Population Health and Health Policy
Health insurance literacy is central to identifying eligibility for coverage and subsidies, choosing a plan, and using optimal healthcare services under the Affordable Care Act (ACA) or other insurance reform initiatives. To fully benefit from policy efforts to improve health insurance access, rural residents must have the ability to select the plan that best meets their healthcare needs. However, a higher proportion of rural residents possess characteristics that may put them at risk of lower health insurance literacy, including lower incomes and educational attainment, less experience with private insurance, and historically higher uninsured rates. Using Health Reform Monitoring Survey data from 2013 and 2014, researchers at the Maine Rural Health Research Center examined whether rural and urban residents demonstrated different knowledge and/or use of the ACA Marketplace and subsidies; enrollment information sources (e.g., Healthcare.gov, the Marketplace); the health insurance mandate; and health insurance terms and concepts. Additionally, they examined whether knowledge and use changed between the fourth quarters of 2013 and 2014.
Findings indicate that familiarity with Healthcare.gov and the Marketplace increased dramatically among both rural and urban residents between 2013 and 2014. However, knowledge in rural areas lagged somewhat behind that of urban residents. Rural and urban residents appear to have comparable levels of health insurance literacy. While this study focuses on some concepts that are specific to ACA policy changes, its results have implications for alternative reforms under consideration by Congress that may require consumer awareness and input.
Contact Information: Erika Ziller, PhD, Maine Rural Health Research Center
Suggested Citation: Ziller EC, Lenardson JD, Burgess AR. Knowledge of Health Insurance Concepts and the Affordable Care Act among Rural Residents. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; July, 2017. PB-68.
Maine people with poor mental health describe significant challenges with affordability and access to health care. A new report released by the Maine Health Access Foundation (MeHAF) and the University of Southern Maine, Mental Health Status and Access to Health Care Service for Adults in Maine, describes how adults 18 and older in Maine who report depression and poor mental health have many barriers to getting health care. These results have important implications for planning in a time when major changes in health insurance coverage are expected.
Analyzing data from the ongoing federal/state public health survey, the Behavioral Risk Factor Surveillance System (BRFSS), Dr. Ziller found that adults in Maine experiencing 14 or more mental health bad days are less likely to have a regular health care provider and more likely to report delays in getting needed health care services (for reasons other than cost). Poorer mental health status was associated with higher rates of foregoing needed medical care because of costs; 25 percent those adults experiencing 14 or more mental health bad days reported they were unable to access needed care from a doctor due to cost compared to 7 percent of adults with no mental health bad days.
MeHAF support allows inclusion of additional questions about access to insurance and health care services in the state’s BRFSS, which surveys a random sample of Maine people throughout the year. Results from the compiled 2012, 2013 and 2014 surveys are included in the report.
For more information on the study design and methodology, please contact Erika Ziller, PhD, (207) 780-4615.
Media contact: Barbara Leonard, President & CEO, (207) 620.8266 x102
Suggested Citation: Ziller EC, Leonard B. Mental Health Status and Access to Health Care Services for Adults in Maine. Augusta, ME: Maine Health Access Foundation and USM Muskie School; February, 2017.
The brief is also available for download on the Maine Health Access Foundation website.
This paper written by research staff at the Maine Rural Health Research Center reports on the design and implementation of a first in the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.
Implementation Lessons: Despite significant challenges, the Maine Rural Veterans Health Access Program (MeRVHAP) successfully established bi-directional connections with Maine’s statewide health information exchange (HIE), allowing for the exchange of clinical health information among U.S. Department of Veterans Affairs (VA) and non-VA providers.
Key factors that contributed to success include:
-A strong business case;
-Strong political and organizational commitment and leadership
-Project champions in the VA with enough seniority to overcome bureaucratic and technical hurdles
-Highly structured and detailed design and implementation plan
-Technical flexibility and capacity to adjust strategy mid-stream
-Collaboration and communication strategies developed by the stakeholders in the course of implementing this project which built a strong foundation for sustainability and replicability
Suggested Citation: Pearson K, Burgess A, Gale J, Coburn A, Hansen A. Health Information Exchange: A Strategy for Improving Access for Rural Veterans in the Maine Flex Rural Veterans Health Access Program. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2016.