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Summary of the Current Status of Health Insurance Enrollment in Connecticut

Core Content

This report provides a detailed analysis of health insurance enrollment in Connecticut, focusing on the year 2019 and the early months of the 2020 COVID-19 pandemic. The study aims to assist state policymakers in understanding the demographic distribution of insurance enrollment to improve affordability, access, and equity in health insurance.

The research combines data from the American Community Survey Public Use Microdata Sample (ACS PUMS) with state-specific data sources to create comprehensive estimates of insurance enrollment across different categories. The report also includes high-level estimates of changes in enrollment between 2019 and 2020, informed by published data on the impact of the pandemic.

Main Points

• Insurance Enrollment in 2019:

  • Overall, 93.5% of Connecticut's population was enrolled in some form of health insurance.
  • Medicaid coverage was highest among younger individuals, especially those under 18.
  • Employer-sponsored insurance (ESI) was the most common form of coverage, with over two-thirds of the 40-49 age group enrolled.

• Racial and Ethnic Disparities:

  • Asians had the highest ESI coverage (76.0%), while Black individuals had the lowest (52.8%).
  • Hispanic individuals had a significantly higher Medicaid coverage rate (35.7%) compared to non-Hispanic individuals (19.4%).
  • Subsidized marketplace enrollment was highest among White individuals (46.6%) and Other race individuals (55.2%), whereas Black and Asian individuals had lower rates of subsidized enrollment (30.8% and 35.2%, respectively).

• Individual Market Trends:

  • Younger people were more likely to have off-marketplace coverage, possibly due to purchasing student health insurance or other non-marketplace plans.
  • The distribution of age, gender, race, and ethnicity in the individual market was derived using a combination of ACS PUMS and Current Population Survey (CPS) data.

• ESI Market Breakdown:

  • ESI was categorized into small group, large group (nonprofit and for-profit), and Taft-Hartley/multiemployer plans.
  • The report uses the ratio of small group to large group enrollment (10/84) and the proportion of nonprofit to for-profit large group enrollment (0.405) to estimate the size of these subcategories.

• Impact of the Pandemic (2020):

  • Uninsurance decreased slightly during the early months of the pandemic.
  • Medicaid enrollment increased, while private insurance coverage fell.
  • These changes were estimated using data from the National Center for Health Statistics (NCHS) and the Connecticut Department of Social Services.

Key Information

• Data Sources:

  • The report primarily uses the ACS PUMS, which provides demographic and insurance status data.
  • It also incorporates data from the Connecticut All-Payer Claims Database (APCD), Access Health CT, the U.S. Department of Labor (DoL), and the Kaiser Employer Health Benefits Survey (EHBS).

• Methodology:

  • The researchers applied iterative proportional fitting to reweight the ACS PUMS data to align with official Connecticut population estimates.
  • This method ensures that the demographic distributions in the data match known state-specific distributions.
  • A hierarchy was established to determine the primary source of insurance coverage, prioritizing Medicaid, other public coverage, ESI, individual market coverage, and finally, the uninsured.

• Challenges:

  • The APCD lacks accurate race and ethnicity data and does not represent self-funded employer plans.
  • The NHIS data are not state-specific and were adjusted to reflect Connecticut's population characteristics.

Structure of the Report

• Introduction:

  • Highlights the importance of understanding insurance enrollment for policy development.

• Methods:

  • Explains how data were combined and reweighted to produce accurate estimates.

• Results:

  • Presents detailed findings on insurance enrollment by age, gender, race, and ethnicity.
  • Includes high-level estimates of changes in enrollment due to the pandemic.

• Discussion:

  • Emphasizes the need for better data to inform future policy decisions.

• Appendix:

  • Contains a summary of data sources used in the analysis.

• References:

  • Lists sources of data and published studies used in the report.

Conclusion

This report offers Connecticut policymakers a comprehensive view of health insurance enrollment by age, gender, race, and ethnicity. It underscores the importance of detailed, accurate data in shaping policies that enhance affordability and reduce disparities in coverage. The findings suggest that the pandemic had a mixed impact on insurance enrollment, with a slight decrease in uninsurance and an increase in Medicaid coverage.

Key Figures and Tables

• Figure 2.1: Employer-Sponsored Insurance Market Taxonomy.
• Figure 3.1–3.12: Distribution of insurance categories by age, gender, race, and ethnicity in 2019.
• Table 3.1: Connecticut demographics for individuals under 65 in 2019.
• Table 3.2: High-level estimates of 2020 insurance enrollment.
• Table A.1: Summary of data sources used in the analysis.
• Table A.2: Estimated insurance enrollment in Connecticut among those under 65 in 2019.

Funding and Acknowledgments

• The research was jointly funded by Arnold Ventures and the Commonwealth Fund.
• Special thanks to Miriam Miller and Josh Wojcik from Connecticut's Office of the State Comptroller, Jill Zorn from the Universal Health Care Foundation of Connecticut, Carter Price from RAND, and Naomi Zewde from the City University of New York for their contributions and reviews.