Evaluating Changes to the Health InsuranceQuestions in the Current Population Survey:State ImplicationsState Health Resear...
Acknowledgements• Thanks to the U.S. Census Bureau for their  support of this work  – Funded under contract #000000033114•...
Outline• Background and implications for state policy  research• Overview of the Census Bureau field test• Experimental he...
Current Population Survey Annual Socialand Economic Supplement (CPS)• Over 20 years of health insurance coverage  estimate...
Policy Questions• Gaps in coverage?• Churning of coverage?• Crowd-out?                          5
Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. House...
Re-designed (Experimental) CPS• Census Bureau test of a new approach to  asking questions about health insurance  coverage...
Field Test of Experimental Questions• After multiple rounds of testing, Census  Bureau fielded in March 2010• Field test o...
Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. House...
CPS: Calendar year look-back              2009                     Today:                                     March 2010  ...
Experimental: Retrospective HealthInsurance Questions Covered Now     Yes    Before or after Before   Continuous (March 20...
Coverage Scenario• Had employer-based coverage, but lost job  and unable to afford Cobra• After being uninsured for a few ...
Coverage Scenario: Production CPS              2009                     Today:                                     March 2...
Coverage Scenario: Production CPS           2009                  Today:                               March 2010       Em...
Coverage Scenario: Experimental CPS                                     January 2010      February 2010              2009 ...
Coverage Scenario: Experimental CPS                                     January 2010     February 2010              2009  ...
Coverage Scenario: Experimental CPS                                      January 2010     February 2010               2009...
Coverage Scenario: Experimental CPS                                          January 2010     February 2010               ...
Coverage Scenario: Experimental CPS                                                      2010                             ...
Coverage Scenario: Experimental CPS                                                 2010                                  ...
Coverage Scenario: Experimental CPS                                      2010                         Employer-based    Em...
Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. House...
CPS: Questionnaire Structure• Each plan type is asked about sequentially  –   Plan through current/former employer or unio...
Experimental: Questionnaire Structure• Simplified questions• Starts with yes/no question on coverage• Drills down as neede...
Experimental: Questionnaire Structure                        Any coverage now?                       If 65+, Medicare now?...
Experimental: Questionnaire Structure          General source: job, government or other?                       Government:...
Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. House...
Household-level vs. Person-level• Household-level            Person-level        Person 1                         Q1      ...
Conclusions and Next Steps• 2010 field test shows proof of concept• Census Bureau making improvements and full  test in 20...
Policy Questions• Gaps in coverage?• Churning of coverage?• Crowd-out?                          30
Joanna TurnerState Health Access Data Assistance Center University of Minnesota, Minneapolis, MN               612-624-480...
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  1. 1. Evaluating Changes to the Health InsuranceQuestions in the Current Population Survey:State ImplicationsState Health Research and Policy Interest GroupOrlando, FloridaJune 23, 2012Joanna TurnerState Health Access Data Assistance Center (SHADAC)University of Minnesota, School of Public Health Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. Acknowledgements• Thanks to the U.S. Census Bureau for their support of this work – Funded under contract #000000033114• Co-authors – Brett Fried (SHADAC) – Joanne Pascale (Census Bureau) – Kathleen Call (SHADAC) – Michel Boudreaux (SHADAC) 2
  3. 3. Outline• Background and implications for state policy research• Overview of the Census Bureau field test• Experimental health insurance coverage questions• Next steps 3
  4. 4. Current Population Survey Annual Socialand 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. 5. Policy Questions• Gaps in coverage?• Churning of coverage?• Crowd-out? 5
  6. 6. Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. Household-level designSource: Joanne Pascale (AAPOR, 2012) 6
  7. 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. 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. 9. Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. Household-level designSource: Joanne Pascale (AAPOR, 2012) 9
  10. 10. CPS: Calendar year look-back 2009 Today: March 2010 January February March April May June July August September October November December 10
  11. 11. Experimental: Retrospective HealthInsurance Questions Covered Now Yes Before or after Before Continuous (March 2010)? January 1, 2009? until now? After No What Any coverage month did in 2009? it start? 11
  12. 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. 13. Coverage Scenario: Production CPS 2009 Today: March 2010 January February March April May June July August September October November December 13
  14. 14. Coverage Scenario: Production CPS 2009 Today: March 2010 Employer-based and Medicaid 14
  15. 15. Coverage Scenario: Experimental CPS January 2010 February 2010 2009 Today: March 2010 January February March April May June July August September October November December 15
  16. 16. Coverage Scenario: Experimental CPS January 2010 February 2010 2009 Employer- based January February March April May June July August September October November December 16
  17. 17. Coverage Scenario: Experimental CPS January 2010 February 2010 2009 Employer- based Employer- February March based April May June July August September October November December 17
  18. 18. Coverage Scenario: Experimental CPS January 2010 February 2010 2009 Employer- based Employer-based April May June July August September October November December 18
  19. 19. Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer- Employer-based based April May June July August September Employer-based 19
  20. 20. Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer- Employer-based based April May June Medicaid Employer-based 20
  21. 21. Coverage Scenario: Experimental CPS 2010 Employer-based Employer-based 2009 Employer- Employer-based based Uninsured Medicaid Employer-based 21
  22. 22. Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. Household-level designSource: Joanne Pascale (AAPOR, 2012) 22
  23. 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. 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. 25. Experimental: Questionnaire Structure Any coverage now? If 65+, Medicare now? No YesMedicaid, Medicaid Assistance, CHIP? General source: job,Medicare? government or other?State specific plan name?Verification of uninsured 25
  26. 26. Experimental: Questionnaire Structure General source: job, government or other? Government: Job with government? Government type? Other:Job: Parent/spouse?Military related? Medicare Medicaid, Medical Direct…TRICARE,VA, Etc. purchase? Assistance, CHIP Military or VA Other? Other 26
  27. 27. Problematic CPS Questionnaire Features1. Calendar year reference period2. Questionnaire structure = “laundry list”3. Household-level designSource: Joanne Pascale (AAPOR, 2012) 27
  28. 28. Household-level vs. Person-level• Household-level Person-level Person 1 Q1 Person 2 Q2 . . Q1 . Person 1 . . . Person N QN Person 1 Q1 Person 2 Q2 . Person 2 . Q2 . . . . Person N QN 28
  29. 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. 30. Policy Questions• Gaps in coverage?• Churning of coverage?• Crowd-out? 30
  31. 31. Joanna TurnerState Health Access Data Assistance Center University of Minnesota, Minneapolis, MN 612-624-4802 turn0053@umn.edu Sign up to receive our newsletter and updates at www.shadac.org @shadac
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