1. The Power of Health Insurance On the Lives of The effectiveness of the Vermont Health Access Plan Catherine Hamilton, Ph.D. New York University Blue Cross and Blue Shield of Vermont

2. Overview Background Research Design Findings Implications

3. 0% 5% 10% 15% 20% Vermont United States Uninsured Vermont vs. US 19901998

4. Research Model Individual Factors Evaluation of Costs/Benefits Enrollment Decision (-) Access Barriers (+) Perceived Access (+/-) Utilization (+) Health Outcomes (+) Satisfaction Year before VHAP enrollment UNINSURED Year after VHAP enrollment INSURED (+) (-)

5. Selection Bias 11% 5% 19% 9% DisabledHospitalized Enrollees Non-enrollees

6. Access Barriers 15% 3% CostKnowledge Uninsured Insured

7. 15.0% 33.0% 31.0% 55.0% Uninsured Delayed needed care Did not get needed care Insured Access to Needed Care

8. Preventive Care Access

9. Access & Use Members: unable to find doctors accepting insurance less likely to seek preventive care with long appointment waits and unmet health care needs twice as likely to end up in the hospital with unmet needs 1.4 times as likely to visit the ER

10. Hospitalization & ER Drop Dentist and Doctors’ Rise (-14%)(+12%)(-16%)(+30%)

11. Increase in mental health visits (for those with at least one visit) Average change is 1.44 (.016)

12. Uninsured Insured Average change is -22% (.000) Health Status Reported a health problem

13. Lessons Initiating insurance in a rural setting improved psychological & physical well-being. –Could be cheaper, too! Program successfully targeted uninsured with the greatest needs. –Benefit design, enrollment process influence selection Inverse relationship between perceived access and hospital use. Mental health status of males improved significantly.

14. Final Thoughts… Vermont’s Opportunities Sustaining the financing of the program over time and reaching the final 10% uninsured Rethinking –how to pay for and manage the care of acutely ill members –how to promote access within the individual market –how to finance health care for the uninsured