Health Insurance Decision Tools for States Steven B. Cohen, Ph.D. Agency for Healthcare Research and Quality

Current Capacity AHRQ’s MEPS data and research findings provide national and state specific estimates of: the uninsured population – by length of time, availability of offers, income level the uninsured population – by length of time, availability of offers, income level the characteristics of employer sponsored coverage – availability, employee take up, premium costs (employer/employee) the characteristics of employer sponsored coverage – availability, employee take up, premium costs (employer/employee) health care utilization, expenditures, source of payment, and health status profiles by insurance coverage status health care utilization, expenditures, source of payment, and health status profiles by insurance coverage status

Medical Expenditure Panel Survey (MEPS) Annual Survey of 15,000 households: provides national estimates of health care use, expenditures, insurance coverage, sources of payment, access to care and health care quality Permits studies of: Distribution of expenditures and sources of payment Distribution of expenditures and sources of payment Role of demographics, family structure, insurance Role of demographics, family structure, insurance Expenditures for specific conditions Expenditures for specific conditions Trends over time Trends over time

MEPS Household Component Sample Design Oversampling of policy relevant domains 1996 Minorities (Blacks & Hispanics) 1997 Minorities Low income Children with activity limitations Children with activity limitations Adults with functional limitations Adults with functional limitations Predicted high expenditure cases Predicted high expenditure cases Elderly Elderly Minorities 2002+Minorities, Asians, Low Income 15,000 households; ~35,000 persons

Key Features of MEPS-HC Survey of U.S. civilian noninstitutionalized population Survey of U.S. civilian noninstitutionalized population Sub-sample of respondents to the National Health Interview Survey (NHIS) Sub-sample of respondents to the National Health Interview Survey (NHIS) Oversample of minorities and other target groups Oversample of minorities and other target groups Panel Survey – new panel introduced each year Panel Survey – new panel introduced each year – Continuous data collection over 2 ½ year period – 5 in-person interviews (CAPI) – Data from 1st year of new panel combined with data from 2nd year of previous panel

Published Estimates from the MEPS-Household Component The MEPS-HC survey produces State-level estimates of: The MEPS-HC survey produces State-level estimates of: – Percent of persons with an expense, – Mean expense per person with an expense, and – Percent of total expenses paid out-of-pocket for: Total Health Services, Total Health Services, Dental Services, Dental Services, Prescription Drugs, and Prescription Drugs, and Office-Based Medical Provider Services. Office-Based Medical Provider Services. Estimates are available for the 29 largest States Estimates are available for the 29 largest States

MEPS Insurance Component Annual survey of 40,000 establishments National and State Level estimates of employer sponsored coverage: Availability of health insurance Availability of health insurance Access to health insurance Access to health insurance Cost of health insurance Cost of health insurance Benefit and payment provisions of private health insurance Benefit and payment provisions of private health insurance

Published Estimates from the MEPS-Insurance Component Each year the MEPS-IC produces 280 tables of State- level estimates for private-sector employers: Each year the MEPS-IC produces 280 tables of State- level estimates for private-sector employers: – Premiums, – Contributions, – Enrollments, – Take-up rates, and – Other (i.e., percent of employees with a choice of plans) Survey began in 1996 with estimates for 40 States Survey began in 1996 with estimates for 40 States Since 2003, estimates are available for all States Since 2003, estimates are available for all States

Published Estimates from the MEPS-Insurance Component State-level estimates are broken out by: State-level estimates are broken out by: – Firm Size – Industry Groupings – Ownership Type – Age of Firm – Proportion of Employees Who Are Full-time – Proportion of Employees Who Are Low-wage – Average Wage Quartiles

Published Estimates from the MEPS-Insurance Component Starting in 2005, MEPS-IC produces a smaller set of private-sector estimates for: Starting in 2005, MEPS-IC produces a smaller set of private-sector estimates for: – 20 largest Metro Areas in the United States (by small/large firms) – The largest Metro Areas in each State (at least one per State) and the Remainder of the State. All State and Metro Area estimates are available on- line in Excel and CSV spreadsheet formats in addition to HTML and PDF tables. All State and Metro Area estimates are available on- line in Excel and CSV spreadsheet formats in addition to HTML and PDF tables.

Special State-level Estimates from the MEPS-IC Spreadsheets with State-level estimates for self- insured and fully-insured plans are distributed to a mailing list of 90+ State-level data users (most States are represented) Spreadsheets with State-level estimates for self- insured and fully-insured plans are distributed to a mailing list of 90+ State-level data users (most States are represented) Special requests from State governments and Federal agencies for more detailed breakouts are handled on an individual basis Special requests from State governments and Federal agencies for more detailed breakouts are handled on an individual basis – Estimates often tied to proposed or pending legislation – Distributional estimates – Estimates for specific sub-categories (i.e., geographic areas within State)

Special State-level Estimates from the MEPS-IC AHRQ has partnered in years past with State and Federal agencies to allow the purchase of additional sample to improve estimates for specific States: AHRQ has partnered in years past with State and Federal agencies to allow the purchase of additional sample to improve estimates for specific States: – Through the HRSA State-Planning Grant Program Increased samples in selected years for 32 States and a special collection for the U.S. Virgin Islands Increased samples in selected years for 32 States and a special collection for the U.S. Virgin Islands – Through Contract or Grant Arkansas, Massachusetts, Wisconsin, and the Robert Wood Johnson Foundation Arkansas, Massachusetts, Wisconsin, and the Robert Wood Johnson Foundation

MEPSnet/IC Interactive Web-based tool provides national, and State-by-State, and public sector insurance data in tabular format Interactive Web-based tool provides national, and State-by-State, and public sector insurance data in tabular format

Health Insurance Decision Tools Identification of affordable benefit designs Nationally representative data on: health plan benefit provisions, deductibles and co-pays, Consumer Driven Health Plans health plan benefit provisions, deductibles and co-pays, Consumer Driven Health Plans consumer behavior in response to coverage decisions and choice of plans consumer behavior in response to coverage decisions and choice of plans linkages between MEPS household and policy booklet data, and MEPS employer data on coverage offers, take up and premium costs linkages between MEPS household and policy booklet data, and MEPS employer data on coverage offers, take up and premium costs

MEPS Informs Consumers’ Checkbook Guide to Health Plans Annual publication Annual publication Rates every plan available to federal employees and retirees Rates every plan available to federal employees and retirees Compares likely cost of various plan options to employee Compares likely cost of various plan options to employee Example: Estimated 2007 cost to average family of 4 with head of household under 55 years of age Example: Estimated 2007 cost to average family of 4 with head of household under 55 years of age Approximate Yearly Cost to You ($) Plan Code Plan NameYearly Premium ($) If Your Health Care Usage were Low If Your Health Care Usage were Average If Your Health Care Usage were High Yearly Limit on Cost to You Excluding Dental ($) Local Plans E35Kaiser-St E32Kaiser-Hi JP2M.D. IPA JN5Aetna Open Access-Basic JN2Aetna Open Access-Hi Aetna HealthFund CDHP G2CareFirst BlueChoice

Components of Program Data collection and analysis Data collection and analysis – Health plan benefit provisions and costs – Consumer behavior Modelling effort Modelling effort – coverage benefits, costs and take up Produce user friendly decision tools Produce user friendly decision tools – Estimate impact of specific proposed state plans (cost of plan, take up, expected service use and expenditures of beneficiaries) Technical assistance on design issues and use of tool Technical assistance on design issues and use of tool

Short Term Outputs Number of uninsured (6+ month); socio- economic characteristics Number of uninsured (6+ month); socio- economic characteristics Classifications by income/poverty status; age; eligibility for offers of coverage Classifications by income/poverty status; age; eligibility for offers of coverage Medical Expenditures: mean; median, total; Medical Expenditures: mean; median, total; % with $ above X; total expenditures above X % with $ above X; total expenditures above X Comparisons with full year insured Comparisons with full year insured National, regional and state estimates National, regional and state estimates

Outputs Target population Target population Number of uninsured Number of uninsured Additional persons covered Additional persons covered Plan benefits Plan benefits Estimated premiums Estimated premiums Estimated state cost Estimated state cost Covered families cost Covered families cost – Premiums plus out-of-pocket

Greater Access to AHRQ Restricted Data Use of Census Bureau Research Data Centers (RDC) to improve accessibility of non-public AHRQ data Examples of off-site approved projects in RDC’s: Columbia University - Department of Health Policy and Management - Sherry Glied – “The Tax Treatment of Health Insurance Revisited” University of Michigan - Economic Research Initiative on the Uninsured, – Matthew Rutledge – “Estimation of Adverse Selection & Moral Hazard in Health Insurance” Growing utility of AHRQ Data Center