Joanna Turner from the State Health Access Data Assistance Center presented results from the Census Bureau's field test of revised health insurance questions. The test aimed to improve estimates of coverage by asking questions about point-in-time and duration of coverage, rather than just the calendar year. Preliminary results showed the new approach could better capture complex coverage scenarios involving gaining and losing policies. The Census Bureau will conduct a larger test in 2013 and evaluate the revised questions for potential use in surveys.

1. Results from the Survey of Health Insurance and
Program Participation
Joint Statistical Meetings
San Diego, California
July 31, 2012
Joanna Turner
State Health Access Data Assistance Center (SHADAC)
University of Minnesota, School of Public Health
Funded by a grant from the Robert Wood Johnson Foundation

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)
– Michel Boudreaux (SHADAC)
– Kathleen Call (SHADAC)
2

3. Outline
• Background
• Overview of the Census Bureau field test
• Experimental health insurance coverage
questions
• Next steps
3

4. Current Population Survey Annual Social
and 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. Policy Questions
• Gaps in coverage?
• Churning of coverage?
• Crowd-out?
5

6. Problematic CPS Questionnaire Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
6

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. 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. Problematic CPS Questionnaire Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
9

10. CPS: Calendar year look-back
2009 Today:
March 2010
January February March
April May June
July August September
October November December
10

11. Experimental: Retrospective Health
Insurance 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. 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. Coverage Scenario: Production CPS
2009 Today:
March 2010
January February March
April May June
July August September
October November December
13

14. Coverage Scenario: Production CPS
2009 Today:
March 2010
Employer-based
and
Medicaid
14

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. 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. 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. Coverage Scenario: Experimental CPS
January 2010 February 2010
2009 Employer-
based
Employer-based
April May June
July August September
October November December
18

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. Coverage Scenario: Experimental CPS
2010
Employer-based Employer-based
2009
Employer-
Employer-based based
April May June
Medicaid
Employer-based
20

21. Coverage Scenario: Experimental CPS
2010
Employer-based Employer-based
2009
Employer-
Employer-based based
Uninsured
Medicaid
Employer-based
21

22. Problematic CPS Questionnaire Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
22

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. Experimental: Questionnaire Structure
• Simplified questions
• Starts with yes/no question on coverage
• Drills down as needed to current CPS level of
detail
24

25. Experimental: Questionnaire Structure
Any coverage now?
If 65+, Medicare now?
No Yes
Medicaid, Medicaid Assistance,
CHIP? General source: job,
Medicare? government or other?
State specific plan name?
Verification of uninsured
25

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. Problematic CPS Questionnaire Features
1. Calendar year reference period
2. Questionnaire structure = “laundry list”
3. Household-level design
Source: Joanne Pascale (AAPOR, 2012)
27

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. 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. Policy Questions
• Gaps in coverage?
• Churning of coverage?
• Crowd-out?
30

31. Joanna Turner
State 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