Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
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9 Health Insurance Coverage in the American Community Survey: A Comparison to Two Other Federal Surveys--Joanna Turner and Michel Boudreaux
9 Health Insurance Coverage in the American Community Survey: A Comparison to Two Other Federal Surveys--Joanna Turner and Michel Boudreaux
Pages 83-108
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From page 83... ...
The next section compares key uninsurance estimates from the ACS with estimates from the Annual Social and Economic Supplement to the Current Population Survey (CPS ASEC) and the National Health Interview Survey (NHIS)
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The sample coverage of the ACS is different from other surveys that gather information about health insurance coverage. For example, nei ther the CPS ASEC nor the NHIS samples institutional GQ, residents of Puerto Rico, or active-duty military members.
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4 The CPS ASEC multiyear estimates are 2- and 3-year averages, but they are not based on pooled data. Thus, while the ACS and the CPS employ a conceptually similar moving-average concept, they are distinct.
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The health insurance question is intended to capture comprehensive plans.6 Plans that cover only specific health services, such as dental plans, or are limited to coverage due to an accident or disability are not considered health insurance coverage. Furthermore, it is important to note that subpart d intends to capture all public health insurance programs and is not just an estimate of Medicaid coverage.
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and left the rest blank. The edited final response for that person would be a "yes" for employer- or union-based coverage and a "no" to all of the others: direct purchase, Medicare, Medicaid, military health care, VA, and Indian Health Service.
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SOURCE: Data from U.S. Census Bureau, 2008 American Community Survey, Turner et al.
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The Census Bureau publishes CPS ASEC estimates of health insurance coverage for the nation and all states. Health Insurance Coverage Question The CPS ASEC income and health insurance coverage questions are asked at the household level, that is, "Does anyone in the household .
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The NHIS also asks if the respondent has been uninsured for at least part of the year prior to the interview and if the respondent has been uninsured for more than a year at the time of the interview. The question series includes a comprehensive 9 For more information on health insurance coverage in the CPS ASEC, see: http://www.
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From page 91... ...
The ACS health insurance coverage question uses a clearly defined current coverage measure, referred to as "point in time," that is easily interpreted. In contrast, the CPS ASEC asks respondents to report any 11 For more information on the NHIS, see: http://www.cdc.gov/nchs/nhis.htm.
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counties allow it to produce estimates for state and substate geographic areas and for key population subgroups. COMPARISON OF HEALTH INSURANCE COVERAGE ESTIMATES In order to compare 2008 ACS data with data from the 2009 CPS ASEC (2008 calendar year estimates)
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The health insurance coverage rates for children under age 18 are also shown in Table 9-2. Both the ACS and the CPS ASEC estimate that 90.1 percent of children have health insurance coverage, and the NHIS estimates that 91.0 percent of children have health insurance coverage.
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Direct purchase 14.20 0.03 8.90 0.08 *
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aThe CPS ASEC asks about health insurance coverage over the prior calendar year, however, there is considerable uncertainty as to how respon dents answer the health insurance questions in the survey (Congressional Budget Office, 2003; Davern et al., 2007a)
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TABLE 9-3 Uninsured Rate by Selected Characteristics in the ACS, CPS ASEC, and NHIS, 2008 Universe: U.S. Civilian Noninstitutionalized Population ACS CPS ASECa NHIS ACS-CPS ACS-NHIS Estimate SE Estimate SE Difference Estimate SE Difference Percentage of People Uninsured 15.10 0.05 15.40 0.14 *
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n/a = not available; SE = standard error. aThe CPS ASEC asks about health insurance coverage over the prior calendar year, however, there is considerable uncertainty as to how respon dents answer the health insurance questions in the survey (Congressional Budget Office, 2003; Davern et al., 2007a)
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Data Processing As a whole, the ACS produces estimates of health insurance coverage that are remarkably similar to the CPS ASEC and the NHIS. One potential source of variation could be the different data processing regimens used by the three surveys.
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. 14 Imputation Bias in the CPS ASEC The CPS ASEC imputation routine is known to produce less private dependent coverage than is expected from the explicitly reported distribution (Davern et al., 2007b)
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100 TABLE 9-4 Uninsured Rate for Children by Selected Characteristics in the ACS, CPS ASEC, and NHIS, 2008 Universe: U.S. Civilian Noninstitutionalized Population ACS CPS ASECa NHIS ACS-CPS ACS-NHIS Estimate SE Estimate SE Difference Estimate SE Difference Percentage of Children Under Age 10.40 0.07 10.30 0.21 9.50 0.42 *
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n/a = not available; FPL = federal poverty level; SE = standard error. aThe CPS ASEC asks about health insurance coverage over the prior calendar year, however, there is considerable uncertainty as to how respon dents answer the health insurance questions in the survey (Congressional Budget Office, 2003; Davern et al., 2007a)
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To account for the imputation bias in the CPS ASEC, we used the SHADAC-enhanced CPS ASEC data set.15 These estimates were produced by removing the fully imputed cases (roughly 10 percent of the entire sample) , weighting up the remaining cases to population controls, and adjusting for changes to the health insurance question (State Health Access Data Assistance Center, 2009; ziegenfuss and Davern, 2010)
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the absence of state public program names could result in public program enrollees mistakenly reporting direct purchase; (2) the absence of a qualifier in the response option that explicitly states that direct purchase is not employersponsored coverage (as is done in the CPS ASEC)
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Civilian Noninstitutionalized Population ACS with Consistency Edits SHADAC-Enhanced CPS ASECa NHIS ACS-CPS ACS-NHIS Estimate SE Estimate SE Difference Estimate SE Difference Percentage of People Uninsured 14.60 0.05 14.80 0.14 14.80 0.25 Age Under 6 years 8.00 0.07 7.80 0.30 7.60 0.60 6 to 18 years 10.60 0.07 10.30 0.25 10.50 0.44 19 to 64 years 19.50 0.06 19.80 0.19 20.00 0.32 65 years and over 0.90 0.02 1.70 0.11 *
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n/a = not available; FPL = federal poverty level; SE = standard error. aThe CPS ASEC asks about health insurance coverage over the prior calendar year, however, there is considerable uncertainty as to how respon dents answer the health insurance questions in the survey (Congressional Budget Office, 2003; Davern et al., 2007a)
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that are not possible using other available data sources. This paper shows that the ACS estimates of health insurance coverage are remarkably consistent with estimates from the other national surveys that are often used to track health insurance coverage -- the CPS ASEC and the NHIS.
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Census Bureau and presented in the working paper "A Preliminary Evaluation of Health Insurance Coverage in the 2008 American Community Survey," released September 22, 2009. That working paper was led by Joanna Turner while she was at the U.S.
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. Applying and Evaluating Logical Coverage Edits to Health Insurance Coverage in the American Community Survey.
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