Association for Public Policy Analysis & Management

This paper describes the results of a study to understand Oregon’s health insurance coverage immediately following the implementation of major policies of the Affordable Care Act (ACA). The primary research objective is to estimate the uninsured rate and track changes to other types of insurance during this pivotal period. The methodology uses a novel approach, called the OHSU Health Insurance Coverage Model, to combine administrative data from Medicare, Medicaid, and state insurance division enrollment data with population estimates and survey estimates of the uninsured to arrive at more timely estimates of coverage. The 2015 coverage estimates provide levels consistent with enrollment source data. Additionally, through comparison with survey-based approaches the estimates provide some indication of survey response issues that may be occurring. The findings of the study show increases of 10 points in Oregon’s Medicaid program, the Oregon Health Plan. Additionally, group coverage is shown to decrease between 2013 and 2015 by  4 percentage points from 46 to 42 percent, a 9 percent drop. The percentage drop in coverage is largest, for the small group (18%), followed by large group (8%), and self-insured (6%). These coverage changes led to a large decrease in the uninsured rate from 14.5 percent in 2013 to 5.8 percent in 2015. The model results include county detail. Unlike survey estimates, the coverage indications are just counts and do not have other characteristics of the individuals. Nonetheless, the geographic pattern shows large gains in coverage in rural areas but still not reaching the lower levels of uninsured in the more populous areas of the state.