uninsured eligibles ESTIMATES OF INDIVIDUALS ELIGIBLE FOR QHP OR MEDICAID WHO REMAIN UNINSURED BY ZCTA 2013 AND 2015 JOE CAMPO, SENIOR FORECAST ANALYST HEALTH CARE RESEARCH CENTER OFFICE OF FINANCIAL MANAGEMENT JUNE 19, 2015

acknowledgements Wei Yen, Ph.D. Thea Mounts, M.S. Eli Kern, M.P.H., R.N. Public Health/Seattle-King County Health Care Research Center, OFM

overview begin at the end (what we found) discuss background and methods (how we found what we found) focus on hot spots Health Care Research Center, OFM

QHP eligible uninsured – 2013 Less than ,000 or more Health Care Research Center, OFM

QHP eligible uninsured – 2015* Less than ,000 or more *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange. Health Care Research Center, OFM

Medicaid eligible uninsured – 2013 Less than ,000 or more Health Care Research Center, OFM

Medicaid eligible uninsured – 2015* Less than ,000 or more *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange. Health Care Research Center, OFM

background – county estimates The County Population Estimation Model, developed under contract with Krupski and Associates in 2009, forecasted poverty and insurance rate utilizing: ◦American Community Survey data from the US Census Bureau ◦OFM age/sex/race/ethnicity population forecasts In 2014 a modified County Population Estimation Model added in: ◦Medicaid enrollee counts from Health Care Authority ◦Qualified Health Plans enrollee counts from Health Benefits Exchange ◦State and national insurance rates from Gallup, Commonwealth Fund, and Kaiser Family Foundation Health Care Research Center, OFM

background – ZCTAs ZIP Code Tabulation Area (ZCTA) ◦There are no official ZIP code boundaries (!) ◦ZCTAs are based upon the ZIP code reported by the majority of households within a Census Block ◦ZCTAs generally correspond with various proprietary ZIP code boundary maps (because those maps are often based on ZCTAs) ◦ZCTAs include census measures such as income level and insurance status Health Care Research Center, OFM

background – ZCTAs ZCTAs within each county were identified ◦If parts of a ZCTA were within two counties, the ZCTA was put in the county with the largest proportion of the ZCTA’s population. Of the 592 ZCTAs all but 64 where wholly contained in one county ◦Of those 64, none constituted more than six percent of the population of the secondary county that they were not assigned to. Health Care Research Center, OFM

methods – ZCTA estimates For 2013: ◦Using the US Census Bureau estimate of uninsured by ZCTA, age group and income status, we computed the percent each age and income category represented of the total county estimate. ◦Using those percentages, we allocated the 2013 estimate of uninsured from the Modified County Population Estimation Model ◦Those whose income was 137% or less of the federal poverty level (FPL) were considered to be Medicaid eligible; those whose income was between 138% and 399% FPL, QHP eligible Health Care Research Center, OFM

estimate NOTE: These estimates of uninsured include non-citizens

methods – ZCTA estimates For 2014: ◦We assumed that the change in insurance status only occurred among those ages 18 to 64. ◦The percentages of uninsured by age group and income status from the US Census estimate of uninsured were recomputed based only on those ages 18 to 64. ◦These percentages were then used to allocate the 2014 estimate of uninsured from the Modified County Population Estimation Model proportionately among each of the 18 to 64 year old age- and income- groups within each ZCTA within each county Health Care Research Center, OFM

methods – ZCTA estimates For 2015: There are no control totals from the Modified County Population Estimation Model (updated national survey data not yet available), so… For Medicaid, we subtracted the number of Medicaid enrollees in July 2014 from those enrolled in February 2015 (the most current data available) and assumed that 40% of those new enrollees were previously uninsured For QHP, we subtracted the number of QHP enrollees in October 2014 from those enrolled in March 2015, and assumed 35.9% of those new enrollees were previously uninsured We then subtracted these estimates of new enrollees who were previously uninsured from our 2014 estimates of uninsured eligibles for the Medicaid and QHP programs. The remainder are the estimate of uninsured eligibles for 2015 Health Care Research Center, OFM

hot spots Kittitas Yakima Health Care Research Center, OFM

hot spots – QHP uninsured eligibles 2013 Health Care Research Center, OFM

hot spots – QHP uninsured eligibles 2015 ZCTA eligibles: ~ eligibles: ~1500 ZCTA eligibles: ~ eligibles: ~1700 Health Care Research Center, OFM

hot spots Kittitas Yakima Health Care Research Center, OFM

hot spots – Medicaid uninsured eligibles 2013 Health Care Research Center, OFM

hot spots – Medicaid uninsured eligibles 2015 ZCTA eligibles: ~ eligibles: ~1600 ZCTA eligibles: ~ eligibles: ~1600 ZCTA eligibles: ~ eligibles: ~1100 Health Care Research Center, OFM

hot spots Whatcom Snohomish Skagit Island San Juan Health Care Research Center, OFM

hot spots – Medicaid uninsured eligibles 2015 ZCTA ~1500 ZCTAs 98201, 98203, ~3800 Health Care Research Center, OFM

hot spots – QHP uninsured eligibles 2015 ZCTAs & ~2200 ZCTAs & ~2800 ZCTAs 98201, 98203, 98204, 98208, 98087, 98012, 98037, ~12,000 Health Care Research Center, OFM

hot spots Benton Franklin Walla Health Care Research Center, OFM

hot spots – Medicaid uninsured eligibles 2015 ZCTA ~1400 ZCTA ~1400 ZCTA ~1200 Health Care Research Center, OFM

hot spots – QHP uninsured eligibles 2015 ZCTA ~1000 ZCTA ~1000 ZCTA ~1300 ZCTA ~2200 ZCTA ~2500 Health Care Research Center, OFM

hot spots Spokane Health Care Research Center, OFM

hot spots – Medicaid uninsured eligibles 2015 ZCTA ~1000 Health Care Research Center, OFM

hot spots – QHP uninsured eligibles 2015 ZCTAs & ~2400 ZCTAs 99205, & ~4300 Health Care Research Center, OFM

Medicaid eligible uninsured – 2015* Less than ,000 or more *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange. Health Care Research Center, OFM ZCTA ~1100 ZCTA ~1300 ZCTA ~2300

QHP eligible uninsured – 2015* Less than ,000 or more *Estimates for 2015 are preliminary and do not account for net changes in employer-sponsored coverage and other private insurance coverage outside the Exchange. Health Care Research Center, OFM ZCTA ~1000 ZCTA ~1400 ZCTA ~1500 ZCTA ~1100 ZCTAs & ~3400 ZCTAs & ~2200

questions? Joe Campo, MPH Health Care Research Center, OFM