Iowa follows U.S. patterns on loss of employer-sponsored coverage

new report from the Economic Policy Institute traces the erosion of job-based health coverage across the last decade — and the slowing of that decline in the last year. Nationally, as EPI Director of Health Policy Research Elise Gould underscores, job-based health coverage has shed almost 14 million non-elderly Americans since 2000. But slow improvement in the national economy over the last year, coupled with key components of the Affordable Care Act (most notably the provision that young adults are allowed to stay on or join their parents health insurance policies) have slowed those losses since 2011.

The other important trend across this decade is the dramatic growth in public health insurance. Medicaid and CHIP (hawk-i in Iowa) have picked up coverage for at least some of those who have lost job-based coverage. While losses (2000 to 2012) in employer-sponsored insurance were greater among children than among non-elderly adults, for example, the share of children without any coverage actually fell 1.8 percentage points.

Basic RGBMuch the same pattern has played out in Iowa.  In 2000-2001, Iowa’s rate of job-based coverage for those under the age of 65 was 76.9 percent — one of the highest rates in the nation; by 2011-2012, that had fallen to 64.5 percent — closer to the middle of the pack among states.

As the graphic below shows (Iowa is the red dot), this was one of the steepest rates of loss in the nation (coverage down 12.4 percent) and represented a net loss in job-based coverage of over 200,000 non-elderly Iowans. Of those losing coverage, about half (97,075) were working-age adults and about half (111,839) were kids (indeed, the share of kids losing job-based coverage in Iowa, at 16 percent, was the highest in the country).

ESI changes in statesclick on graph for interactive version

Again, public programs pick up some of this slack. Since 2000, Iowa has enrolled about 120,000 more working age adults in Medicaid, and added another 80,000 to the ranks of the uninsured. For Iowa’s kids, public coverage (Medicaid and hawk-i) has been much more effective — picking up 140,000 Iowans under the age of 18 since 2000, while actually reducing the number of kids uninsured.

Colin GordonPosted by Colin Gordon, Senior Research Consultant

Iowa leads the way to kids’ health coverage

Two recent reports highlight Iowa’s success in extending health insurance coverage to children.

Andrew Cannon
Andrew Cannon

Two recent reports highlight Iowa’s success in extending health insurance coverage to children. Both reports are the work of the Kaiser Family Foundation (KFF), a nonprofit private operating foundation, based in Menlo Park, Calif., dedicated to producing and communicating the best possible information, research and analysis on health issues.

The first report — “Performance Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012” — demonstrates the steps that all states are taking to cover children. For instance, hawk-i, Iowa’s version of the Children’s Health Insurance Program (CHIP), has expansive income eligibility guidelines, allowing children from families with income up to 300 percent of the federal poverty level ($67,050 for a family of four) to enroll in the program. Only two states (New York and New Jersey) have broader eligibility guidelines.

Iowa has enacted other policies that make enrolling in public programs less cumbersome, less costly, and more consistent with the goal of getting kids covered.

KFF’s second report highlights Iowa — along with Alabama, Massachusetts and Oregon — among states leading the way in children’s health coverage. “Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage” notes that Iowa has experienced, thanks to its use of CHIP in policies including hawk-i, a nearly 20 percent decrease in the number of uninsured kids. Efforts to expand and simplify the eligibility and enrollment process are key to Iowa’s success in covering kids.

As we noted last month, Iowa’s efforts to cover kid not only help the kids and their families, but also help the state. The U.S. Department of Health and Human Services awarded Iowa with a $9.5 million Children’s Health Insurance Program Reauthorization Act bonus payment in late December, in reward for the state’s efforts to expand children’s health insurance coverage.

Though Iowa has implemented some of the policies that led to success in kids’ coverage in the adult health coverage program, Medicaid, additional policy changes could further reduce the overall rate of uninsurance in the state. For instance, Iowa’s Medicaid eligibility thresholds are Iowa are quite low, especially in comparison to hawk-i eligibility levels

Both Kaiser reports note that Iowa, like every state, will face challenges to maintain and further improve its health insurance coverage. Budgetary pressures, burgeoning caseloads and a growing strain on information technology systems make it difficult. However, both articles illustrate a number of policies Iowa could pursue to continue to be a leader in kids’ health coverage.

Posted by Andrew Cannon, Research Associate

Expanding kids’ coverage pays dividends

Iowa is one of 23 states receiving a children’s health program bonus for its performance in 2011.

Andrew Cannon photo
Andrew Cannon

Iowa has made a huge effort in recent years to expand health insurance coverage to children. Those efforts are paying dividends to the newly covered children and their families, of course, but also to the state.

The 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) gave states new tools to make insuring kids easier. Many of these tools meant a reduced workload for state enrollment officials, and made it easier for families to obtain coverage for their children. CHIPRA also provided cash bonuses to states that implemented the tools and excelled in enrolling children in public health insurance programs.

On Wednesday, the U.S. Department of Health and Human Services announced that Iowa is one of 23 states receiving a CHIPRA bonus for performance in 2011. Iowa is one of just five states to have implemented nearly all of the CHIPRA enrollment tools. Iowa’s $9.5 million bonus can be used to further improve enrollment and eligibility processes or to offset the cost of increased enrollment.

In addition to streamlining the  Medicaid and hawki (Healthy and Well Kids in Iowa — the state’s CHIP program) enrollment process, Iowa has also increased enrollment beyond a baseline level, further increasing the size of the bonus. In November 2011, more than 34,000 children were enrolled in hawk-i, with 248,000 enrolled in Medicaid, compared to 22,300 and 219,000, respectively, in July 2009, just months after CHIPRA passed.

Undoubtedly, the effect of thousands of Iowa parents losing their jobs and health insurance has contributed to enrollment increases. Nonetheless, the tools CHIPRA made available, as well as Iowa’s implementation of many of them, made the process of enrolling kids in public health insurance programs less onerous for many parents at a time they most needed assistance.

Posted by Andrew Cannon, Research Associate