SHADAC staff gave two presentations at the 2013 Joint Statistical Meeting (JSM) of the American Statistical Association (ASA), held in Montreal, Quebec, from August 3 through 8. The first presentation,“Measuring Transitions, Spells of Uninsurance, and Churning in the Redesigned CPS,” considered the face validity of the coverage duration estimates generated by the redesigned CPS, observing that the prevalence of coverage transitions in the redesigned CPS is lower than expected. The second presentation,“Medicaid Undercount in the American Community Survey: Preliminary Results,”examined the survey response error for the American Community Survey (ACS) question about Medicaid coverage by linking the 2008 ACS with the 2008 Medicaid Statistical Information System (MSIS). Preliminary results indicate that approximately 75.9 percent of linked cases were correctly reported as Medicaid, for an implied undercount of 24.1 percent.
Lynn Blewett Discusses the Low-Income Uninsured Who Are Ineligible for Expanded Medicaid
SHADAC Director Lynn Blewett gave apresentationon July 24 to theAffinity Group for U.S. Charity Care Programsabout the size and composition of the low-income uninsured population excluded from the ACA Medicaid expansion due to their immigration status. Combining immigration estimates from the Survey of Income and Program Participation (SIPP) with population estimates from the American Community Survey (ACS), SHADAC estimates that 4.9 million people will be excluded from the Medicaid expansion (assuming all states expand the program). The bulk of this population will consist of unauthorized immigrants who are excluded from Medicaid eligibility except under limited circumstances (e.g., pregnancy), and a smaller proportion will be legal permanent residents who are excluded from the program for their first five years of residence. Click hereto read SHADAC Issue Brief #35, which provides state-level estimates of this population.
Universityof MinnesotaResearch Team Wins IHIS Research Award
University of Minnesota researchers Katy Kozhimannil, Jean Abraham, and Beth Virnig won the 2012 Integrated Health Interview Series (IHIS) Research Award for their article,“National Trends in Health Insurance Coverage of Pregnant and Reproductive-Age Women, 2000 to 2009,”published in March 2012 inWomen’s Health Issues. The article, which analyzes ten years of IHIS data to portray how health insurance coverage for childbearing-aged and pregnant women has changed over time, was part of a research project for which SHADAC Director Lynn Blewett is the Principal Investigator. IHISis a harmonized set of data and documentation based on public use files of the National Health Interview Survey (NHIS) from the 1960s to the present. It is a project of theMinnesota Population Centerlocated at the University of Minnesota.
News from the States
California: Effects of Economic Recession on Composition of Uninsured
In a recent policy brief, researchers at the UCLA Center for Health Policy Research use data from the California Health Interview Survey(CHIS) to evaluate the impacts of the 2008 economic recession on California’s uninsured population. The researchers analyze 2007 and 2009 CHIS data to compare rates of uninsurance and demographic characteristics of the uninsured at the county level before and after the start of the recession. Counties that were most affected by the recession (according to a recession index based on unemployment growth and decreases in household income) actually saw a slight drop in the percentage of uninsured due to expansions of public coverage. Overall, the uninsured population in 2009 was older, had lower household income, was more likely to have U.S. citizenship, and was less likely to have full-time employment than the 2007 uninsured population.
MaxEnroll: State Experiences Using Technology to Streamline Enrollment
A newreportfrom the RWJF-fundedMaxEnrollprogram analyzes the use of innovative technology strategies to streamline Medicaid/CHIP enrollment in eight states (AL, IL, LA, MA, NY, UT, VA, and WI). Technologies explored by the study states include: online application and renewal; telephonic application and renewal; online accounts; self-service kiosks; online chat functions; electronic eligibility verification; electronic document management; electronic case records; and express lane eligibility procedures. In order to maximize the benefit of these innovations, some states redesigned business processes, changed job structures, and introduced new management tools and incentives as well.
2012 BRFSS Data Available
Public use data from the 2012 Behavior Risk Factor Surveillance System (BRFSS) arenow availablein ASCII and SAS transport format. The BRFSS is an ongoing, state-based, random-digit-dial telephone survey (now including both landline and wireless phones) of non-institutionalized adults aged 18 years and older from all 50 states, the District of Columbia, Guam, and Puerto Rico. The survey collects data on a wide variety of factors including health status, health care coverage and access, HIV/AIDS risks, exercise, and immunization. The 2012 BRFSS data are available in ASCII and SAS transport formats.
2011-2012 California Health Interview Survey Data Released
Data from the 2011-2012 California Health Interview Survey (CHIS) arenow available. The CHIS is an ongoing, random-digit-dial (including both landline and wireless phones since 2007) survey of California households. CHIS surveys more than 50,000 Californians and can provide county-level estimates for the state’s 41 most populated counties, with the remaining 17 counties combined into three different groups. Major content areas for the 2011-2012 survey include health status and conditions, health-related behaviors, health insurance coverage, mental health, and access to and utilization of health care and mental health services. CHIS public use data files are available in SAS,SPSS, and STATA formats.
Census Bureau Announces Upcoming Data Releases
The U.S. Census Bureau has announced its upcomingdata release schedulefor the Current Population Survey (CPS) and American Community Survey (ACS):
September 17: 2012CPSestimates
September 19: 2012ACS1-year estimates
October 24: 2010-2012ACS3-year estimates
December 5: 2008-2012ACS5-year estimates
The 2008-2012ACS5-year estimates are the first 5-year estimates to include health insurance coverage, which was added to the survey in 2008. Additionally, for the first time, comparison profiles will be available for the three-year estimates, permitting users to compare two non-overlapping three-year periods (2007-2009 versus 2010-2012) and see which changes are statistically significant.
Census Bureau’s “My Congressional District” App Includes ACS Coverage Statistics
The U.S. Census Bureau launched a new online application,“My Congressional District,”that uses the 2011 American Community Survey (ACS) to provide demographic and economic statistics, including health insurance coverage, for each of the nation’s 435 congressional districts. Insurance coverage, including whether coverage is public or private, is included under the “Economic” category, with estimates provided as counts. Also included among the economic statistics are household income and the percentage of the population below the poverty level (overall and by family composition). Employment statistics are provided in the “Jobs” category.
CMS Posts Enrollee Satisfaction Surveys for Public Comment
The Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) released its methodology and survey instruments for assessing enrollee satisfaction with the Marketplace and Qualified Health Plans (QHPs). The surveys will assess consumer experiences with the Marketplaces and QHPs, such as enrollment and customer service experiences, as well as experiences with the health care system, such as communication skills of providers and ease of access to health care services. The surveys will also ask about prior health insurance coverage (Questions 68 and 69 in the Marketplace Survey; Questions 80 and 81 in the QHP Survey). The methodology and instruments are open for public comment through August 27.
The U.S. Department of Health and Human Services (HHS) posted a state-by-state ACA impact tool,“How the Health Care Law Benefits You,”that uses estimates from a number of data sources, including the American Community Survey (ACS), the National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS), to provide information for each state on a variety of impact measures. These measures include (among others): the number of uninsured individuals who are eligible for Marketplace coverage, the number of uninsured who are eligible for subsidized coverage through Medicaid and/or the Marketplace, the number of young adults who have gained coverage through the young adult dependent coverage expansion, and the number of Pre-Existing Condition Insurance Plan (PCIP) enrollees.
State and Local Coverage Changes under Full ACA Implementation
Abrieffrom researchers at the Urban Institute provides highlights from new state and sub-state estimates of how the number and composition of individuals enrolled in Medicaid/CHIP under full ACA implementation, including Medicaid expansion. This analysis provides more detail on the projected coverage changes under the ACA at the state level than in prior research and provides new information on the expected coverage changes resulting from the ACA at the local level in all states. The analysis uses the Urban Institute’s American Community Survey – Health Insurance Policy Simulation Model (ACS-HIPSM), examining pooled 2008, 2009, and 2010ACSdata in order to achieve sufficient precision at the state and local level, with the data reweighted to match 2011 Census Bureau population estimates. The simulation projects a Medicaid/CHIP enrollment of 74 percent nationally, with state-level increases ranging from a low of 14 percent in New York to 161 percent in Nevada.
The State Health Access Data Assistance Center (SHADAC) is a program of the Robert Wood Johnson Foundation and a part of the Health Policy and Management Division of the School of Public Health at the University of Minnesota.