Montanas Uninsured

1
Montanas Uninsured

• Steve Seninger, Ph. D. Economist
• Bureau of Business and
• Economic Research
• The University of Montana-Missoula
• May 7, 2003

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INTRODUCTION

• PURPOSE Report preliminary findings on uninsured
  Montanans, employers, key informants, focus
  groups
• Bureau Team Steve Seninger, Health Economist
  John Baldridge, Survey Development Jim
  Sylvester, Survey Operations Daphne Herling, Key
  Informant Interviews

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BBER Data Collection AnalysisCurrent Status

• Household survey (n4,113) with over-sampling of
  transitional hardcore uninsured
• Employer survey (n358)
• Focus groups (4 of uninsured/at risk 2 small
  employers all completed)
• Key informant interviews (16 completed)

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Current Response RateHousehold Survey

• Total household contacts
• Refusals
• Non-interviews
• Perpetual appointments
• Completions
• Analyzed data in this report

5,200 950 99 38 4,113 2,941
Response Rate 79.1
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Insurance Coverage by Type, Montana Preliminary
May 7, 2003 (n2,941)
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Insurance Coverage by TypeMontana Residents 0-64
Years OldPreliminary May 7, 2003 (n2,348)
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Montana Uninsured by Age GroupPreliminary May 7,
2003n2,941
39.1
22
20.7
19
17.0
( range from 2, 3, 7)
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AT RISK of No Health Insurance

• 1. Hardcore uninsured ...no insurance -public
  or private- all year?
• 2. Uninsured at interview but covered at some
  point during past year
• 3. Insured at interview butnot covered sometime
  in past year
• At Risk 1 2 3

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At Risk of Being UninsuredMontana Residents 0-64
Years OldPreliminary May 7, 2003n2,348
25.3
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At Risk of Being Uninsured by Size of Employer
Montana Residents 0-64 Years OldPreliminary May
7, 2003n2,348
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Medical Debt Montana Residents 0-64 Years Old
Preliminary May 7, 2003n2,348
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Insurance Coverage by AgeMontana Residents 0-64
Years OldPreliminary May 7, 2003n2,348
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Insurance Coverage by Employment Status of
Primary Wage EarnerMontana Residents 0-64 Years
Old Preliminary May 7, 2003n2,319
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Insurance Coverage by RaceMontana Residents 0-64
Years Old Preliminary May 7, 2003n2,348
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Insurance Coverage by Household SizeMontana
Residents 0-64 Years Old Preliminary May 7,
2003n2,348
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Household Income ComparisonBBER Sample 2000
Census
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Insurance Coverage by Household IncomeMontana
Residents 0-64 Years Old Preliminary May 7,
2003n2,348
54,694
55,884
46,463
19,604
31,582
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Factors Determining Patterns of Montana Uninsured

• Income?especially low income
• Employment?small businesses
• Household size?single larger (5)
• Personal choices?costs major determinant forcing
  people to be uninsured

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Preliminary Findings from Employer Survey

• Target of 500
• All industries with employees
• Over-sampling of small employers
• Completed by May 25

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Current Response RateEmployer Survey

• Total business contacts
• Refusals
• Completions

376 18 358
Response Rate 95.2
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Percent of Employers Offering Insurance byNumber
of EmployeesPreliminary May 7, 2003n358
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Why Firms Do Not Offer Health Insurance
CoveragePreliminary May 7, 2003n209
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Why Eligible Employees Do Not Use Firms Health
Insurance CoveragePreliminary May 7, 2003n220
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Monthly Health Insurance PremiumMontana Small
Businesses Preliminary May 7, 2003n201
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Key Informant Interviews

• 16 interviews completed, 11 in central eastern
  Montana, 5 in western Montana
• Represent business, hospitals, community health
  organizations, public health agencies
• Additional interviews to include farming/ranching
  sector, insurance sector, advocates business
• Final report ?June 25, 2003

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Key Informant Preliminary Findings-Major Points

• Healthcare costs 1 OBSTACLE to health insurance
  for consumers for business
• Current system cannot be fixed by band- aid
  solutions of past 20 years
• Single payer system as long term solution

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Key Informant-Preliminary Specific Points

• Loss of safety net for low income people major
  barrier to healthcare access
• Lack of competition in Montana insurance market
  barrier to diversity in insurance products
• Oral and mental health needs of uninsured are
  major problems

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Focus Group

• Six focus groups in Miles City (2 groups),
  Billings, Havre, Polson, Missoula completed
• At Risk Consumers28, businesses 12
• Final Report, June 25, 2003

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Focus Group Initial Findings

• Payoff of medical debt/bills of uninsured serious
  family budget hardship
• Pre-existing conditions obstacle to insurance
  coverage for family members
• Mental health care, especially for kids, a real
  problem
• Premium costs 1 obstacle to health insurance

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Concluding Observations on Montanas Uninsured

• Low income small business employer base
  negative impacts on insurance coverage
• Real hardships from uninsured including medical
  debt and unmet health needs
• Band-aid approaches failing to provide coverage
• Some strong opinions for single payer as solution