Montanas Uninsured: Report on State Planning Grant

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Montanas Uninsured Report on State Planning
Grant

• Steve Seninger, Ph. D. Economist
• Bureau of Business and Economic Research
• The University of Montana-Missoula
• June 25, 2003

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INTRODUCTION

• PURPOSE Summary report on uninsured Montanans,
  employers, key informant interviews, focus
  groups
• Bureau Team Steve Seninger, Health Economist
  Jim Sylvester, Survey Operations Daphne Herling,
  Key Informant Interviews John Baldridge, Survey
  Development.

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John on patrol west of Baghdad
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Response RateHousehold Survey

• Total household contacts
• Refusals
• Non-interviews
• Perpetual appointments
• Completions
• Core sample
• Screened for select characteristics

6,747 1,422 144 107 5,074 2,941 2,133
Response Rate 75.2
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Insurance Coverage by Type, Montana 2003
(n2,941)
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Insurance Coverage by TypeMontana Residents 0-64
Years Old 2003 (n2,348)
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Montana Uninsured Rate by Age 2003
39
22
24
19
17
14
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Uninsured Rate by Income As A Percent of
PovertyMontana Residents 0-64 Years Old 2003
48
43
34
35
13
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Montana Residents 0-64 Years Old with Medical
Debt 2003(n2,251)
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Medical DebtMontana Residents 0-64 Years Old
2003
2,828
2,700
2,506
2,546
25
16
13
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Means are based on data without the upper and
lower outliers
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Individual InsuranceMontana Residents 0-64 Years
Old 2003(n714)
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Individual Insurance Premiums and
DeductiblesMontana Residents 0-64 Years Old
2003
418
3,283
3,136
265
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Focus Group (n40)

• Four at risk consumer groups Miles City,
  Billings, Havre, Polson (n28)
• Two employer groups (n12) Miles City
  (hospitality services) Missoula (professional
  services)
• Age range 25 to 62 years old
• Female70, male30

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Focus Group (n40)Where Uninsured Get their
Health Care

• I either go to the walk-in clinic or the ER
• I self-diagnose
• I havent been to the doctor in 10 years it
  scares me.
• Ive got a really good doctor..knows I dont have
  a lot of money..and he just sets it aside until I
  can pay him.

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Individual Insurance Premiums As A Percent of
Monthly Household IncomeMontana Residents 0-64
Years Old 2003

• Focus Group Comments (n40)
• I ranch, because Im self-employed they want to
  hit you again for more
• I think the rates should be same for everyone.
  Whats the deal if youre not part of a group?
• I cant be a part of the group because I am no
  longer a partner in the business.

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8
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Are Montanas uninsured forced or do they choose
to be uninsured? 2003(n1,227)

• Focus Group Comments (n40)
• Cost..even though available through job..is 360
  per month..little left for living on
• Cant afford 400 a month..for just catastrophic
  insurance
• Insurance companies charge too much.

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Previous Insurance Coverage of Montanas
Uninsured 2003(n1,227)
Focus Group Comments (n40) ---..had it through
job..but so expensive my employer dropped it..I
was without for 7 years ---We used to have
coverage for everyone..back in the day when
business was a little better.
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Ability to Afford Low Cost Health
InsuranceMontanas Uninsured 2003 (n1,227)
96
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Who are Montanas uninsured in 2003? (n1,227)
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KEY INFORMANT 29 interviews have been conducted

• 7 from health care providers
• 6 from community based organizations or community
  leaders
• 8 from private industry
• 8 from administrators of public agencies or
  non-governmental organizations

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Key InformantMajor themes

• Cost is the reason that people do not have health
  insurance or that businesses cannot offer it
• Current system(s) can not be fixed
• Most respondents identified some type of
  universal, single-payer health system as the
  long-term solution

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Other Key Informant themes

• Problem too big for states solutions must come
  from federal level
• Creation of a tiered health care system
• Development of haves and have nots within
  private sector
• Problem with pre-existing conditions and large
  deductibles

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Key Informants Private Sector

• Want to offer HI but cannot afford to
• Small business owners going without or purchasing
  catastrophic plans
• Subsidies, tax credits or other incentives
  unlikely to be large enough
• High levels of frustration
• HI as a benefit helps to recruit and retain good
  employees

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Key InformantsAgricultural Sector

• Distance/access to providers
• Disqualified from public programs by high assets
  (even with low income)
• High premiums/high deductibles not affordable
• No ability to pool
• Workers Compensation confused w/ private
  insurances
• Mobility of seasonal farm workers lack of
  access to county programs

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Key Informants Culture of Agric Sector

• Traditionally looks after its own and will not
  ask for help
• Perception that the public insurance programs are
  charity

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Key Informants Catastrophic insurance

• 19 equated a catastrophic plan with being
  underinsured
• 3 thought a catastrophic plan constituted a
  minimum bare bones insurance policy

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Response RateMontana Employer Survey

• Total business located (sample)
• Unable to contact
• Contacted
• Refusals
• Completions

642 95 546 26 520
Response Rate for Contacts 95.2 Response Rate
for Sample 81.0
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Monthly Health Insurance PremiumsMontana
Businesses 2003(n132)
596
492
325
124
94
31
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Why Eligible Employees Do Not Use Montana Firms
Health Insurance Coverage 2003 (n347)
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Why Montana Firms Do Not Offer Health Insurance
Coverage2003(n302)
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Montana Employers Offering Insurance byNumber of
Employees2003(n520)
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Health Insurance Policy Alternatives for Those
Firms Not Providing Health Insurance As An
Employee Benefit

• Provide small firms with tax credits to offset a
  portion of the premium.
• Allow employers to buy into large, public health
  insurance plans like the state employees plan
  only low-income employees would be eligible for
  such a buy-in plan.
• Create a purchasing pool that allows many small
  businesses to join together to purchase insurance
  at rates that are similar to those found in large
  group plans.

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Montana Employer Views on Health Insurance
Premium Increases in 2003(n520)
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Provide Health Insurance With A Tax
Credit2003(n170)
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Participate in Insurance Purchasing
Alternatives2003(n170)
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Focus Group Policy Comments Medicaid CHIP

• 2 kidsno insurance.. I make too much money to
  qualify for Medicaid
• I worked for a doctor that limited the number of
  Medicaid patients.
• CHIP..great program initiallybut each year keeps
  getting cut
• CHIPthere are certain doctors that wont accept
  it.
• I applied to the CHIP program but we were just
  over the level, twice.

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FOCUS GROUP POLICY COMMENTS MCHA COBRA

• I checked on the MCHA. It was too much.
• MCHA they give you a limit, 5000 a year.
  asthma attack can be 5000 in a nightchild..he
  had a bad one..flown to Great Falls it was over
  8,000 for ER and flight
• I qualified for Cobraalready signed upuntil I
  saw the costabout 500 a month.
• If the employee looses his job, there should be
  some way he can afford to keep his insurance.

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Evaluating Policy Options

• Per person costs of extending health insurance
• Uninsured groups brought into coverage
• Potential side effects on existing insured

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Who are Montanas uninsured? 2003(n1,227)
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Summary Observations on Montanas Uninsured

• Not just the poor?45 are 2 times above poverty
  level
• 77 are employed
• 92 high school education or higher
• Many small business owners cant afford insurance
  for themselves their family