Kathleen Thiede Call, Ph.D.
AcademyHealth, Seattle WA
June 25, 2006
Supported by Blue Cross and Blue Shield of Minnesota Foundation, the federal Health Resources and Services Administration, and the Minnesota Department of Human Services

Julie Sonier, Director
April Todd-Malmlov, Associate Director
Health Economics Program
Minnesota Department of Health
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•
Reform movement in late 1980s led to large-scale state-funded survey in 1990
– 1990 Minnesota Health Access Survey
(MNHA) telephone survey showed a 6 percent uninsurance rate
– Large enough sample size to provide detailed information about uninsured
– Funded by the Minnesota Health Care
Commission
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MinnesotaCare Act enacted in 1992
– Comprehensive approach to reform
MN Health Care Commission’s legislative mandate to monitor number of uninsured
– No $ attached
– Triagulation approach: CPS, BRFSS, 1993
Robert Wood Johnson Foundation (RWJF)
– “9 percent movement”
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MNHA 1995
– Showed a stable 6% uninsuance rate
– CPS 3-year rolling estimate shows 9% rate
– Multiple interpretations—
• No change- MinnesotaCare Act not successful
• Rate dropped- MinnesotaCare Act successful; work is done
• Compromose “6-9 percent movement”
– Education “campaign”
• Different data produce different estimates but consistent story—rate of uninsurance is low and stable
– The importance of advisory committee structure in education campaign
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MNHA Sample
Design
1999
2001
2004
Statewide
Probability
Stratified
Stratified
Number of
Completes
(Response
Rate*)
Survey
Languages
9,571
(79%)
English
Hmong
Spanish
27,315
(65%)
13,802
(59%)
English
Hmong
Spanish
English
Hmong
Spanish
Funding
Source(s)
BCBS of MN
HRSA-SPG
HRSA-SPG
DHS
BCBS of MN
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Larger sample size
•
Access to micro data
•
Ability to adapt survey to address needs of policy makers
– Change in sample design
– Change in survey
• Collect coverage for all household/family members
• Collect employment status, employment characteristics for all adults
• Add policy relevant segments (e.g., Medicare drug coverage, information about access to employer coverage)
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•
Informed changes in MinnesotaCare eligibility (from children, to families, to adults without children)
•
Instrumental in passage of Eliminating Health Disparities
Initiative
•
Basis for regular policy and data briefs on MDH-HEP and
SHADAC websites used by state, county, city agencies and advocacy groups
•
Yearly legislative and administrative briefings to frame debates
•
Fiscal note analyses used for House and Senate Bills
– MinnesotaCare Small Employer Option
•
Advocacy group use:
– Children’s Defense Fund Report—legislative proposal
– National Academy of Social Insurance—Medicare forum focused on near elderly (55-64)
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•
MNHA enables detailed analysis of coverage dynamics, reasons for changing coverage sources, and impact of policy options
•
Examples using 2001 and 2004 data:
– Changes in coverage were related to changing employment, job characteristics, and access to employer coverage;
– Rapid demographic change in Minnesota’s
Hispanic/Latino population also played a significant role
•
With other data sources, usually no ability to do state-level analysis more detailed than a single statewide estimate
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Minnesota analysts use different data for different purposes. For example:
– National data sources
• CPS: national and cross state comparisons
• NSAF: uninsured children prior to 1999
• BRFSS: use of surveys and coverage
– The Minnesota survey
• Coverage, access, eligibility
• Policy simulations
• Fiscal notes
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Generalization of MN experience?
– Foreshadow of similar “concerns” with statespecific data witnessed in other states of late
– With time, acceptance of state-specific data has grown so that MNHA is the preferred source of data (no more ranges)
• Policymakers trust state-specific data and expect it to be available to them
– State must be prepared to address questions about differences between various survey estimates and their advantages/disadvantages
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www.shadac.org
2221 University Avenue, Suite 345
Minneapolis, Minnesota 55455
(612) 624-4802
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