Income, Poverty, and Health Insurance Coverage ... - Census Bureau
Income, Poverty, and Health Insurance Coverage ... - Census Bureau
Income, Poverty, and Health Insurance Coverage ... - Census Bureau
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APPENDIX C.<br />
ESTIMATES OF HEALTH INSURANCE COVERAGE<br />
Quality of <strong>Health</strong> <strong>Insurance</strong> Reporting of coverage through 2.8 million Medicaid enrollees. A key<br />
<strong>Coverage</strong> Estimates major federal health insurance finding indicating survey response<br />
National surveys <strong>and</strong> health insur- programs The CPS ASEC data under- error in the CPS ASEC was that 16.9<br />
ance coverage. <strong>Health</strong> insurance covreport Medicare <strong>and</strong> Medicaid cover- percent of people with an MSIS record<br />
erage is likely to be underreported on age compared with enrollment <strong>and</strong> indicating Medicaid coverage reported<br />
the Current Population Survey (CPS). participation data from the Centers<br />
for Medicare <strong>and</strong> Medicaid Services<br />
in the CPS ASEC that they were<br />
uninsured. 2 While underreporting affects most,<br />
(CMS)<br />
The report found that<br />
1 if not all, surveys, underreporting of<br />
health insurance coverage appears<br />
to be a larger problem in the Annual<br />
Social <strong>and</strong> Economic Supplement<br />
(ASEC) than in other national sur-<br />
veys that ask about insurance. Some<br />
reasons for the disparity may include<br />
the fact that income, not health insur-<br />
ance, is the main focus of the ASEC<br />
questionnaire. In addition, the ASEC<br />
collects health insurance information<br />
in February through April but asks<br />
about the previous year’s coverage.<br />
Asking annual retrospective questions<br />
appears to cause few problems<br />
. Because the CPS is largely<br />
a labor force survey, interviewers<br />
receive less training on health insurance<br />
concepts than labor concepts.<br />
Additionally, many people may not be<br />
aware that a health insurance program<br />
covers them or their children if<br />
they have not used covered services<br />
recently. CMS data, on the other h<strong>and</strong>,<br />
represent the actual number of people<br />
who have enrolled or participated in<br />
these programs.<br />
The State <strong>Health</strong> Access Data<br />
Assistance Center (SHADAC) of the<br />
University of Minnesota has worked<br />
Medicaid subscribers with longer <strong>and</strong><br />
more recent enrollment were more<br />
likely to report coverage. Respondents<br />
for children enrolled in Medicaid<br />
were more apt to report coverage for<br />
those children than for enrolled adults<br />
within the household. Families with<br />
lower incomes tended to report cover-<br />
age more frequently. Individuals who<br />
received Medicaid services during<br />
the reporting cycle tended to report<br />
coverage more often than individu-<br />
als who had not received services.<br />
Reporting differences were also apparent<br />
among states.<br />
when collecting income data (possibly with the U.S. <strong>Census</strong> <strong>Bureau</strong>, CMS, Phase 3 of the research project is<br />
because the interview period is close <strong>and</strong> the Office of the Assistant further broken down into three steps<br />
to when people pay their taxes), but Secretary for Planning <strong>and</strong> Evaluation that attempt to account for discrepit<br />
may be less than ideal when asking (ASPE) on a research project to evalu- ancies found in Phase 2 between the<br />
about health insurance coverage. ate why CPS ASEC estimates of the MSIS records <strong>and</strong> the CPS ASEC files.<br />
Compared with other national sur- number of people with Medicaid are These steps focus on determining<br />
veys, the CPS estimate of the number lower than counts of the number of the number of enrollees who were<br />
of people without health insurance people enrolled in the program from out-of-scope for the 2001 March CPS<br />
more closely approximates the num- CMS. Reports from all four phases of interview (people living in instituber<br />
of people who are uninsured at a the research project are available from tions <strong>and</strong> other group quarters are not<br />
specific point in time during the year the <strong>Census</strong> <strong>Bureau</strong>’s Web site at eligible for CPS ASEC interview; MSIS<br />
than the number of people uninsured . counts all people, regardless of their<br />
for the entire year. For a comparison<br />
of health insurance coverage rates<br />
from the major federal surveys, see<br />
How Many People Lack <strong>Insurance</strong> <strong>and</strong><br />
for How Long? (Congressional Budget<br />
During Phase 2, files from the<br />
Medicaid Statistical Information<br />
System (MSIS) were linked with the<br />
CPS ASEC files <strong>and</strong> the individual<br />
living situation). Phase 3 narrowed the<br />
gap between CPS ASEC estimates <strong>and</strong><br />
MSIS files by 1.0 million, to 1.8 million<br />
Medicaid enrollees.<br />
Office, May 2003). records were compared. The report Phase 4 consisted of repeating the<br />
from Phase 2 showed a gap between Phase 2 process using the National<br />
CPS ASEC estimates <strong>and</strong> MSIS files of 2 For consistency purposes across the MSIS<br />
<strong>and</strong> the CPS, SHADAC removed all MSIS enrollees<br />
who received only partial coverage, those who<br />
had died before the CPS reporting cycle, <strong>and</strong><br />
1 CMS is the federal agency primarily respon- all duplicate person records. Also, all Children’s<br />
sible for administering the Medicare <strong>and</strong> Medic- <strong>Health</strong> <strong>Insurance</strong> Program (CHIP) enrollees were<br />
aid programs at the national level.<br />
removed from the MSIS count.<br />
U.S. <strong>Census</strong> <strong>Bureau</strong> <strong>Income</strong>, <strong>Poverty</strong>, <strong>and</strong> <strong>Health</strong> <strong>Insurance</strong> <strong>Coverage</strong> in the United States: 2009 69