2011 health insurance coverage estimates
TRANSCRIPT
Funded by a grant from the Robert Wood Johnson Foundation
2011 Health Insurance Coverage Estimates SHADAC Webinar featuring U.S. Census Bureau experts
September 25, 2012, 1:00 PM EDT
You will be connected to broadcast audio through your computer
You can also connect via telephone: 1-800-630-0591
Slides and Handouts at: http://tinyurl.com/8gl33wz
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• Troubleshooting:
– Call Readytalk’s help line: 1-800-843-9166
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• Download slides at http://tinyurl.com/8gl33wz
• The webinar archive will be posted on
SHADAC’s web site
– E-mail notice will be sent to participants
2
Presenters
3
Kathleen Call SHADAC Investigator
and Associate Professor, University
of Minnesota School of Public Health
Joanna Turner SHADAC Senior Research Fellow
Brett O’Hara Chief, Health and Disability Statistics
Branch, U.S. Census Bureau
Jennifer Day Assistant Division Chief for
Employment Characteristics,
U.S. Census Bureau
Joanne Pascale
Research Social Science Analyst
Center for Survey Management
U.S. Census Bureau
ACS and CPS design differences
4
CPS ACS
Survey Methods
Data collection period February to April Continuous
Mode of data collection Phone and in-person Mail, phone, and in-person
Annual Number of Housing Units Surveyed About 80,000 About 2 million
Population surveyed Civilian non-institutionalized population U.S. population (including group quarters)
Geography for which Estimates are Produced
Nation, States, and District of Columbia All All
Counties Most over 100,000 in population All
Metropolitan Areas Largest 250 in population All
Congressional Districts None All
Census tracts None All
Health Insurance Measurement
Information Collected for Everyone in a Household Yes Yes
Uninsurance measure Uninsured all year Point in time
State-specific public program names Yes No
Verification question Yes No
Other Key Content
Activities of Daily Living (ADL) Yes Yes
Self Reported Health Status Yes No
Housing Values (and Rent and Mortgage Payment) No Yes
What’s new for CPS
• Implementation of Census 2010-based
population controls for 2011 estimates
• For consistency, Census Bureau re-ran 2010
estimates with Census 2010-based population
controls
– Included in “Income, Poverty, and Health Insurance
coverage in the United States: 2011”
http://www.census.gov/hhes/www/hlthins/index.html
– Public use file of updated weights
http://www.census.gov/housing/extract_files/
5
0
5
10
15
20
25
30
35
2008 2009 2010 2011
Perc
en
t
Under 65 I‘~
Under 18 I‘~
18 to 64 ‘
65 and over ^I‘~
Comparisons over time:
Percent uninsured by age group
‘10-’11 Change
’09-’11 Change
ACS -4.2* CPS -2.1*
ACS -3.6* CPS -5.8*
CPS -0.6* ACS -0.4*
CPS +0.7* ACS +0.4*
CPS -0.5* ACS -0.4*
CPS -0.8* ACS +0.1
CPS -0.4 ACS -0.5*
CPS -0.3 ACS -1.1*
CPS -0.3* ACS −
CPS +0.1 ACS −
19 to 25 ^I‘
Lighter shades of color indicate ACS; darker shades indicate CPS.
^2008 ACS and CPS age-group estimates are statistically different.
I2009 ACS and CPS age-group estimates are statistically different.
‘2010 ACS and CPS age-group estimates are statistically different.
~2011 ACS and CPS age-group estimates are statistically different.
* Within-survey change across years in the uninsured rate is statistically significant at the 90 percent confidence interval.
− Represents or rounds to zero.
6
Comparisons over time:
Percent uninsured by race/ethnicity (all ages)
7
0
5
10
15
20
25
30
35
2008 2009 2010 2011
White alone ^I‘~
Black alone ^I‘~
Lighter shades of color indicate ACS; darker shades indicate CPS.
^2008 ACS and CPS race and Hispanic groups estimates are statistically different.
I2009 ACS and CPS race and Hispanic groups estimates are statistically different.
'2010 ACS and CPS race and Hispanic groups estimates are statistically different.
~2011 ACS and CPS race and Hispanic groups estimates are statistically different.
* Within-survey change across years in the uninsured rate is statistically significant at the 90 percent confidence interval.
− Represents or rounds to zero.
Hispanic ^I
‘10-’11 Change
’09-’11 Change
CPS -0.6 ACS -1.1*
CPS -2.3* ACS -1.2*
CPS -1.3* ACS -0.5*
CPS +0.3 ACS -0.4*
CPS -0.4* ACS -0.3*
CPS -0.9* ACS +0.1
Comparisons over time:
Coverage type (all ages)
8
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011
Lighter shades of color indicate ACS; darker shades indicate CPS.
^2008 ACS and CPS coverage type estimates are statistically different.
I2009 ACS and CPS coverage type estimates are statistically different.
'2010 ACS and CPS coverage type estimates are statistically different.
~2011 ACS and CPS coverage type estimates are statistically different.
* Within-survey change across years in the uninsured rate is statistically significant at the 90 percent confidence interval.
− Represents or rounds to zero.
Private Health Insurance ^I‘~
Public Coverage ^I‘~
Uninsured ^I‘~
‘10-’11 Change
’09-’11 Change
ACS -0.6* CPS -0.1
ACS -2.2* CPS -1.8*
CPS +1.0* ACS +0.8*
CPS +3.0* ACS +2.0*
CPS -0.6* ACS -0.4*
CPS -0.7* ACS −
Comparisons over time:
Coverage type, children (<18 years)
9
0
10
20
30
40
50
60
70
2008 2009 2010 2011
Private Health Insurance I~
Lighter shades of color indicate ACS; darker shades indicate CPS.
^2008 ACS and CPS coverage type estimates are statistically different.
I2009 ACS and CPS coverage type estimates are statistically different.
'2010 ACS and CPS coverage type estimates are statistically different.
~2011 ACS and CPS coverage type estimates are statistically different.
* Within-survey change across years in the uninsured rate is statistically significant at the 90 percent confidence interval.
− Represents or rounds to zero.
Public Coverage ^I‘~
Uninsured I‘~
‘10-’11 Change
’09-’11 Change
CPS -0.2 ACS -0.8*
CPS -0.4 ACS -2.8*
CPS +0.9* ACS +1.3*
CPS +1.1* ACS +4.0*
CPS -0.4 ACS -0.5*
CPS -0.3 ACS -1.1*
10
Source: ACS Brief “Health Insurance Coverage of Young Adults Aged 19 to 25:
2008, 2009, and 2011”
ACS public use data release
• Public use microdata samples (PUMS)
available in late October
– 1% public use microdata sample (1% of
population)
– The smallest identifiable geographic unit is
the PUMA, containing at least 100,000
persons
• PUMAs are generally groups of counties or parts
of counties, but there are exceptions
• PUMAs do not cross state boundaries
11
Upcoming 3-year ACS data release
• October 25, 3-year ACS estimates for
2009-2011 will be released for health
insurance coverage
– Estimates for areas with populations of
20,000 or more
• Public use data release 1-2 months later
– Smallest identifiable geographic unit is the
PUMA
12
Census Bureau resources
• Updated health insurance page
– http://www.census.gov/hhes/www/hlthins/index.html
• American FactFinder summary tables
– http://factfinder2.census.gov
– Uninsured <138% of poverty group added
• “Health Insurance Coverage of Young Adults
Aged 19 to 25: 2008, 2009, and 2011” (ACS
Brief)
– http://www.census.gov/acs/www/data_documentation/
2011_acs_briefs/
13
SHADAC’s Data Center releases
• Updating with new 2011 CPS estimates
and 2010 CPS estimates with new weights
• Updating SHADAC-Enhanced CPS series
• Updating with 2011 ACS and 2009-2011
ACS 3-year estimates
• http://www.shadac.org/datacenter
14
MN Population Center releases (IPUMS)
• 2011 CPS data currently available
– SHADAC-Enhanced CPS will be available soon
• ACS data files will be released about 1-2 weeks
after available from the Census Bureau
• SHADAC Health Insurance Unit (HIU) and
Federal Poverty Guideline (FPG) variables now
available from IPUMS for CPS and ACS
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http://www.ipums.org
SHADAC resources
• “Comparing Federal Government Surveys
that Count the Uninsured”
– http://www.shadac.org/publications/comparing
-federal-government-surveys-count-uninsured
• “Understanding 1-, 3-, and 5-year ACS
Estimates: Summary Tabulations and
Public Use Files”
– http://www.shadac.org/publications/understan
ding-1-3-and-5-year-acs-estimates-summary-
tabulations-and-public-use-files
16
SHADAC resources (2)
• ACS tables from American FactFinder for
the nation and all states showing change
from 2008, 2009, and 2010, to 2011
– For all ages: uninsured, private coverage, and
public coverage
– For children 0-17: uninsured
– For employed people 18-64: uninsured,
private coverage, and public coverage
– http://tinyurl.com/8gl33wz
17
Census Bureau:
March 2013 CPS Content Test
• Alternative health insurance coverage
questions
– Improve all year coverage measure
– Add point-in-time coverage measure
• New questions to measure Exchange
participation
• New questions on employer offered health
insurance coverage
• Federal Registrar Doc. 2012–16389
18
Census Bureau:
March 2013 CPS Content Test
• Alternative health insurance coverage
questions
– Improve all year coverage measure
– Add point-in-time coverage measure
• New questions to measure Exchange
participation
• New questions on employer offered health
insurance coverage
• Federal Registrar Doc. 2012–16389
19
Problematic CPS Questionnaire
Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
20
Problematic CPS Questionnaire
Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
21
CPS: Calendar year look-back
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January February March
June May April
September August July
December November October
2009 Today:
March 2010
Experimental: Retrospective Health
Insurance Questions
23
Covered Now
(March 2010)?
Before or after
January 1, 2009? Yes
No
Any coverage in
2009?
Before Continuous
until now?
After
What month
did it start?
Coverage Scenario
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• 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
Coverage Scenario: Production CPS
25
January February March
June May April
September August July
December November October
2009 Today:
March 2010
Coverage Scenario: Production CPS
26
Employer-based
and
Medicaid
2009 Today:
March 2010
Coverage Scenario: Alternative CPS
27
January February March
June May April
September August July
December November October
2009 Today:
March 2010
January 2010 February 2010
Coverage Scenario: Alternative CPS
28
January February March
June May April
September August July
December November October
2009 Employer-based
January 2010 February 2010
Coverage Scenario: Alternative CPS
29
Employer-
based February March
June May April
September August July
December November October
2009 Employer-based
January 2010 February 2010
Coverage Scenario: Alternative CPS
30
Employer-based
June May April
September August July
December November October
2009 Employer-based
January 2010 February 2010
Coverage Scenario: Alternative CPS
31
Employer-based
June May April
September August July
Employer-based
2009
Employer-based
Employer-
based
Employer-
based
2010
Coverage Scenario: Alternative CPS
32
Employer-based
June May April
Medicaid
Employer-based
2009
Employer-based
Employer-
based
Employer-
based
2010
Coverage Scenario: Alternative CPS
33
Employer-based
Uninsured
Medicaid
Employer-based
2009
Employer-based
Employer-
based
Employer-
based
2010
Problematic CPS Questionnaire
Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
34
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]
35
Alternative: Questionnaire Structure
• Simplified questions
• Starts with yes/no question on coverage
• Drills down as needed to current CPS
level of detail
36
Alternative: Questionnaire Structure
37
Any coverage now?
If 65+, Medicare now?
Medicaid, Medical Assistance,
CHIP?
Medicare?
State specific plan name?
Verification of uninsured
General source: job,
government or other?
Yes No
Alternative: Questionnaire Structure
38
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?
Problematic CPS Questionnaire
Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
39
Household-level vs. Person-level
Household-level Person-level
40
Person 1
Q 1
Person 2
Person N
Q 2
Person 1
Person 2
Person N
Person 1
Q 1
Q 2
Q N
Person 2
Q 1
Q 2
Q N
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