The federal government’s collection of surveys plays a critical role in monitoring and researching a panoply of health issues for the U.S. population, including health insurance coverage, health behaviors, and other health-related topics. These surveys often have features that make them uniquely well-suited for particular uses, such as the ability of the American Community Survey (ACS) to produce estimates of health insurance coverage for sub-state geographies.
A limitation of most of these surveys, however, is the inherent time-lag associated with the collection of large-scale, complex surveys. For instance, the ACS is fielded for data collection throughout the calendar year, and then it requires additional months of data processing before data files and estimates can be published in the fall of the following year—all with the purpose of producing high-quality, reliable data. But during times of rapid change in the health landscape or policy environment, that means policymakers may not have timely data to inform their decisions.
The Household Pulse Survey
In light of these challenges, the U.S. Census Bureau’s Household Pulse Survey (HPS) has been a key data source. The survey, first conducted and released in the early months of the COVID-19 pandemic, has collected and released data on a sub-annual basis (e.g., biweekly or monthly). This helped the Census Bureau provide various stakeholders with timely and ongoing data on a variety of issues for the U.S. adult population, including health coverage information.
The survey has also been responsive and flexible, adding policy-relevant topics as challenges emerged—such as vaccines, childcare arrangements, and dimensions of mental health during the pandemic—that supported state-level estimates. Unlike many administrative data sources that are often used as alternatives to survey data, the HPS also measured a broad distribution of health insurance coverage types, including uninsurance, providing a much more complete picture of coverage. Further, it could also disaggregate coverage rates by important factors such as race and ethnicity, income, education level, and employment status, among others.
Along with many other researchers, SHADAC has used data from the HPS to provide decision makers with critical, up-to-date information about a range of rapidly-evolving topics over the past five years, including:
- Trends in health insurance coverage during the post-Public Health Emergency unwinding of the Medicaid continuous coverage requirement
- Elevated rates of anxiety and depression symptoms during both the first nine months and after the first year of the COVID pandemic
- Trends in COVID-19 vaccination rates and vaccine hesitancy after the public release of a COVID-19 vaccine in 2021
- Trends in health insurance coverage during the first 12 months of the COVID-19 pandemic
Household Trends and Outlook Pulse Survey (HTOPS)
However, the Census Bureau’s plans for continued support for a rapid-release sub-annual survey are currently unclear. In fall 2024, the Census Bureau announced that the HPS would be succeeded by the Household Trends and Outlook Pulse Survey (HTOPS), a redesigned survey featuring a new, panel survey methodology but without the defined ability to produce state-level estimates.
In April 2025, Census announced that HTOPS data collection had begun and that the sample had been expanded to nearly 30,000 households, allowing the survey to release subnational-level data. The first HTOPS data release (covering February/March 2025) was published April 2025 as a public-use file (PUF), but as of December 2025, no further data files had been released. And whereas previous HPS data had been released as data tables and through an interactive tool, the April 2025 HTOPS release included neither of these.
Additionally, the federal government has not released the same detailed survey documentation for the HTOPS that it had for the HPS and for most other federally sponsored surveys. This is why SHADAC did not include the HTOPS in our Survey Data Finder interactive tool, as the necessary details on the survey to include the HTOPS had not been published publicly.
In summary, the HPS represented a fundamentally different approach to federal data collection, one that prioritized speed, adaptability, and breadth. Its rapid, sub-annual release schedule and flexible questionnaire provided near real-time insight during periods of social and policy change. At the same time, the HPS maintained key analytic strengths associated with federal survey data, such as a large sample, methodological rigor, transparency, the ability to capture a broad distribution of health insurance coverage, and the ability to disaggregate outcomes across demographic and socioeconomic groups, including at the state level. As the federal government considers the future of HTOPS, the experience of the HPS underscores the enduring value of timely, transparent, and flexible data for understanding and responding to the needs of state policymakers.
This blog is part of the State Alternatives for Health Data Continuity project funded by Robert Wood Johnson Foundation (RWJF). With this project, SHADAC is developing resources to help anyone involved in the health policy process consider their options for identifying and filling gaps in important measures of health. Please contact us if you would like to learn more or if you have questions.