An Interview with Catherine Strode
The Colorado Health Access Survey (CHAS) is the leading source of information on health insurance coverage, access to health care and use of health care services in the state. Since 2009, over 10,000 Colorado households have been surveyed every two years on changes impacting health policy.
In an interview with Catherine Strode, the Colorado Health Institute’s Manager of Public Policy Outreach Joe Hanel, says this year the survey included new questions about satisfaction of care. Results show the state’s Medicaid program fared well with recipients’ responses.
What is considered as the biggest takeaway from the 2017 survey?
“I think the biggest takeaway is that the coverage gains achieved in 2015 through the Affordable Care Act have proved to be pretty durable. The big improvement that we saw in 2015 with the state falling to 6.7 per cent uninsured from more than 14 per cent (uninsured) two years earlier, those gains appear to have been locked in barring any new radical changes in federal policy. We call it ‘the new normal’ that Colorado is now a state where the vast majority of people have insurance. That doesn’t mean they have access; it doesn’t mean they have affordable coverage. But the first step that we see in getting access and affordable care is to get insured. For the vast majority of Coloradans, 93.5 per cent, that achievement has been locked in.”
Denver County reported one of the highest uninsured rates. What is attributed to that?
“It’s 9.0 per cent uninsured in Denver County. The state average is 6.5 per cent uninsured. About a quarter of Denver County residents are in Medicaid, about 25.5 percent; and 12.5 per cent are in Medicare. That’s getting close to 40 per cent in public programs. There are fewer people living in Denver County who are getting insurance through their jobs than the state average. You have a lot of young people in Denver who might be working but might be declining employer coverage. You have people living in Denver who aren’t offered insurance through their jobs so they might be employed but not getting great benefits at their jobs. Those are two reasons. One other thing is there are people in Denver who would qualify for Medicaid but have not enrolled for one reason or another.”
What is the biggest takeaway for Medicaid recipients?
“We asked some new questions about satisfaction with health coverage this year. People on Medicaid, on the whole, were pretty satisfied. Roughly 9 in 10 said they were satisfied with the range of services covered by Medicaid. That’s almost exactly the same as it is for people who are on Medicare or getting employer-sponsored coverage. About 8 in 10, 81.9 per cent, said they were satisfied with their choice of doctors. That’s somewhat below both Medicare and employer-sponsored insurance. Both of those were up above 90 per cent. That wasn’t really a surprising finding to us because we have heard about problems finding doctors in the Medicaid program and it is not surprising that is showing up in satisfaction survey responses from Medicaid recipients. Nine in 10 were satisfied with co-pays and co-insurance. On the whole, Medicaid seems to have stood up to other forms of insurance for satisfaction.”
What did the survey show about the health status of Medicaid recipients?
“More people in the Medicaid program seem to report fair or poor health compared with other forms of insurances. In terms of general health, one out of four Medicaid and Child Health Plan Plus ( CHP+) members, 25.3 per cent reported fair or poor health in comparison with 20 per cent in Medicare, 15.9 per cent of the uninsured, and only 7 per cent of people with job-based insurance. What’s most likely at work here is, frankly, poverty. We see that measures of health are tied very closely to people’s income. When people have employer based insurance, they have steady income. People who are on Medicare include a lot of people who have retired and are drawing pensions or living on investments. People on Medicaid, by terms of what the program is set up to do and who it reaches, are making 138 per cent of the federal poverty level or $16,000 per year or less. Income and health track very closely. I think that’s why you’re seeing high levels of fair or poor health among our Medicaid population. It’s not because of the care they’re getting. Its’ because of the income they make.”
What did the survey show for the mental health of Medicaid recipients as compared to other populations?
“We define poor mental health as having eight or more days of bad mental health in the past month. When we asked that question, 21.1 per cent of people on Medicaid said they had poor mental health. That is higher than any other coverage group. Again, I think the same drivers are at work there. It’s an income question. Not having income is stressful and it leads to all other sorts of stressors in life.”
Catherine Strode is Advocacy Denver’s Communications and Policy Specialist. She holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.