1. Section 6: Uninsurance and the Safety Net Statewide measures of uninsurance Specific population groups Age, income, race/ethnicity, country of birth, region Characteristics of the uninsured in Minnesota Potential access to coverage for the uninsured Health Care safety net: uncompensated care 1

2. STATEWIDE MEASURES OF UNINSURANCE

3. Uninsurance Rate Trends in Minnesota (Past 5 survey years) *Indicates statistically significant difference (95% level) from prior year shown. Source: 2004, 2007, 2009, 2011 and 2013 Minnesota Health Access Surveys 3

4. Estimated Number of Uninsured in Minnesota, 2004 to 2013 (past 5 survey years) Source: Minnesota Health Access Surveys, 2004 to 2013; population estimates from U.S. Bureau of the Census 4

5. Sources of Insurance Coverage in Minnesota, 2009 to 2013 Estimates that rely solely on household survey data differ slightly from annual estimates that include both survey and administrative data. Source: Minnesota Health Access Surveys, 2011 and 2013. 5

6. Measures of Uninsurance in Minnesota, 2009 to 2013 *Indicates statistically significant difference (95% level) from prior year shown. Source: 2007, 2009 and 2011 Minnesota Health Access Surveys. 6

7. SPECIFIC POPULATION GROUPS

8. Minnesota Uninsurance Rates by Age, 2011 and 2013 ^ Indicates statistically significant difference (95% level) from all ages within year. Source: Minnesota Health Access Surveys, 2011 and 2013 8

9. Sources of Health Insurance Coverage in Minnesota by Age, 2013 ^ Indicates statistically significant difference (95% level) from all ages. Source: Minnesota Health Access Surveys, 2013 9

10. Trends in Health Insurance Coverage in Minnesota by Age, 2011 to 2013 GroupIndividualPublicUninsured 20112013201120132011201320112013 0 to 1765.4%^65.3%^5.5%5.4%23.7%^23.2%^5.4%^6.2%^ 18 to 2559.9%60.4%^7.1%6.3%16.7%^19.4%^16.3%^13.9%^ 26 to 3458.1%56.9%3.5%^3.7%^19.9%^22.1%^18.4%^17.3%^ 35 to 5468.9%^65.2%^5.6%6.8%15.3%^19.3%*^10.1%8.8% 55 to 6460.4%^62.9%^7.7%^8.1%^24.5%22.8%^7.5%6.2%^ 65 & older3.0%^2.0%^1.6%^1.1%^94.7%^96.4%^0.7%^0.5%^ All ages56.6%55.2%5.2%5.4%29.2%31.1%*9.0%8.2% *Indicates statistically significant difference from 2011 (95% level). ^Indicates statistically significant difference rate for all ages (95% level). Source: Minnesota Health Access Surveys, 2011 and 2013 10

11. Sources of Children’s Health Insurance Coverage in Minnesota by Age, 2013 ^ Indicates statistically significant difference (95% level) from rate for all children (0 to 17). Source: Minnesota Health Access Surveys, 2011 11

12. Trends in Children’s Health Insurance Coverage in Minnesota by Age, 2011 to 2013 GroupIndividualPublicUninsured Age in years20112013201120132011201320112013 0 to 560.9%57.6%^4.1%5.2%29.9%^29.8%^5.2%7.4% 6 to 1767.6%69.0%^6.2%5.4%20.7%^20.0%^5.5%5.6% All Children (0 to 17)65.4%65.3%5.5%5.4%23.7%23.2%5.4%6.2% ^ Indicates statistically significant difference (95% level) from rate for all children (0 to 17). Source: Minnesota Health Access Surveys, 2011 and 2013. 12

13. Minnesota Uninsurance Rates by Income, 2011 and 2013 ^ Indicates statistically significant difference (95% level) from all incomes within year. Source: Minnesota Health Access Surveys, 2011 and 2013 13

14. Sources of Health Insurance Coverage in Minnesota by Income, 2013 ^Indicates statistically significant difference from rate for all incomes (95% level). Source: 2013 Minnesota Health Access Survey 14

15. Trends in Health Insurance Coverage in Minnesota by Income, 2011 to 2013 GroupIndividualPublicUninsured 20112013201120132011201320112013 0 to 100%20.7%^20.6%^4.4%4.2%58.2%^57.4%^16.8%^17.7%^ 101 to 200%32.1%^33.2%^4.0%^ 47.9%^48.2%^16.0%^14.5%^ 201 to 300%52.4%^54.8%6.1%5.3%29.0%30.1%12.4%^9.7% 301 to 400%66.9%^63.2%^5.7%6.4%20.4%^25%*^6.9%^5.4%^ 401%+77.3%^74.3%*^5.5%6.2%14.5%^16.9%*^2.6%^ All Incomes56.6%55.2%5.2%5.4%29.2%31.1%9.0%8.2% Household Income as Percent of Federal Poverty Guidelines (FPG) *Indicates statistically significant difference from 2011 (95% level). ^Indicates statistically significant difference from rate for all incomes (95% level). Source: Minnesota Health Access Surveys, 2011 and 2013 15

16. Minnesota Uninsurance Rates by Race/Ethnicity, 2011 and 2013 ^ Indicates statistically significant difference (95% level) from all race/ethnicities within year. Source: Minnesota Health Access Surveys, 2011 and 2013 16

17. Sources of Health Insurance Coverage in Minnesota by Race/Ethnicity, 2013 ^Indicates statistically significant difference rate from statewide rate (95% level). Source: Minnesota Health Access Survey 2013 17

18. Trends in Health Insurance Coverage in Minnesota by Race/Ethnicity, 2011 to 2013 GroupIndividualPublicUninsured 2011201320112013201120132011 White59.3%^57.9%^5.4%5.8%^27.8%^30.2%*^7.5%^6.0%*^ Black31.4%^32.7%^1.6%^1.8%^49.2%^50.8%^17.7%^14.7%^ American Indian29.5%^39.1%^1.5%^2.5%^54.6%^40.4%14.3%18.0%^ Asian59.7%53.2%5.1%6.7%23.9%26.9%11.3%13.2% Hispanic/Latino37.7%^33.9%^3.5%1.4%^32.6%29.8%26.2%^34.8%^ All Residents56.6%55.2%5.2%5.4%29.2%31.1%*9.0% *Indicates statistically significant difference from 2011 (95% level). ^Indicates statistically significant difference rate for all residents (95% level). Source: Minnesota Health Access Surveys, 2011 and 2013 18

19. Uninsurance Rates in Minnesota by Country of Birth, 2011 and 2013 ^ Indicates statistically significant difference (95% level) from all Minnesotans within year. Source: Minnesota Health Access Surveys, 2011 and 2013 19

20. Minnesota Uninsurance Rates by Education, 2011 and 2013 ^ Indicates statistically significant difference (95% level) from all education levels within year. Source: Minnesota Health Access Surveys, 2011 and 2013 20

21. Sources of Health Insurance Coverage in Minnesota by Education, 2013 21 ^ Indicates statistically significant difference (95% level) from all education levels within year. Source: Minnesota Health Access Survey, 2013

22. Trends in Health Insurance Coverage in Minnesota by Education, 2011 to 2013 GroupIndividualPublicUninsured 20112013201120132011201320112013 Less than high school 21.2%^20.5%^4.0%2.2%^53.3%^57.4%^21.5%^20.0%^ High school graduate 42.0%^41.4%^4.7%4.5%41.5%^43.2%^11.7%^11.0%^ Some college/ tech school 55.5%55.4%6.0%6.8%^29.4%29.7%9.1%8.1% College graduate75.1%^70.0%^5.0%6.0%14.5%^19.0%*^5.4%^5.0%^ Postgraduate78.0%^74.0%^5.3%4.5%14.6%^18.9%*^2.0%^2.6%^ All Education Levels 56.6% 5.2%5.4%29.2%31.1%*9.0%8.2% *Indicates statistically significant difference from 2011 (95% level). ^ Indicates statistically significant difference (95% level) from all education levels. Source: Minnesota Health Access Surveys, 2011 and 2013 22

23. Uninsurance Rates in Twin Cities and Greater Minnesota, 2011 and 2013 Source: Minnesota Health Access Surveys, 2011 and 2013 23

24. Uninsurance Rates by Economic Development Region,2011 and 2013 24 ^ Indicates statistically significant difference (95% level) from statewide. Source: Minnesota Health Access Survey, 2011 and 2013 2011 Uninsurance Rate by EDR2013 Uninsurance Rate by EDR 10.0% or greater7.0% to 9.9%Less than 7.0%

25. Sources of Health Insurance Coverage by Region in Minnesota, 2011 and 2013 GroupIndividualPublicUninsured 20112013201120132011201320112013 Northwest 44.0%^50.0%4.1%9.0%42.0%^34.6%9.9%6.4% Headwaters 33.7%^37.5%^4.9%6.4%47.4%^43.7%^14.0%12.4% Arrowhead 49.3%^52.0%3.9% 34.3%35.8%12.5%8.2% West Central 41.4%^54.4%*7.1%6.7%45.5%^33.8%*6.0%5.2%^ North Central 43.8%^44.8%^6.1%10.3%37.6%^37.7%12.5%7.2% Mid-Minnesota 49.4%47.2%^8.3%8.7%35.4%37.3%6.9%6.7% Upper MN Valley 41.7%^46.4%13.2%^5.4%*38.5%41.4%^6.6%6.8% East Central 51.5%52.5%6.4%5.1%33.8%33.3%8.3%9.0% Central 63.5%^59.5%5.3%5.7%25.6%27.4%5.6%^7.4% Southwest 38.9%^42.3%^9.2%^5.2%42.4%^39.0%9.5%13.6% South Central 51.3%47.0%^7.0%5.0%31.0%35.9%10.7%12.1% Southeast 60.3%54.0%5.5%6.4%27.7%33.9%6.5%^5.7% Twin Cities 60.6%^58.9%^4.6%^4.7%^25.4%^28.0%*^9.5%8.4% All Regions 56.6% 5.2%5.4%29.2%31.1%*9.0%8.2% *Indicates statistically significant difference from 2011 (95% level). ^Indicates statistically significant difference from rate for all regions (95% level). Source: Minnesota Health Access Surveys, 2011 and 2013 25

26. CHARACTERISTICS OF THE UNINSURED IN MINNESOTA

27. Income Distribution of Minnesota’s Uninsured Population, 2011 and 2013 Household Income as % of Federal Poverty Guidelines (FPG) UninsuredTotal Population 2011201320112013 0 to 100% 23.6%^28.4%^12.8%13.2% 101 to 200% 30.3%^31.1%^17.1%17.6% 201 to 300% 23.5%^18.20%17.1%15.4%* 301 to 400% 11.5%^10.4%^14.9%16.0% 401%+ 11.2%^11.8%^38.1%37.8% Total100% * Indicates statistically different at 95% level from 2011. ^ Indicates statistically significant difference between uninsured and total population at 95% level within year. Source: Minnesota Health Access Surveys, 2011 and 2013 27

28. Employment Characteristics of Minnesota’s Uninsured Population, 2011 and 2013 UninsuredTotal Population 2011201320112013 Employed67.7%73.5%72.1%72.9% Of Those Who Are Employed: Temporary/Seasonal Job 21.6%^21.8%^8.8%9.3% Number of Hours Worked Per Week: 0 to 10 hours3.6%3.0%2.5%2.4% 11 to 20 hours 6.5%10.8%^6.2%6.4% 21 to 30 hours20.1%^9.1%*8.4%8.3% 31 to 40 hours44.1%^54.5%*52.5%53.8% More than 40 hours25.8%22.6%^30.4%29.1% Total100% 28 * Indicates statistically different at 95% level from 2011. ^ Indicates statistically significant difference between uninsured and total population at 95% level within year. Source: Minnesota Health Access Surveys, 2011 and 2013

29. Employment Characteristics of Minnesota’s Uninsured Population, 2011 and 2013: Size of Employer All UninsuredTotal Population 2011201320112013 Self Employed, no employees11.2%^11.8%^5.3%5.5% 2 to 10 employees23.2%^22.4%^11.9% 11 to 50 employees23.1%^19.4%^12.5%11.5% 51 to 100 employees10.4%15.1%^10.3%9.6% 101 to 500 employees11.7%^11.2%^17.1%18.1% More than 500 employees20.4%^20.0%^43.0%43.4% Total100.0% 29 ^ Indicates statistically significant difference between uninsured and total population at 95% level within year. Source: Minnesota Health Access Surveys, 2011 and 2013

30. Racial/Ethnic Distribution of Minnesota’s Uninsured Population, 2011 and 2013 All UninsuredTotal Population 2009201120092011 White72.0%^60.9%*^86.6%83.4%* Black11.5%^11.1%^5.9%6.2% American Indian3.3%3.6%^2.1%1.6% Asian5.5%7.6%4.4%4.7% Hispanic/Latino13.6%^20.2%*^4.7%4.8% See note Note: Distribution adds to more than 100% since individuals could choose more than one race/ethnicity. * Indicates statistically different at 95% level from 2011. ^ Indicates statistically significant difference between uninsured and total population at 95% level within year. Source: Minnesota Health Access Surveys, 2011 and 2013 30

31. POTENTIAL ACCESS TO COVERAGE FOR THE UNINSURED

32. Access to Employer Coverage, 2011 to 2013 (Non-elderly population) 32 *Indicates statistically significant difference from previous year shown (95% confidence level). Source: Minnesota Health Access Surveys, 2011 to 2013 1 Among people with a connection to an employer offering coverage. 2 Among people eligible to enroll in employer coverage

33. Potential Access to Coverage for the Uninsured, 2011 to 2013 * Indicates statistically different from 2011 at 95% level. 1 Employer offer: percent of uninsured who work for or have a family member who works for an employer offering coverage. 2 Employer eligible: percent of uninsured who are eligible for coverage through an employer. 3 Potentially public eligible: based on family structure, income, and eligibility for employer coverage. Note: The employer eligible, potentially public eligible, and not eligible for employer or public coverage categories add to more than 100 percent because some of the uninsured are potentially eligible for both employer or public coverage. Source: Minnesota Health Access Surveys, 2011 and 2013 33

34. HEALTH CARE SAFETY NET: UNCOMPENSATED CARE AT MINNESOTA COMMUNITY HOSPITALS

35. Trends in Uncompensated Care Costs in Minnesota Hospitals 35 *Uncompensated care figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System.

36. Uncompensated Care Trends in Minnesota and the U.S. 36 *Uncompensated care figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System; American Hospital Association.

37. Uncompensated Care Trends for Rural and Urban Minnesota Hospitals 37 *Uncompensated care figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System.

38. Largest Minnesota Providers of Hospital Uncompensated Care, 2012 2012 Uncompensated Care ($ millions) Percent Change to 2011 UC as % of Operating Expenses Hennepin County Medical Center$37.129.4%5.1% Regions Hospital$20.037.0%3.4% Saint Mary’s Hospital$18.1-28.3%2.2% North Memorial Medical Center$13.97.1%3.0% University of Minnesota Medical Center - Fairview$13.025.2%1.1% SMDC Medical Center$12.017.1%3.3% Abbott Northwestern Hospital$9.6-5.1%1.1% St. Cloud Hospital$9.4-17.8%1.7% Park Nicollet Methodist Hospital$9.0-10.4%2.0% United Hospital$8.2-5.9%1.7% Other Hospitals (123 Hospitals)$166.40.4%2.0% All Minnesota Community Hospitals$316.72.8%2.2% 38 *Uncompensated care figures are adjusted to reflect costs of providing services. UC is uncompensated care. Source: MDH analysis of data from the Health Care Cost Information System.

39. Largest Minnesota Providers of Hospital Uncompensated Care, 2012 39 *Uncompensated care figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System.

40. Distribution of Uncompensated Care by Hospital, 2012 *Uncompensated care figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System. 2012 Total Uncompensated Care: $316.7 Million 40

41. Components of Minnesota Hospital Uncompensated Care: Charity Care and Bad Debt *Charity care and bad debt figures are adjusted to reflect costs of providing services. Source: MDH analysis of data from the Health Care Cost Information System. 41

42. Hospital Uncompensated Care and Components by Insurance Status, 2012 42 Source: MDH analysis of data from the Health Care Cost Information System.

43. Additional Information from the Health Economics Program Available Online Health Economics Program Home Page http://www.health.state.mn.us/healtheconomics Publications http://www.health.state.mn.us/divs/hpsc/hep/publications/index.html Health Care Market Statistics (Chartbook Updates) http://www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html Interactive Health Insurance Statistics https://pqc.health.state.mn.us/mnha/Welcome.action 43