Utah Parents and Families Would Benefit from Medicaid Expansion by Alisa Chester, Lincoln Nehring, Sophia Duong, and Joan Alker Key Points Introduction 1. In Utah, uninsured parents account The U.S. has made significant progress in for over one-third of the population decreasing rates of uninsurance. However, potentially eligible for health many low-income families in Utah still coverage if the state expands struggle to obtain health coverage. In Medicaid.1 If Utah does not move 2013 (prior to the Affordable Care Act’s forward with Medicaid expansion, or major coverage provisions) there were over an alternative proposal like Governor 400,000 uninsured individuals living in Utah. Of those uninsured Gary Herbert’s Healthy Utah Plan, a The Affordable Care Act (ACA) created parents that could significant coverage gap for parents new opportunities for low-income adults to benefit from living with dependent children will enroll in coverage, including flexible options remain uninsured. for states to expand Medicaid coverage extended Medicaid 2. Of low-income, uninsured parents, to adults up to 138 percent of the Federal eligibility, two- those who are 26 to 49 years old Poverty Level (FPL). Today, twenty-nine thirds are employed. and have school-aged children (6 states have taken the option to expand to 17 years old) are most likely to Medicaid.2 be helped by Medicaid expansion Currently, Utah has not decided on whether in Utah. Of those parents that could to expand Medicaid to the newly eligible benefit from extended Medicaid adult population, leaving a number of eligibility, more than two-thirds (68 Utah’s parents uninsured. At present, Utah’s percent) are employed. Medicaid program covers parents in a family 3. Covering parents in Utah offers of three up to 46 percent of the FPL ($749 the state an opportunity to help its per month for a family of three).3 In Utah children by reducing their uninsured and other states that do not move forward rate, enhancing a family’s financial with the Medicaid expansion, a significant security, and improving the health of coverage gap for parents will remain. parents. Utah ranks 43rd in the U.S. for percent of uninsured children; consequently, there is significant room for improvement. February 2015 CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG UTAH MEDICAID EXPANSION 1 Who are the uninsured in Utah? Utah has high rates of uninsurance Utah also has high rates of uninsurance for for children, adults, and parents. adults. Nationally, an average of one in five Data reported here is from 2013 and does not adults (20 percent) are uninsured. With 19 reflect the impact of the ACA’s major provisions percent (315,000) of its adult population that took effect on January 1, 2014. Full lacking health coverage, Utah ranks 25th in implementation of the ACA will likely improve the nation. coverage rates for both adults and children In the U.S., there are 13.9 million uninsured and will be reflected in 2014 data.4 parents. While Utah is doing better than the national average (20 percent), Utah Utah ranks 43rd among all states and still has very high rates of uninsured the District of Columbia in percent of parents. Utah has the 24th highest rate of uninsured children (10 percent or 85,000 uninsurance in the nation, with 17 percent uninsured children in Utah). By contrast, (133,000) of all parents uninsured. About 7 percent of U.S. children are uninsured. one-third of very low-income parents Only eight states had higher rates of (those with incomes under 138 percent of uninsured children than Utah. the FPL) lack health coverage. Utah ranks 43rd among all states and the District Figure 1. Rates of Uninsurance in Utah and the U.S., 2013 of Columbia in percent of uninsured 25.0% U.S. children. 20.0% Utah 15.0% 10.0% 5.0% 0.0% Children Adults Parents (under 18 years old) (18-64 years old) (18-64 years old) 2 UTAH MEDICAID EXPANSION CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG February 2015 Who are the potentially eligible parents in Utah? The population of low-income uninsured Top professions for potentially eligible parents most likely to be helped by Medicaid uninsured parents include restaurant, expansion in Utah are white, employed, and in construction, department and grocery young to middle adulthood (26 to 49 years old). store, and elementary and secondary school workers. Employment Working parents are most likely to be Utah’s Medicaid expansion would lead to helped by Medicaid expansion in Utah. greater health coverage for the working poor. Of those that could benefit from extended Medicaid eligibility, more than two-thirds Compared to their higher income (68 percent) are employed. One quarter counterparts, poor parents are more likely (25 percent) of parents are not in the to go without health coverage. Nearly half labor force, meaning they are most likely (49 percent) of eligible parents live below students, homemakers, or otherwise the poverty line (46 to 100 percent FPL). retired workers. Only eight percent of Accordingly, a little over half (51 percent) of parents are unemployed. One quarter (25 eligible parents live above the poverty line percent) of eligible people are working and (101 to 138 percent FPL). have a spouse who is working. About half (49 percent) of all eligible parents work in retail, professional service (scientific, management, administrative and waste management), restaurant, and construction industries. Figure 2. Top 10 Industry Sectors for Potentially Eligible Uninsured Parents 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% February 2015 CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG UTAH MEDICAID EXPANSION 3 Family Demographics American Indian/Alaska Native (3 percent), The majority of eligible parents are in young or Asian/Native Hawaiian/Pacific Islander to middle adulthood, between ages 26 and 49 (3 percent). years of age (69 percent). Eligible parents are Just over one quarter (26 percent) of most likely to have families with one or two eligible parents are Hispanic (who may children (61 percent). Almost half of families (46 be of any race). Note that Hispanic refers percent) have school-aged children (those ages to a person’s ethnicity and is a separate 6 to 17 years old). and distinct concept from race. See the Race/Ethnicity Methodology section for more information. Of the eligible parent population, three- fourths are white (75 percent). The remaining quarter of the eligible population identifies as another race (15 percent), Black (4 percent), Figure 3: Potentially Eligible Parent Population by Race/Ethnicity 15% Other race 75% white 4% Black 3% American Indian/Alaska Native 3% Asian/Native Hawaiian/Pacific Islander 4 UTAH MEDICAID EXPANSION CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG February 2015 Covering Parents is Good for Kids Covering parents increases the likelihood of enrolled in Medicaid fare better economically children being enrolled in health coverage. With and educationally as adults. One study found one in ten children lacking health coverage, this that children enrolled in Medicaid had higher is particularly important in Utah.5 The majority wages and, because they contributed more of the uninsured children in Utah are eligible taxes later in life, led the government to recoup for public coverage but are not enrolled. In most of the dollars spent on Medicaid for fact, only 73 percent of children eligible for children. In addition, Medicaid eligible children public coverage in Utah are actually enrolled in were more likely to attend college and had Only 73 percent of Medicaid or CHIP. Only one state is worse than lower rates of mortality than their non-Medicaid children eligible for Utah at enrolling eligible children.6 Nationally, eligible counterparts.10 Medicaid coverage the children’s participation rate is 87 percent. improves access to necessary health care and public coverage in decreases out-of-pocket spending for low- Utah are actually Extending Medicaid coverage for parents and income adults, increasing financial stability for enrolled in Medicaid other low-income adults has proven to be an effective strategy to boost children’s enrollment the whole family.11 or CHIP. rates. A number of studies have shown the States choosing to extend Medicaid to parents causal link between parent enrollment in directly help children by reducing the number Medicaid and their child’s subsequent receipt of uninsured children, boosting family’s of health coverage.7 A recently published study financial security, and providing children with in Oregon showed children’s odds of receiving better care from healthier parents. Medicaid or CHIP coverage significantly increased if their parents enrolled in Medicaid.8 Not only does Medicaid coverage for children lead to better access to health care, but recent studies have also highlighted the positive long- term effects of Medicaid coverage. Children enrolled in Medicaid are more likely to receive well-child care and are significantly less likely to have unmet or delayed needs for medical care, dental care, and prescription drugs due to cost.9 In the long run, children who were February 2015 CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG UTAH MEDICAID EXPANSION 5 Appendix: Profile of Uninsured Parents Potentially Eligible for Medicaid Age Age of Children 18 5% Presence of young children (under 6 years only) 23% 19-25 17% Presence of school-aged children 26-34 32% (6-17 years only) 46% 35-49 38% Presence of both young and school- 50-64 9% aged children (under 6 and 6-17 years) 30% Federal Poverty Level Employment Status 46-100% of FPL 49% Employed (Civilian) 68% 101-138% of FPL 51% Unemployed 8% Not in Labor Force 25% Race White 75% Top 10 Industry Sectors Other/Multiracial 15% Retail 19% Black 4% Professional Services (accounting, architecture business support, etc.) 12% Asian/Hawaiian/API 3% Restaurants/Food Services 9% American Indian/Alaska Native 3% Construction 8% Ethnicity Manufacturing 8% Hispanic 26% Service (beauty, car wash, maintenance, Not Hispanic 74% other) 7% Financial (banking, insurance, real Number of Children estate) 5% 1 29% Education 5% 2 32% Medical (hospitals, dentist, outpatient 3 14% care) 4% 4 14% Transportation 3% 5+ 10% Note: Due to rounding, percentages may not add to 100 percent. 6 UTAH MEDICAID EXPANSION CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG February 2015 Methodology Data Source coverage estimates. The U.S. Census Bureau This brief analyzes 2013 Public Use Microdata recognizes and reports race and Hispanic origin Sample (PUMS) from the U.S. Census Bureau (i.e., ethnicity) as separate and distinct concepts. American Community Survey (ACS) and applies the PUMS person weight. The U.S. Census To report on an individual’s race, we merge the Bureau publishes PUMS data on Data Ferrett. data for “Asian alone” and “Native Hawaiian or other Pacific Islander alone.” In addition, we Parents report the ACS category “some other race alone” The estimates presented here focus on parents and “two or more races” as “Other.” Except defined as civilian non-institutionalized adults for “Other,” all other racial categories refer to age 18 to 64 living with a biological, adoptive, or respondents who indicated belonging to only one step child under the age of 18 (“own” children). race. Note that the definition of “own” children excludes We report “Hispanic or Latino,” as “Hispanic.” As foster children since they are not related to the this refers to a person’s ethnicity, these individuals householder. may be of any race. We report data for both Health Coverage “white” parents and “white non-Hispanic parents.” Data on health insurance coverage are point- The former refers to all parents whose race is in-time estimates that convey whether a person reported as white, without regard to their ethnicity; does not have coverage at the time of the survey. the latter category refers to parents who reported The estimates are not adjusted to address the their race as white and do not report their ethnicity Medicaid undercount often found in surveys, as Hispanic. For more detail on how the ACS which may be accentuated by the absence of defines racial and ethnic groups see “American state-specific health insurance program names in Community Survey and Puerto Rico Community the ACS. Survey 2013 Subject Definitions.” Medicaid Eligibility Under Current Rules Employment Data on poverty levels includes only those This brief reports those who are employed as individuals for whom the poverty status can those who had a job or business and those who be determined for the last year. Therefore, this are unemployed as those who do not work or population is slightly smaller than the total non- are actively looking for work. The labor force is institutionalized population of the U.S. We include everyone classified as employed or unemployed. only those parents whose income-to-poverty People who are not in the labor force are mostly status is determined to be 46 percent to 138 students, homemakers, retired workers, seasonal percent of Federal Poverty Level ($8,983.80 to workers, institutionalized people, and people $26,951.40 for a family of three in 2013). doing unpaid family work. The ACS does not contain sufficient information to As defined by the U.S. Department of Labor determine whether an individual is an authorized Bureau of Labor Statistics, working part-time is immigrant and therefore potentially eligible for working between 1 and 34 hours per week and full Medicaid coverage, we only include those who time work is 35 hours or more per week. are classified at citizens (those who are born in Limitations of Data the U.S.; born in Puerto Rico, Guam, the U.S. Data provided in this brief should be noted as Virgin Islands, or the Northern Marina; born an estimate. Variables presented are defined abroad of American parent(s); a U.S. citizen by using only the information provided on the PUMS naturalization). and do not include adjustments for possible Demographic and Socio-economic measurement problems. We did not use statistical Characteristics models to impute for various socio-demographic In this brief we report data for all seven race factors (e.g., authorized immigration status). categories and two ethnicity categories for which the ACS provides one-year health insurance February 2015 CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG UTAH MEDICAID EXPANSION 7 Endnotes 1 Based on a Georgetown CCF analysis of U.S. Census Bureau American Community Survey (ACS) data, 2013 single year estimates. Georgetown CCF estimated that there are about 27,000 uninsured parents potentially eligible for Medicaid if Utah expands eligibility, accounting for 36 percent of the total newly eligible adult population (see Methodology for complete methodological notes). 2 Kaiser Family Foundation, “Status of State Action on the Medicaid Expansion Decision,” (January 27, 2015), available at http://kff. org/health-reform/state-indicator/state-activity-around-expanding- medicaid-under-the-affordable-care-act/. 3 T. Brooks et. al, “Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015,” Kaiser Commission on Medicaid and the Uninsured (January 2015). 4 For examples of preliminary data on uninsurance rates in 2014, see federal data from the CDC in “Health Insurance Coverage: Early Authors: Alisa Chester, Lincoln Nehring, Sophia Release of Estimates From the National Health Interview Survey, Duong, and Joan Alker. Design and layout January-June 2014;” policy briefs from the Urban Institute’s Health assistance provided by Nancy Magill. Reform Monitoring Survey including “A First Look at Children’s Health The Center for Children and Families (CCF) Insurance Coverage under the ACA in 2014” and “Taking Stock: is an independent, nonpartisan policy and Health Insurance Coverage for Parents under the ACA in 2014.” research center whose mission is to expand and improve health coverage for America’s children 5 G. Kenney, N. Anderson, and V. Lynch, “Medicaid/CHIP and families. CCF is based at Georgetown Participation Rates Among Children: An Update,” Robert Wood University’s Health Policy Institute. Johnson Foundation and Urban Institute (September 2013), available at http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/ Voices for Utah Children works to make Utah a rwjf407769. place where all children thrive. We start with one basic question: “Is it good for kids?” At Voices 6 G. Kenney, V. Lynch, et. al, “Medicaid/CHIP Participation Among for Utah Children, we believe that every child Children and Parents,” Robert Wood Johnson Foundation and Urban deserves the opportunity to reach his or her full Institute (December 2012), available at http://www.rwjf.org/content/ potential. dam/farm/reports/reports/2012/rwjf403218. 7 Georgetown Center for Children and Families, “Medicaid Expansion: Good for Parents and Children,” (January 2014), available at http:// ccf.georgetown.edu/wp-content/uploads/2013/12/Expanding- Center for Children and Families Coverage-for-Parents-Helps-Children-2013.pdf. Health Policy Institute 8 J. DeVoe, et. al, “Effect of Expanding Medicaid for Parents on Georgetown University Children’s Health Insurance Coverage: Lessons From the Oregon Box 571444 Experiment,” JAMA Pediatrics 169 (2014): e143145, available at 3300 Whitehaven Street, NW, Suite 5000 doi:10.1001/jamapediatrics.2014.3145 (accessed February 9, 2015). Washington, DC 20057-1485 Phone (202) 687-0880 9 J. Paradise and R. Garfield, “What is Medicaid’s Impact on Access Email childhealth@georgetown.edu to Care Outcomes, and Quality of Care? Setting the Record Straight on the Evidence,” Kaiser Commission on Medicaid and the Uninsured (August 2013). ccf.georgetown.edu/blog/ 10 D. Brown, et. al, “Medicaid as an Investment in Children: What is facebook.com/georgetownccf the Long-Term Impact on Tax Receipts?,” Working Paper 20835, National Bureau of Economic Research (January 2015), available at http://www.nber.org/papers/w20835.pdf. twitter.com/georgetownccf 11 Ibid. 8 UTAH MEDICAID EXPANSION CCF.GEORGETOWN.EDU and UTAHCHILDREN.ORG February 2015