Results from the Survey of Health Insurance and Program Participation

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1 Results from the Survey of Health Insurance and Program Participation Joint Statistical Meetings San Diego, California July 31, 2012 Joanna Turner State Health Access Data Assistance Center (SHADAC) University of Minnesota, School of Public Health Funded by a grant from the Robert Wood Johnson Foundation

2 Acknowledgements Thanks to the U.S. Census Bureau for their support of this work Funded under contract # Co-authors Brett Fried (SHADAC) Joanne Pascale (Census Bureau) Michel Boudreaux (SHADAC) Kathleen Call (SHADAC) 2

3 Outline Background Overview of the Census Bureau field test Experimental health insurance coverage questions Next steps 3

4 Current Population Survey Annual Social and Economic Supplement (CPS) Over 20 years of health insurance coverage estimates Estimates for all 50 states and the District of Columbia Survey of record for state and national health insurance policy 4

5 Policy Questions Gaps in coverage? Churning of coverage? Crowd-out? 5

6 Problematic CPS Questionnaire Features 1. Calendar year reference period 2. Questionnaire structure = laundry list 3. Household-level design Source: Joanne Pascale (AAPOR, 2012) 6

7 Re-designed (Experimental) CPS Census Bureau test of a new approach to asking questions about health insurance coverage in the CPS Goals: Improve estimates of coverage and provide a richer set of measures Calendar year Point-in-time Duration 7

8 Field Test of Experimental Questions After multiple rounds of testing, Census Bureau fielded in March 2010 Field test of 5,000 households Administered using Computer Assisted Telephone Interview (CATI) instrument 8

9 Problematic CPS Questionnaire Features 1. Calendar year reference period 2. Questionnaire structure = laundry list 3. Household-level design Source: Joanne Pascale (AAPOR, 2012) 9

10 CPS: Calendar year look-back 2009 Today: March 2010 January February March April July October May August November June September December 10

11 Experimental: Retrospective Health Insurance Questions Covered Now (March 2010)? Yes Before or after January 1, 2009? Before Continuous until now? After No Any coverage in 2009? What month did it start? 11

12 Coverage Scenario Had employer-based coverage, but lost job and unable to afford Cobra After being uninsured for a few months obtained Medicaid Got a new job and is currently covered by job 12

13 Coverage Scenario: Production CPS 2009 Today: March 2010 January February March April July October May August November June September December 13

14 Coverage Scenario: Production CPS 2009 Today: March 2010 Employer-based and Medicaid 14

15 Coverage Scenario: Experimental CPS January 2010 February Today: March 2010 January February March April July October May August November June September December 15

16 Coverage Scenario: Experimental CPS January 2010 February Employerbased January February March April July October May August November June September December 16

17 Coverage Scenario: Experimental CPS January 2010 February 2010 Employerbased 2009 Employerbased February March April July October May August November June September December 17

18 Coverage Scenario: Experimental CPS January 2010 February Employerbased Employer-based April July October May August November June September December 18

19 Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer-based Employerbased April July May August Employer-based June September 19

20 Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer-based Employerbased April May Medicaid June Employer-based 20

21 Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer-based Employerbased Uninsured Medicaid Employer-based 21

22 Problematic CPS Questionnaire Features 1. Calendar year reference period 2. Questionnaire structure = laundry list 3. Household-level design Source: Joanne Pascale (AAPOR, 2012) 22

23 CPS: Questionnaire Structure Each plan type is asked about sequentially Plan through current/former employer or union Plan purchased directly from insurance company Plan of someone outside the HH Medicare Medicaid/state-specific plan name CHIP/state-specific plan name TRICARE, CHAMPVA, VA, military health care Other [such as state-specific plan name] 23

24 Experimental: Questionnaire Structure Simplified questions Starts with yes/no question on coverage Drills down as needed to current CPS level of detail 24

25 Experimental: Questionnaire Structure Any coverage now? If 65+, Medicare now? No Yes Medicaid, Medicaid Assistance, CHIP? Medicare? State specific plan name? Verification of uninsured General source: job, government or other? 25

26 Experimental: Questionnaire Structure General source: job, government or other? Job: Military related? TRICARE, VA, Etc. Government: Job with government? Government type? Medicare Medicaid, Medical Assistance, CHIP Military or VA Other Other: Parent/spouse? Direct purchase? Other? 26

27 Problematic CPS Questionnaire Features 1. Calendar year reference period 2. Questionnaire structure = laundry list 3. Household-level design Source: Joanne Pascale (AAPOR, 2012) 27

28 Household-level vs. Person-level Household-level Q 1 Person 1 Person 2... Person N Person-level Person 1 Q 1 Q 2... Q N Q 2 Person 1 Person 2... Person N Person 2 Q 1 Q 2... Q N 28

29 Conclusions and Next Steps 2010 field test shows proof of concept Census Bureau making improvements and full test in 2013 Larger sample, about 15,000 households Evaluate in production environment Also include health insurance exchange questions 29

30 Policy Questions Gaps in coverage? Churning of coverage? Crowd-out? 30

31 Joanna Turner State Health Access Data Assistance Center University of Minnesota, Minneapolis, MN Sign up to receive our newsletter and updates at

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