Changes to the Design of the National Health Interview Survey to Support Enhanced Monitoring of Health Reform Impacts at the State Level.

Pursuant to passage of the Patient Protection and Affordable Care Act, the National Center for Health Statistics has enhanced the content of the National Health Interview Survey (NHIS)-the primary source of information for monitoring health and health care use of the US population at the national level-in several key areas and has positioned the NHIS as a source of population health information at the national and state levels. We review recent changes to the NHIS that support enhanced health reform monitoring, including new questions and response categories, sampling design changes to improve state-level analysis, and enhanced dissemination activities. We discuss the importance of the NHIS, the continued need for state-level analysis, and suggestions for future consideration.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota.

OBJECTIVES: We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. METHODS: Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. RESULTS: ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesota's insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. CONCLUSIONS: Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Survey of high-risk pool enrollees suggests that targeted transition education and outreach should begin soon.

Several provisions of the Affordable Care Act make state and federal high-risk pools unnecessary beginning in January 2014. As a result, thousands of enrollees in those pools will be transferred to Medicaid and the new state and federal insurance exchanges. Our study analyzed new survey data collected from enrollees in the country's oldest and largest state-based high-risk pool, the Minnesota Comprehensive Health Association. We estimate that approximately half of the enrollees in that pool will qualify for Medicaid or premium subsidies in the exchange. More than 60 percent of the enrollees reported being somewhat or very unfamiliar with health care reform and the resulting changes to their current coverage. Their concerns about the expected impact of health reform varied by income, geography, and level of deductible. Targeting education and outreach information to address these concerns will be critical for this population's smooth transition to new coverage.