Symposium: Evaluating Health Care Reform: Are Federal and State Surveys Meeting the Need?

Kathleen Thiede Call, "Using State Surveys to Evaluate Health Care Reform."

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 reinforced and generated new data needs for monitoring and evaluating health reform in the Unites States overall and in individual states.  Staff at the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, School of Public Health recently developed a framework for tracking the impacts of the ACA.  The framework focuses on monitoring change over time in three main areas relevant to the ACA:  health insurance coverage (uninsurance, public coverage, employer-sponsored insurance, and health insurance exchange); affordability and comprehensiveness of health insurance coverage (cost-sharing, financial burden associated with health insurance); and access to health insurance services (use of services including usual sources of care and preventive care services, barriers to care including difficulty finding a provider, system-level access, and the role of safety net providers).  Studying the effects of the ACA on these key outcomes will not only provide important insights for federal and state policymakers early on in the full implementation of the ACA but inform future policy decisions as well.

Possible data sources for assessing the impact of the ACA include general population surveys, provider surveys, Medicaid and all-payer claims databases, and health plan data reported to insurance regulators. This symposium will focus on federal and state-level general population surveys and adjustments these surveys have made in the past couple of years to address information needs related to health reform policy.  Key survey changes have included sample improvements (e.g., increase in sample sizes for individual states, oversampling enhancements); expansions in survey questionnaire content specifically relevant to health reform (e.g., insurance coverage via a health insurance exchange); and attempts to expedite access to policy-relevant data for timely analysis and dissemination.  Our symposium will concentrate particularly on adjustments in questionnaire design and will summarize changes to U.S. Census Bureau and National Center for Health Statistics (NCHS) surveys and health surveys conducted in select states in response to the new health reform environment. Three federal surveys will be addressed: the Current Population Survey (CPS), the American Community Survey (ACS), and the National Health Interview Survey (NHIS). Our symposium will highlight the strengths and weaknesses across these surveys and discuss outstanding gaps in information needs related to monitoring and evaluating ACA and health reform efforts in general.