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1. SMALL AREA HEALTH INSURANCE ESTIMATES (SAHIE)
SHADAC Webinar Featuring U.S. Census Bureau Experts
June 9, 2016, 12:00 -12:30 PM EDT
You will be connected to broadcast audio through your computer.
You can also connect via telephone:
(866)-831-1467, Conference ID 17495609
Slides and handouts at:
www.shadac.org/2016SAHIEwebinar
2. Technical Items
• For those dialing in: Phones automatically muted
• Submit questions using the chat window at any
time during the webinar
• Problems:
• Call Readytalk’s help line: (800) 843-9166
• Ask for help using the chat feature
• Download the slides at
www.shadac.org/2016SAHIEwebinar
• Webinar archive will be posted on SHADAC’s
website
• E-mail notice will be sent to participants
2
4. Small Area Health Insurance
Estimates from the Census Bureau:
2013 and 2014
David Powers and Lauren Bowers
Social, Economic, and Housing Statistics Division
United States Census Bureau
Presentation for State Health Access Data Assistance Center (SHADAC)
June 9, 2016
Disclaimer: This presentation is released to inform interested parties of ongoing research and
to encourage discussion. Any views expressed are those of the authors and not necessarily
those of the U.S. Census Bureau.
4
5. Small Area Health Insurance Estimates (SAHIE)
5
• Model-based health insurance
coverage estimates
• Only source of single-year
health insurance coverage
estimates for all U.S. counties
• Recently released estimates
• 2014 SAHIE
• Updated version of 2013 SAHIE
• Release highlights
• Incorporated new up-to-date
Medicaid source data
• Substantial 2013 to 2014 changes
in health insurance in many areas
6. • SAHIE is partially funded by the Centers for Disease
Control and Prevention’s (CDC) National Breast and
Cervical Cancer Early Detection Program (NBCCEDP)
• The CDC uses SAHIE to assess the eligible population
of low-income, uninsured women for cancer screening
and diagnostic services under the NBCCEDP
Sponsor: Centers for Disease Control and
Prevention (CDC)
6
7. SAHIE Cross Classifications
Age Sex Income Race and Ethnicity
(State only)
Under age 65
18 to 64 years
40 to 64 years
50 to 64 years
Under age 19*
Both Sexes
Male
Female
All Incomes
At or below 200% of poverty
At or below 250% of poverty
At or below 138% of poverty
At or below 400% of poverty
Between 138 and 400% of poverty
All Race and Ethnicities
White Alone, not Hispanic
Black Alone, not Hispanic
Hispanic
*For the population under age 19 estimates are not available by sex or by race and ethnicity
7
By “% of poverty,” we mean the ratio of
income to the federal poverty threshold
8. SAHIE Cross Classifications
Age Sex Income Race and Ethnicity
(State only)
Under age 65
18 to 64 years
40 to 64 years
50 to 64 years
Under age 19*
Both Sexes
Male
Female
All Incomes
At or below 200% of poverty
At or below 250% of poverty
At or below 138% of poverty
At or below 400% of poverty
Between 138 and 400% of poverty
All Race and Ethnicities
White Alone, not Hispanic
Black Alone, not Hispanic
Hispanic
*For the population under age 19 estimates are not available by sex or by race and ethnicity
Centers for
Disease Control
(CDC)
Children’s Health
Insurance Program
(CHIP)
Patient Protection and
Affordable Care Act
(ACA)
8
By “% of poverty,” we mean the ratio of
income to the federal poverty threshold
9. When to Use SAHIE?
U.S. Census Bureau Health Insurance Data Source Recommendations
Available on the web: http://www.census.gov/hhes/www/hlthins/about/index.html
9
11. SAHIE Data Sources
• American Community Survey (1-year and 5-year)
• Census 2010 (housing tenure, % rural tabulations)
• Population estimates
• County Business Patterns
• Aggregated federal 1040 tax returns
• Supplemental Nutrition Assistance Program (SNAP)
participation records
• Medicaid participation records
• Children's Health Insurance Program (CHIP)
participation records
12. Benefits from Modeling
• Estimates can be released for all counties,
regardless of population size, and for many
detailed domains
• Reduction in year-to-year volatility relative
to the survey estimates
• Improvement in precision (margins of error)
relative to the survey estimates
12
17. • American Community Survey (1-year and 5-year)
• Census 2010 (housing tenure, % rural tabulations)
• Population estimates
• County Business Patterns
SAHIE Data Sources
• Aggregated federal 1040 tax returns
• Supplemental Nutrition Assistance Program (SNAP)
participation records
• Medicaid participation records
• Children's Health Insurance Program (CHIP)
participation records
18. • Starting in late 2013, CMS began to release new timely
Medicaid/CHIP summary data
• SAHIE historically has used Medicaid/CHIP participation
data that lagged 2 years behind the estimate year
• e.g., 2012 SAHIE used 2010 Medicaid and CHIP data
• Opportunity for SAHIE to improve source data timeliness
and to protect against uncertain delays in future delivery
• Using more up-to-date Medicaid/CHIP data may be
especially important during 2013-2014 as many states
expanded Medicaid eligibility under the ACA
New Medicaid Data (1)
18
19. • SAHIE production now incorporates the new CMS
Medicaid/CHIP summary data together with the
previous (detailed but lagged) Medicaid/CHIP data
• The resulting SAHIE, which uses the combined new
Medicaid/CHIP data, show improved consistency
with ACS 1-year estimates of the uninsured for
people aged 0-18 in smaller counties
New Medicaid Data (2)
19
For more information on SAHIE’s use of updated Medicaid
enrollment data, please visit
http://www.census.gov/did/www/sahie/methods/inputs/medicaid.html
20. 2013-2014 Changes in Uninsured Rates
• Decreases in uninsured rates
occurred in 74.1 percent of
U.S. counties for the
population under age 65
• Were largely driven by the
decreases for the working-age
adult (aged 18-64) population
• Were more prominent in
states that expanded their
Medicaid eligibility criteria
SAHIE Highlights and figures are available
at: http://www.census.gov/did/www/sahie/
data/highlights/2014.html
20
21. U.S. Department of Commerce Economic and Statistics Administration U.S. CENSUS BUREAU
Health Insurance Coverage Estimates
MODEL-BASED ESTIMATES
2013 Uninsured Rate
Population Under Age 65
Source: U.S. Census Bureau,
2013 Small Area Health Insurance
Estimates (SAHIE)
The data provided are indirect estimates
produced by statistical model-based
methods using sample survey, decennial
census, and administrative data sources.
The estimates contain error stemming from
model error, sampling error, and
nonsampling error.
The data provided are indirect estimates
produced by statistical model-based
methods using sample survey, decennial
census, and administrative data sources.
The estimates contain error stemming from
model error, sampling error, and
nonsampling error.
MODEL-BASED ESTIMATES
MODEL-BASED ESTIMATES
Percent Uninsured
by County
in 2014
25.1 and Above
20.1 to 25.0
15.1 to 20.0
10.1 to 15.0
10.0 and Below
State
Percent Uninsured: 2013 and 2014
2014 Uninsured Rate
Population Under Age 65
Percent Uninsured
by County
in 2013
25.1 and Above
20.1 to 25.0
15.1 to 20.0
10.1 to 15.0
10.0 and Below
State
Source: U.S. Census Bureau,
2014 Small Area Health Insurance
Estimates (SAHIE)
21
28. • Press Release
• Census Bureau’s API
• Research Matters blog
2014 Release Products
28
29. • Press Release
• Census Bureau’s API
• Research Matters blog
• Conference papers
2014 Release Products
29
30. • Press Release
• Census Bureau’s API
• Research Matters blog
• Conference papers
• SAHIE website:
‒ Data for download
o .CSV, .TXT files
‒ Interactive tool
2014 Release Products
30
31. • Press Release
• Census Bureau’s API
• Research Matters blog
• Conference papers
• SAHIE website:
‒ Data for download
o .CSV, .TXT files
‒ Interactive tool
‒ Updated 2013 SAHIE and comparison tab of original vs.
new
2014 Release Products
31
32. • Press Release
• Census Bureau’s API
• Research Matters blog
• Conference papers
• SAHIE website:
‒ Data for download
o .CSV, .TXT files
‒ Interactive tool
‒ Updated 2013 SAHIE and comparison tab of original vs. new
‒ Highlights document
2014 Release Products
32
33. • Press Release
• Census Bureau’s API
• Research Matters blog
• Conference papers
• SAHIE website:
‒ Data for download
o .CSV, .TXT files
‒ Interactive tool
‒ Updated 2013 SAHIE and comparison tab of original vs. new
‒ Highlights document
‒ Heat map for 2005 through 2014
2014 Release Products
33
35. SAHIE Website: http://www.census.gov/did/www/sahie/index.html
Data for download:
Data interactive tool (table , maps , and trend tools)
http://www.census.gov/did/www/sahie/data/interactive/sahie.html
CSV and text files
http://www.census.gov/did/www/sahie/data/20082014/index.html
Census Bureau’s API
http://www.census.gov/data/developers/data-sets/Health-Insurance-Statistics.html
Reports and Graphics:
Press Release
http://www.census.gov/newsroom/press-releases/2016/cb16-86.html
2014 SAHIE Release Highlights
http://www.census.gov/did/www/sahie/data/2014/2014highlights.pdf
2014 SAHIE Maps
http://www.census.gov/did/www/sahie/data/highlights/2014highlights.html
Heat Map
http://www.census.gov/did/www/sahie/data/visualization/healthins/index.html?reload
Conference papers:
Medicaid and CHIP Data Methodology for SAHIE Models - David Powers, Lauren Bowers, Wesley Basel, and Samuel Szelepka
http://www.census.gov/content/dam/Census/library/working-papers/2016/demo/powers-bowers-basel-szelepka-fcsm.pdf
Evaluating 2012-2014 Trends in Health Insurance Coverage for All U.S. Counties - Lauren Bowers, Wes Basel, and David Powers
http://www.census.gov/content/dam/Census/library/working-papers/2016/demo/SEHSD-WP2016-16.pdf
Blogs:
More Timely Medicaid Data Helps Improve Small Area Health Insurance Estimates
http://researchmatters.blogs.census.gov/2016/05/12/more-timely-medicaid-data-helps-improve-small-area-health-insurance-estimates/
Evaluating 2013-2014 Trends in County-Level Health Insurance Coverage for Low-Income Working-Age Adults
http://researchmatters.blogs.census.gov/2016/04/02/evaluating-2013-2014-tr, ends-in-county-level-health-insurance-coverage-for-low-income-
working-age-adults/
Reference Page
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