008 Kathleen Thiede Call, PhD Donna L. Spencer, MA

2 Acknowledgements Oklahoma Health Care Authority (OHCA) –Buffy Heater SHADAC –Mike Davern, PhD (Assistant Professor) –Karen Turner, MA (Research Fellow) –Justine Nelson, MA (Graduate Research Assistant) Westat –Jon Wivagg (Survey Coordinator)

3 Presentation Overview 2004 vs surveys conducted in Oklahoma The uninsured in Oklahoma Health insurance coverage in Oklahoma As time permits and if there is interest, more information on how the 2008 survey was conducted

4 Background New telephone survey conducted in 2008; prior survey conducted in 2004 Purpose of new survey is to update data for the state and assess changes over time All data are based on point-in-time estimates of health insurance coverage and type Results are for randomly-selected household member Data are weighted to represent Oklahoma population –Note: 2004 data were reweighted to be comparable with 2008 weights –Estimates for 2004 vary slightly from 2004 final report

Sample Size5,8475,729 Sampling StrategyRDD (landline only) 3 strata based on geography RDD (landline only) 3 strata based on race/ethnicity Slight oversamples of African-Americans and American Indians Questionnaire Length/Languages Averaged 15 minutes/ English & Spanish Averaged 15 minutes/ English & Spanish Questionnaire Content Health insurance status Access to health care Public program awareness Cost concerns Demographics Generally the same Some additions/deletions Revised items re: income Time of Year Conducted March – MayJuly – September Response Rate (AAPOR RR4) 44.4%15.6% & 2008 OK Survey Comparison

6 Response Rate Insights We anticipated a drop in response rate –Rates are falling for all types of surveys (RDD, mail, in-person, federal and state) Factors contributing to reduced response rates –Growth in non-contact rate (e.g., screening devices) –Growth in refusals –Other potential factors Lower response rates among minority groups (which we slightly oversampled) Response rates and survey quality

7 Oklahoma’s Uninsurance Rate, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Notes: Based on total population (all age groups). Difference between the two years is not statistically significant.

8 Uninsured Rates by Age, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state population within a given year: 2004 = 18.1%, 2008 = 16.7%. * indicates statistically significant difference (p≤.05) between the two years.

9 Uninsured Rates by Gender, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Note: Based on non-elderly population. Differences between males and females and between years are not statistically significant.

10 Uninsured Rates by Race/Ethnicity, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Note: The race/ethnicity groups presented are not exclusive. Depending on a survey participant’s response, s/he may have been assigned to more than one category. Note: For both survey years, the sample size for Asians is quite small (n<60). ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non- elderly population within a given year: 2004 = 20.7%, 2008 = 19.0%. * indicates statistically significant difference (p≤.05) between the two years.

11 Uninsured Rates by Employment Status, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non-elderly population within a given year: 2004 = 20.7%, 2008 = 19.0%. Differences between years are not statistically significant.

12 Uninsured Rates by Select Federal Poverty Levels (FPL), 2008 Source: 2008 Oklahoma Health Care Insurance and Access Survey. Note: Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non- elderly population (19.0%).

13 Uninsured Rates by Select FPLs, 2004 Source: 2004 Oklahoma Health Care Insurance and Access Survey. Note: Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non-elderly population (20.7%).

14 Uninsured Rates by Federal Poverty Level for Adults and Children, 2008 Source: 2008 Oklahoma Health Care Insurance and Access Survey. Note: Based on non-elderly population. Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between children and adults.

15 Uninsured Rates by Region, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and estimate for the total state non-elderly population within a given year: 2004 = 20.7%, 2008 = 19.0%. * Indicates statistically significant difference (p≤.05) between the two years.

Types of Health Insurance Coverage Employer-Based Insurance Own employer A family member’s employer COBRA VA/Military health Private Individual Plan Individual plan privately purchased for family or individual Public Coverage/Program Medicare Medicaid O-EPIC OK High Risk Pool Railroad Retirement Plan 16 Note: Individuals who only reported Indian Health Service were classified as uninsured.

17 Overall Categories of Health Insurance Coverage, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Note: For total population including all age groups. * indicates statistically significant difference (p≤.05) between the two years.

18 Types of Coverage by Age, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state population within a given year. * indicates statistically significant difference (p≤.05) between the two years. Group Individual Public Age %43.3% 4.0%7.7% 38.2%^41.2%^ %49.0% 5.3%4.1% 26.4%36.2%* %43.3% 6.7%6.8% 11.0%^16.5%^ %43.1% * 3.7%6.3% 11.4%^14.0%^ %^60.6% *^ 5.1%4.3% 7.7%^16.6%*^ %^55.9% ^ 6.3%7.2%^15.7%^25.9%*^ %^2.5% *^ 0.7%^0.9%^89.6%^95.8%*^ Total 51.5% 45.3%* 4.6% 4.9% 25.8% 33.1% *

19 Types of Coverage by Gender, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Note: Differences between males and females are not statistically significant within either year. * indicates statistically significant difference (p≤.05) between the two years. MalesFemales

20 Types of Coverage by Race/Ethnicity, 2004 & 2008 Race/ Ethnic Group Group Individual Public White 61.1%^56.0% *^ 5.8%6.1% 13.7%^21.1% *^ Black 51.4%34.7% *^ 2.3%^3.3% 35.4%^44.0%^ Hispanic 41.1%^38.5% ^ 1.7%^3.2% 22.3%27.2% American Indian 44.9%^37.2% *^ 2.8%^2.5%^23.1%^33.4%*^ Asian 59.8% 60.3% 5.8% 10.5% 9.2% 11.4%^ Total 57.8% 51.5% *5.1% 5.4% 16.3% 24.1%* Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. Note: The race/ethnicity groups presented are not exclusive. Depending on a survey participant’s response, s/he may have been assigned to more than one category. Note: For both survey years, the sample size for Asians is quite small (n<60). ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non-elderly population within a given year. * indicates statistically significant difference (p≤.05) between the two years.

21 Types of Coverage by Employment Status, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the overall non-elderly population within a given year. * indicates statistically significant difference (p≤.05) between the two years. Not EmployedEmployed

22 Types of Coverage by Employer Type, 2004 & 2008 Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the overall employed non- elderly population within a given year. * indicates statistically significant difference (p≤.05) between the two years. Self-InsuredGovt. EmployerOther EmployerTotal

23 Types of Coverage by Select Federal Poverty Levels (FPL), 2008 Source: 2008 Oklahoma Health Care Insurance and Access Survey. Note: Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non-elderly population.

24 Types of Coverage by Select FPLs, 2004 Source: 2004 Oklahoma Health Care Insurance and Access Survey. Note: Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between estimate and the estimate for the total state non-elderly population.

25 Types of Coverage by FPLs for Adults and Children, 2008 <100% % % % %300%+ Source: 2008 Oklahoma Health Care Insurance and Access Survey. Note: Federal Poverty Levels (FPL) are for ^ indicates statistically significant difference (p≤.05) between children and adults.

26 Types of Coverage by Region, 2004 & 2008 Group Individual Public Region Northwest 61.7%59.7%^5.7%8.8% 13.2%15.6%^ Central 59.3%51.9%*5.0%5.2% 14.7%22.0%* Southwest 56.8%51.6% 5.4%6.0% 20.7%23.4% Tulsa 68.0%^55.6%*4.6%5.8% 12.6%23.1%* Northeast 55.2%47.6%*4.5%5.3% 17.5%26.8%* Southeast 44.5%^46.2% 6.9% 2.6%*^20.4% 32.0%*^ Total 57.8% 51.5%* 5.1% 5.4% 16.3% 24.1% * Source: 2004 and 2008 Oklahoma Health Care Insurance and Access Surveys. ^ indicates statistically significant difference (p≤.05) between estimate and estimate for the total state non-elderly population within a given year. * Indicates statistically significant difference (p≤.05) between the two years.

27 Summary of Key Findings to Date: Health Insurance Coverage 16.7% of Oklahoma residents, or about 579,036 individuals (including all age groups), uninsured in 2008 Higher uninsurance rates: Young adults (19-34 year olds), Hispanics, American Indians, not in labor force, low income (especially for adults) Overall uninsurance rate was stable between 2004 & 2008 –Increase in public health insurance coverage –Decline in employer-based health insurance –These trends consistent with Current Population Survey data for OK and US A few changes in uninsurance rate between the 2 years: –Decline among near elderly (55-64 years) –Decline among Whites –Decline in Southeast region

Summary of Key Findings to Date: Employer-Based Coverage The overall rate of employer-based (group) coverage dropped from 51.5% of Oklahoma’s total population in 2004 to 45.1% in 2008 Group coverage more prevalent among: –Middle-aged and older non-elderly adults –Whites –Employed –Higher income –Northwest region Decline in employer-based coverage between 2004 & 2008 impacted: –Both males and females –Most adult age groups (25-54 year olds and the elderly) –All racial/ethnic groups except for Hispanics and Asians –Both the employed and unemployed –Central, Northeast, and Tulsa regions 28

Summary of Key Findings to Date: Public Coverage The overall rate of public coverage grew from 25.8% of Oklahoma’s total population in 2004 to 33.3% in 2008 Public coverage more prevalent among: –Young children and the elderly –African-Americans and American Indians –Not employed –Low income (especially for children) –Southeast region Growth in public coverage between 2004 & 2008 impacted: –Both males and females –Most age groups (except for young children and young adults aged 19-34) –Whites and American Indians –Both the employed and unemployed –All regions but the Northwest and Southwest

Summary of Key Findings to Date: Possible Explanations In 2008, fewer Oklahomans may have access to employer-based coverage: –Increase in self-employed (12% vs. 16%) –Fewer working in large firms of 500 employees or more (44% vs. 38%) In 2008, more Oklahomans are potentially eligible for public coverage: –Increase in percent below 100% FPL (18% vs. 22%) –Increase in percent unemployed (28% vs. 32%)

31 SHADAC’s Next Steps Proceed with analyses of 2008 survey data and comparisons with 2004 Conduct small area estimation to estimate rates of uninsurance at the county level More reports and information to come: Final report on 2008 survey including technical appendix on survey methodology County-level chartbook

Thank you Questions?