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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
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
Outline

• Background

• Overview of the Census Bureau field test

• Experimental health insurance coverage
  questions

• Next steps
                                             3
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
Policy Questions

• Gaps in coverage?

• Churning of coverage?

• Crowd-out?




                          5
Problematic CPS Questionnaire Features

1. Calendar year reference period

2. Questionnaire structure = “laundry list”

3. Household-level design


Source: Joanne Pascale (AAPOR, 2012)


                                              6
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
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
Problematic CPS Questionnaire Features

1. Calendar year reference period

2. Questionnaire structure = “laundry list”

3. Household-level design


Source: Joanne Pascale (AAPOR, 2012)


                                              9
CPS: Calendar year look-back


              2009                     Today:
                                     March 2010
    January   February    March

     April      May        June

     July      August    September

   October    November   December




                                                  10
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
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
Coverage Scenario: Production CPS


              2009                     Today:
                                     March 2010
    January   February    March

     April      May        June

     July      August    September

   October    November   December




                                                  13
Coverage Scenario: Production CPS



           2009                  Today:
                               March 2010

       Employer-based
            and
         Medicaid




                                            14
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
Coverage Scenario: Experimental CPS

                                     January 2010     February 2010


              2009                                  Employer-
                                                     based
    January   February    March

     April      May        June

     July      August    September

   October    November   December




                                                                      16
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
Coverage Scenario: Experimental CPS

                                          January 2010     February 2010


               2009                                      Employer-
                                                          based
             Employer-based

    April        May            June

     July       August        September

   October    November        December




                                                                           18
Coverage Scenario: Experimental CPS
                                                      2010

                                         Employer-based    Employer-based

              2009
                                                          Employer-
            Employer-based                                 based

    April       May            June

    July       August        September

            Employer-based




                                                                            19
Coverage Scenario: Experimental CPS
                                                 2010

                                    Employer-based    Employer-based

              2009
                                                     Employer-
            Employer-based                            based

    April       May          June

               Medicaid

            Employer-based




                                                                       20
Coverage Scenario: Experimental CPS
                                      2010

                         Employer-based    Employer-based

          2009
                                          Employer-
        Employer-based                     based

          Uninsured

           Medicaid

        Employer-based




                                                            21
Problematic CPS Questionnaire Features

1. Calendar year reference period

2. Questionnaire structure = “laundry list”

3. Household-level design


Source: Joanne Pascale (AAPOR, 2012)


                                              22
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
Experimental: Questionnaire Structure

• Simplified questions

• Starts with yes/no question on coverage

• Drills down as needed to current CPS level of
  detail



                                                  24
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
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
Problematic CPS Questionnaire Features

1. Calendar year reference period

2. Questionnaire structure = “laundry list”

3. Household-level design


Source: Joanne Pascale (AAPOR, 2012)


                                              27
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
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
Policy Questions

• Gaps in coverage?

• Churning of coverage?

• Crowd-out?




                          30
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

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Pres jsm jul31_jturner

  • 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