Tuesday, May 6, 2014

Bankruptcy Rates as an Indication of the Rate of Underinsured


In my post on the Gallup polls on improvements in the uninsured rates.  I speculated that looking at the rates of medical bankruptcies would provide an indication of the number of underinsured in the US as the Affordable Care Act (ACA).  Data on the number of bankruptcies is available from American Bankruptcy Institute which distinguishes between the number of business and individual bankruptcies each year by state.  The reasons for individual bankruptcies is not given.  Research by PNHP has been done prior to the passage of the Affordable Care Act showing that medical bankruptcies account for 62.1% of all personal bankruptcies.  I have not found recent data on medical bankruptcies (filers or court records would have to be surveyed which is difficult to do) but I can look at overall individual bankruptcy rates in recent years.

The raw number of filings for each state can be seen here for the years 2007-2009.  The numbers were adjusted for state's estimated population for each year to allow for proper comparisons.   The rates are presented as bankruptcies per 1,000 persons.  The US rate increased from 2.70 in 2007 to 4.38 in 2011 which is a 62.15% increase.  The US rate did decrease from 2010 (4.91) to 2011 (4.38) as well as every state except Delaware.  The US rate is shown in the solid blue line above.

California and Arizona had the highest increases from 2007-2011 as can be seen in the table below.  Their increases were both by more than 220% (more than three fold) which is still staggering even after adjusting for their populations.  California is presented in the graph above in the solid black line. 

Of particular interest to health care advocates is Massachusetts (with the dotted purple line above) which has had a version of the ACA since 2006.  The bankruptcy rate there has increased by 43.05% which is below the national rate of 62.15%.  However, if the 50 states plus DC and Puerto Rico are ranked from highest to lowest it ranks exactly in the middle in the change in rate.

Our state, Pennsylvania, had one of the smallest increases at 10.24% (2.30 to 2.54) with a decrease from 2.98 to 2.54 from 2010 to 2011.  Vermont (the dotted yellow line), which passed a single payer plan to be implemented in 2017, had a 31.19% increase in its rate but still ranked 49th out of 52 states in it's 2011 rate.  Only Alaska, DC, and South Carolina had lower rates in 2011 than Vermont.  The state with the lowest rate of change is North Dakota at 1.69% (from 1.76 to 1.79) and is represented with the solid green line.

All of this begs the question how much of the increase in the rates are due to changes in health care or other factors.  There is no clear answer for that right now though the Massachusetts plan has not halted the rise in the overall rate in personal bankruptcies.  I will analyze this data for correlations with other rates such as the uninsured, health outcomes, and income to see if there is an association with these variables.



STATE
Population Adjusted Non Business Bankruptcy Rates by Year (per 1000 persons)
% change 2007-2011
2007
2008
2009
2010
2011
US (50 states + DC and PR)
2.70
3.49
4.55
4.91
4.38
62.15%
AK
0.92
1.18
1.28
1.46
1.30
41.27%
AL
5.04
6.15
7.18
6.98
6.20
22.92%
AR
4.02
4.69
5.51
5.46
4.83
20.02%
AZ
1.69
2.94
5.21
6.42
5.43
220.81%
CA
1.91
3.46
5.43
6.73
6.17
223.68%
CO
3.09
4.13
5.41
6.22
5.72
84.85%
CT
1.60
2.21
2.77
3.09
2.57
60.93%
DC
1.18
1.42
1.80
1.97
1.48
25.67%
DE
1.95
2.58
3.32
3.67
3.94
102.51%
FL
2.15
3.44
4.94
5.74
4.76
121.93%
GA
5.20
6.24
7.50
7.91
7.30
40.26%
HI
1.01
1.50
2.24
2.80
2.32
129.32%
IA
2.26
2.58
3.23
3.10
2.48
9.70%
ID
2.47
3.31
4.71
5.09
4.64
87.80%
IL
3.18
4.28
5.61
6.27
5.52
73.49%
IN
4.78
5.99
7.32
7.15
5.92
23.86%
KS
2.82
3.08
3.74
3.81
3.40
20.74%
KY
3.96
4.88
5.70
5.60
4.97
25.57%
LA
3.15
3.37
3.99
4.05
3.70
17.58%
MA
2.08
2.49
3.11
3.51
2.97
43.05%
MD
2.36
3.06
4.42
4.99
4.29
81.64%
ME
1.62
2.14
2.73
2.99
2.55
57.48%
MI
4.50
5.39
6.79
6.75
5.70
26.70%
MN
2.19
3.00
3.90
4.04
3.50
59.99%
MO
3.55
4.17
5.11
5.42
7.84
121.19%
MS
3.74
4.07
4.81
4.67
4.47
19.55%
MT
1.89
1.93
2.66
2.97
2.48
31.40%
NC
2.10
2.34
2.79
2.64
2.32
10.60%
ND
1.76
1.99
2.30
2.35
1.79
1.69%
NE
2.89
3.59
3.99
4.17
3.46
19.73%
NH
2.02
2.69
3.56
3.82
3.38
67.24%
NJ
2.20
2.96
3.96
4.54
4.17
89.40%
NM
1.64
2.17
2.86
3.05
2.63
60.35%
NV
4.09
6.86
10.74
10.78
8.64
111.38%
NY
2.05
2.36
2.80
2.77
2.41
17.87%
OH
4.29
4.93
5.96
5.97
4.97
15.78%
OK
2.41
2.93
3.66
3.84
3.35
38.89%
OR
2.45
3.28
4.67
5.12
4.42
80.58%
PA
2.30
2.53
2.80
2.98
2.54
10.24%
PR
1.99
2.32
2.93
3.24
2.96
49.04%
RI
2.56
3.94
4.68
5.06
4.55
77.52%
SC
1.61
1.82
2.04
1.93
1.65
2.55%
SD
1.61
1.73
2.18
2.37
2.16
33.85%
TN
6.32
7.47
8.43
7.73
7.18
13.47%
TX
1.70
1.69
2.05
2.14
1.89
11.16%
UT
2.42
3.39
5.20
6.41
6.32
161.58%
VA
2.44
3.52
4.46
4.51
4.04
65.77%
VT
1.33
1.96
2.40
2.53
1.75
31.19%
WA
2.34
3.22
4.56
4.88
4.52
93.54%
WI
3.06
3.69
4.76
5.18
4.64
51.73%
WV
2.37
2.79
3.50
3.18
2.48
4.61%
WY
1.42
1.44
2.27
2.64
2.33
63.97%

**Update**

The journal Annals of Internal Medicine compared mortality rates in Massachusetts to those in similar surrounding counties for four years before and prior to plan implementation in 2006.  They found a 2.95% decrease in the mortality rate compared to the surrounding counties from 2007 to 2010.  Over the same period Massachusetts had a 68.75% increase in the rate of bankruptcies.  

I could not access the journal article so I do not know what the control counties were.  However Rhode Island and Connecticut are similar states in demographics.  Rhode Island had a 97.65% increase and Connecticut had a 93.13% increase in the personal bankruptcy rate.  Is the lower increase in Massachusetts bankruptcies due to their health care law?  I cannot say.  The national rate increased 81.85% over the same period.  There can be many other factors at play in these three states such as differences in bankruptcy law.

Parts of the ACA were implemented in 2011 and there was a 10.79% (4.91 to 4.38 bankruptcies per 1000) decrease nationally from 2010 to 2011.  The slight decrease in the national rate could be due to slight improvements in the economy.  Mortality is a lot easier to measure than bankruptcy.

**Related Posts**

The Affordable Care Act Having an Impact in Some States but not Pennsylvania


 


National, State, & County Uninsured Estimates


 


The Affordable Care Act (ACA) having little effect on PA's Uninsured Rate So Far

 

An Explanation of Washington Post Graphs on the Cost of Procedures

Wednesday, April 30, 2014

Healthcare is a Human Right Concert, June 7

State board member Mike Stout (pictured below) and the Human Union Band will be holding a Health Care is a Human Right concert on June 7. The press release is below with a preview of their new song.

PRESS RELEASE: Legendary Rock Concert for Social Justice in
Pittsburgh!
Mike Stout & The Human Union in Concert to
debut song “Health Care is a Human Right” (previewed below)
and shine a light on the single-payer movement
8:30pm on June 7th 2014 @ First Unitarian
Church of Pittsburgh
605 Morewood Avenue, Pittsburgh, PA 15213
$15/ticket
______________________________________________________________________
"In the Woody Guthrie tradition, his songs reflect contemporary issues without resorting
to journalism. They're more like partisan op-ed columns that grab political opponents by
the throat and don't let go." - John Hayes, Pittsburgh Post Gazette
______________________________________________________________________
On Saturday, June 7th, 2014, the legendary rock band, Mike Stout and the Human
Union, will perform a politically-charged show at the First Unitarian Church of Pittsburgh.
Known for drawing large crowds to Pittsburgh venues such as Club Cafe and Frick Fine
Arts, he also tours internationally to festival-sized audiences. On the evening of June
7th, he’ll debut a special song to his hometown crowd entitled, “Health Care is a
Human Right.”
The song is perhaps the world’s first single-payer universal health care anthem and
appropriately, all proceeds of the show go to Health Care 4 All PA – a nonprofit devoted
to achieving a single-payer health care system in PA. The group has been recognized
nationally for their promotion of a PA single-payer system in places such as Huffington
Post and The New York Times.
Stout’s June 7th concert will also premiere a brand new music video for the featured
song at the start of the show. Other songs performed will include social justice anthems
around anti-fracking, jobs, and peace.
______________________________________________________________________
For advanced tickets, reservations, or inquiries, contact Mike Stout at:
(412) 461-5650 or mikestout619@comcast.net

**Update**


You can see Mike Stout and the Human Union Band performing a tribute to the Triangle Shirtwaist Fire of 1913.

 

Tuesday, April 29, 2014

A Nous la Liberte

Each week, Dr. Aaron Carroll, one of the bloggers at The Incidental Economist, releases a 5-10 min video called "Health Care Triage," in which he discusses current issues in health. This week's installment will be of special interest to single payer advocates, since it concerns the French health care system, which he considers the best in the world. You may not know whether to laugh or cry.


In previous weeks, Dr. Carroll has also discussed the Canadian system--not as good as France's, but much better than ours. He often discusses empirical issues, such as whether organic food is better for your health. If you sign up, You Tube will send you an e-mail each time a new video in this series is released.

You may also be interested in reading:

Monday, April 14, 2014

Recent Uninsured Trends and the ACA

The Gallup Organization has produced quarterly national estimates of the uninsured rate to assess the impact of the Affordable Care Act (aka Obamacare).  It suggests that the rate is at the lowest since the fourth quarter of 2008, before the recession began in earnest.  

The graph below, not surprisingly, shows that the rates are lower for the states that are expanding Medicaid.  The rates are also decreasing at a faster rate for Medicaid expanding states (15.4% in Q4 2013 to 12.45% in Q1 2014) compared to those who are not (19.6% in Q4 2013 to 18.1% in Q1 2014)

MotherJones has printed this table with projections for future costs and coverage under the ACA.  These projections are always based on assumptions which may or may not be reasonable.

A harder thing to measure is the number of underinsured under the ACA relative to the time before the law was passed.  The way in which the word underinsured is defined makes all the difference.  It is much easier just to ask survey respondents whether they have insurance or not that to ask them extensive questions about the type of coverage they have and whether it is adequate for their medical needs.

I have reported extensively on Census Bureau Small Area Health Insurance Estimates (SAHIE)  because they provide a more local picture of trends in the uninsured.  When they are discordant with uninsured rates, the rates of medical bankruptcies could suggest troubles with underinsurance.  Getting access to these statistics is difficult however.  PNHP has conducted a study on 2007 data found 62.1% of all bankruptcies were the result of medical expenses but new studies will need to be done to assess the impact of the ACA.  States with improved uninsured rates but little change in the number of medical bankruptcies could have issues with underinsurance.

**Related Posts**

The Affordable Care Act Having an Impact in Some States but not Pennsylvania

 

National, State, & County Uninsured Estimates

 

The Affordable Care Act (ACA) having little effect on PA's Uninsured Rate So Far

Saturday, April 5, 2014

Medicaid Expansion at a Crossroads

On Monday there will be a Rally for Medicaid expansion in Harrisburg.  There will be a  meeting with Legislators at 11:30 followed by the Rally in the small rotunda in the Capitol Building near the Cafeteria. Along with Iowa, Arkansas, and Michigan, Pennsylvania is now proposing it's own version of expansion.  Utah is still undecided as can be seen in the map below.


Gov. Corbett has proposed an expansion of Medicaid which differs from other states because it adds additional requirements such as a job search requirement and adding premiums and cutting services.  For a year, his administration has been in negotiations with the Federal Department of Health and Human Services to accept his plan but they appear to be foundering with a rejection of the plan likely.  Iowa's and Arkansas' plans have been approved by the Federal Government.

Where the States Stand
Via: The Advisory Board Company

**Related Posts**

 

MEDICAID, MEDICAL INSURANCE, HEALTH CARE and the CORBETT PLAN Op Ed by President Dave Steil

 

No Medicaid Expansion = Higher Health Insurance Premiums