Welcome! Brenda Sharpe President and CEO REACH Healthcare Foundation - PDF document

9/14/2018 Welcome! Brenda Sharpe President and CEO REACH Healthcare Foundation 1

9/14/2018 St Status us Re Report on on Ka Kansas Me Medi dicai caid Study of Health Access in Kansas, Indiana and Ohio Offers Insights into Expansion Approaches September 17, 2018 Today’s Agenda • Review of National Research and Harvard Study Project Introduction – Sara Collins, The Commonwealth Fund • Status Report on Kansas Medicaid: Study of Health Access in Three States – Benjamin Sommers, Harvard T.H. Chan School of Public Health – Audience Questions • Panelist Reflections and Discussion – Audience Questions • Closing Remarks 2

9/14/2018 Sara Collins, Ph.D. Vice President The Commonwealth Fund Medicaid and Kansas: A National Perspective S tatus Report on Kansas Medicaid, Lenexa, KS S ara R. Collins, Ph.D., Vice President Health Care Coverage and Access S eptember 17, 2018 3

9/14/2018 In 2017, nearly 28 million people under age 65 remained uninsured Millions uninsured, under age 65 50 41.3 40 32.3 28.5 30 27.9 27.5 20 10 0 2013 2014 2015 2016 2017 Source: U.S. Census Bureau, 2013, 2014, 2015, 2016 and 2017 (Table A-1) Current Population Survey Reports The uninsured rate has fallen in all states since 2013, but gains have been larger on average in states that expanded Medicaid 2013 2017 3%— ≤ 8% uninsured 8%—<10.5% uninsured 10.5%— ≤ 14% uninsured >14% uninsured Not expanding Medicaid* Notes: *Medicaid expansion status as of January 1, 2017. Of the 19 states that had not expanded eligibility for Medicaid under the ACA as of January 2017, uninsured rates exceeded the national average in 15 of them. Source: Health Insurance Coverage in the United States: 2016. U.S. Census Bureau, 2016 and 2017 American Community Surveys. 4

9/14/2018 Nearly one of five people with the lowest incomes were uninsured in 2017 Income Percent of adults under age 65 who were uninsured 2013 2014 2015 2016 2017 30 26.9 23.2 21.0 18.9 20 18.8 17.8 17.1 15.3 15.3 15.1 14.9 12.5 12.0 10.5 10.7 10.1 10.2 9.9 9.7 9.1 10 6.3 5.4 5.1 5 4.9 0 Total Below 100% FPL 100% to 249% FPL 250% to 399% FPL 400% FPL or more Source: U.S. Census Bureau, 2013, 2014, 2015, 2016 and 2017 Current Population Survey Reports and from CPS’s table creator at http://www.census.gov/cps/data/cpstablecreator.html Uninsured rate in KS exceeds that of other nearby states that have expanded Medicaid Percent of adults ages 19-64 who were uninsured 30 24 25 20 20 15 13 13 12 11 10 10 8 7 4 5 0 Massachusetts Illinois Arkansas Kansas Texas District of Columbia Hawaii Minnesota Iowa Kentucky Michigan Pennsylvania Rhode Island Vermont Wisconsin Connecticut Delaware Maryland New York Ohio New Hampshire North Dakota Washington West Virginia California Colorado Oregon Indiana New Jersey Maine Montana Nebraska Utah Virginia Louisiana Missouri New Mexico South Dakota Alabama Arizona Tennessee Nevada Idaho North Carolina South Carolina Wyoming Alaska Mississippi Florida Georgia Oklahoma Note: For the purposes of this exhibit, we count the District of Columbia as a state. 10 Data source: U.S. Census Bureau, 2017 1-Year American Community Survey. 5

9/14/2018 More than one-quarter of KS adults with low-incom es are uninsured, higher than nearby states with expanded Medicaid Percent of adults ages 19-64 with income under 200% of 50 poverty who were uninsured 43 45 40 35 35 30 27 27 25 20 20 18 15 15 13 10 7 5 0 Massachusetts District of Columbia Vermont Hawaii Kentucky Minnesota Delaware Iowa Michigan New York Rhode Island West Virginia Pennsylvania Connecticut Ohio Wisconsin Oregon Arkansas Montana Washington California Colorado Maryland New Hampshire Illinois Louisiana New Mexico Indiana North Dakota Arizona Maine New Jersey Utah Idaho Nevada Tennessee Alabama Alaska Kansas Missouri Nebraska South Dakota Virginia South Carolina Mississippi North Carolina Florida Wyoming Oklahoma Georgia Texas Notes: 200% of poverty is equal to $24,120 for an individual and $49,200 for a family of four. For the purposes of this exhibit, we count the District of Columbia as a state. 11 Data source: U.S. Census Bureau, 2017 1-Year American Community Survey. States that expanded Medicaid saw greater declines in the share of adults age 18 and older who went without care because of costs Average percentage-point change, 2013 to 2016* Medicaid-expansion states, Nonexpansion states, as of January 1, 2016 as of January 1, 2016 Black Adults All Adults Low-Income Adults Hispanic Adults White Adults -1.5 -2.3 -2.5 -2.9 -3.1 -4.1 -4.8 -5.0 -6.3 -7.3 Not es: *Average percent age point change is defined as t he rat e of adult s 18 and older who report ed going wit hout needed care because of cost s in 2013 less t he rat e in 2016. Rat es were calculat ed in expansion and non-expansion st at es by summing t he number of individuals who did and did not forego needed care. For t he purposes of t his exhibit we count t he Dist rict of Columbia as a Medicaid expansion st at e, and Louisiana, which expanded it s Medicaid program aft er Jan. 1, 12 2016, as a non-expansion st at e. Dat a: 2013 and 2016 Behavioral Risk Fact or S urveillance S yst em (BRFS S ). 6

9/14/2018 Ben Sommers, M.D., Ph.D. Associate Professor of Health Policy and Economics Harvard T.H. Chan School of Public Health and Brigham & Women’s Hospital Medicaid & Health Care Access in Kansas Ben Sommers, MD, PhD Harvard T.H. Chan School of Public Health and Brigham & Women’s Hospital September 2018 7

9/14/2018 Acknowledgments • This work was co ‐ authored with Carrie Fry, Bob Blendon, Arnie Epstein at the Harvard School of Public Health • The research was supported by the Commonwealth Fund and REACH Healthcare Foundation. • The content is the sole responsibility of the authors and does not represent the views of the Commonwealth Fund or REACH. 15 Outline for Today • Results from our recent survey of low ‐ income Kansans about their health care experiences • Some context from other research findings on the Affordable Care Act (ACA) and Medicaid: – Medicaid expansion impacts on patients – Budget effects from Medicaid expansion • Potential effects of work requirements in Kansas Medicaid 16 8

9/14/2018 Study Objectives • Compare rates of coverage, affordability, and access to care in Kansas vs. two other Midwestern states that expanded Medicaid (Ohio and Indiana) • Assess experiences and attitudes towards the ACA and Medicaid expansion in Kansas • Examine the potential effect of a Medicaid work requirement in Kansas Data Source • We conducted a novel random ‐ digit dialing telephone survey of nearly 3000 low ‐ income adults in three Midwestern states – Ohio – traditional expansion – Indiana – expansion with consumer ‐ oriented elements – Kansas – non ‐ expansion • Sample contained U.S. citizens ages 19 ‐ 64, with income less than 138% Federal Poverty Level ($17K for individual, $34K for family of 4) • Cell phone and landline sample, English & Spanish surveys • Response rate 15% • Weighting based on Census benchmarks for age, race/ethnicity, gender, marital status, education, population density, and cell phone use 9

9/14/2018 Coverage and Access to Care Kansas Indiana Ohio 37 37 54 53 35 35* 34 32** 30* 44*** 29 25 36*** 35 33 20* 14 15 Medicaid Private Uninsured No personal doctor Delayed care Trouble wit h because of cost medical bills ***p<.01, **p<.05, *p<.10. Survey of 2700 low ‐ income non ‐ elderly adults. Results were adjusted for age, race/ethnicity, political identification, marital status, educational attainment, sex, family income, and rurality. Perceptions of Quality and the ACA 30 25 20 *** *** ** 15 10 5 0 Helped By ACA Hurt By ACA Kansas Indiana Ohio (REF) ***p<.01, **p<.05, *p<.10. Survey of 2700 low ‐ income non ‐ elderly adults. Results were adjusted for age, race/ethnicity, political identification, marital status, educational attainment, sex, family income, and rurality. 10

9/14/2018 Kansas Medicaid Expansion? Views of Medicaid expansion in Kansas Views of whether quality of care Views of whether quality of care with Medicaid is better, no different, with Medicaid is better, no or worse than with no insurance different, or worse than with private insurance 77 68 37 32 31 23 11 11 9 Yes, in favor No, not in favor Don't know Bett er with No difference Bett er with Bett er with No difference Bett er with Medicaid no insurance Medicaid private insurance • Data: Authors’ analysis of survey responses from U.S. citizens ages 19–64 with incomes below 138 percent of the federal poverty level. • Notes: For all questions, n = 1,000 minus item nonresponse. All responses are survey ‐ weighted to produce representative estimates. Medicaid Expansion: Coverage Source: Sommers, Gunja et al., JAMA 2015 22 11