The ACS Impact in Minnesota: Understanding the Unique Composition of the Uninsured

SHADAC is a multidisciplinary health policy research center that has existed for nearly 25 years within the University of Minnesota School of Public Health. SHADAC is a recognized expert at translating complex research findings into actionable and accessible information for our state and other organizational partners.

One of SHADAC’s core functions, besides providing technical assistance to states, is to collect and apply health-related survey and administrative data to help inform and evaluate state policy decisions. A federal data source we commonly rely on for this work is the U.S. Census Bureau’s American Community Survey (ACS). The ACS is distinctive among surveys because it can provide comprehensive, reliable, and timely demographic and socioeconomic data that are able to serve as a critical foundation for supporting evidence-based health policy and program development.

For instance, we use data from the ACS 5-year files, typically released each year in December, to populate one of our most innovative and unique state-focused resources, the Minnesota Community and Uninsured Profile. This tool enables users to create profiles of uninsured rates in the state by geographic levels such as counties, ZIP codes, and legislative districts. Drawing on the ACS’s large sample

size also allows us to populate the tool with rich demographic details on things like age, disability status, race and ethnicity, income, education and employment. It also includes community-level information like languages spoken at home, industry, and even internet access.

SHADAC recently added another geographic identifier to the tool – the Social Vulnerability Index (SVI).  The SVI is another product based on the ACS that quantifies social vulnerability based on 16 ACS variables grouped into four themes: socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation. The goal of the SVI is to help users identify which communities may need the most support, especially in response to events like public health emergencies or natural disasters.

This tool was funded by the Blue Cross Blue Shield of Minnesota Foundation to support the work of insurance navigators and was created by SHADAC with essential guidance from the advisory board of MNsure navigators and policymakers. Since its creation, it has been applied for a variety of purposes, including strategic planning, equity initiatives, outreach efforts, and case studies.

For example, SHADAC recently used our ACS-based tool to identify uninsurance hotspots by ZIP code for navigator and assister organizations located in and around the Duluth area and then cross-referenced the two identified areas with characteristics of their populations to discover their unique compositions of persons by age, race and ethnicity, sex, disability status, and income level. One ZIP code’s uninsured population identified as mostly male, with higher rates of reported disability, and were younger (age 0-18 and 19-25), while the other identified as mostly white, mostly female, and were more likely to be working age (19-25 and 26-34). Equipped with this important context on the local population found in the profile, navigators and assisters were better able to focus and tailor outreach and enrollment activities and communications to these specific communities.

Tools like this, which leverage the ACS, are essential all year round, but are particularly useful during the MNsure Open Enrollment Period (OEP). In Minnesota, the OEP began on November 1, 2025, and runs through December 15, 2025, for coverage starting January 1, 2026. Understanding the unique characteristics of the communities served can significantly enhance the assistance navigators provide as they help consumers with coverage renewal, transitions, and sign-ups.

For example, identifying areas with the highest concentrations of uninsured individuals can help target and prioritize resources. Understanding the languages spoken and the industries where people work can guide tailored messaging. Awareness of disability prevalence and income profiles can inform what types of health insurance individuals may qualify for. Similarly, knowing the level of internet access can help navigators determine whether consumers can enroll from home, need external resources, or would benefit from in-person assistance.

For more information about this project, visit our resource page, where you can also find the tool and map, along with project details and a helpful video tutorial on using the tool. If you are interested in providing feedback on the tool (letting us know what’s helpful or what could be improved), in letting us know any data sources that could be added to make the tool more useful, or if you’re interested in us creating a version of the tool for another state or another organization with a specific need, reach out to our project leader Christina Worrall at cworrall@umn.edu or use the Contact Us feature on the SHADAC website.