. "13 Small-Domain Estimation of Health Insurance Coverage--Brett O'Hara and Mark Bauder." Databases for Estimating Health Insurance Coverage for Children: A Workshop Summary. Washington, DC: The National Academies Press, 2010.
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Databases for Estimating Health Insurance Coverage for Children: A Workshop Summary
sample sizes. The SAHIE team established that it was feasible to produce estimates for all counties by using a methodology similar to SAIPE.
In 2007, the SAHIE program published state estimates of the prevalence of uninsured low-income women by age, race, and Hispanic origin. Low income is defined in terms of family income divided by the poverty threshold. The subpopulations of interest were determined by a sponsor of the SAHIE program, the Centers for Disease Control and Prevention’s (CDC’s) National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Its funding of the SAHIE program made it possible to produce estimates of income-eligible women by age group (18-64, 40-64, and 50-64). Income eligibility for this benefit varies by state. Most state programs chose income eligibility at 0-200 or 0-250 percent of the poverty threshold. From these estimates, the SAHIE team evaluated whether the state model could meet the CDC requirements. State and county estimates of health insurance coverage were published in 2008 that met the requirements. The SAHIE model was later modified so that it had the functionality to support many more income categories and more age categories. However, the 3-year average of the CPS ASEC health insurance coverage data could not support model-based estimates of more income categories or additional age groups (Small Area Health Insurance Estimates Team, 2008).
Currently, the SAHIE program publishes state health insurance coverage estimates by age, sex, race, Hispanic origin (i.e., demographic characteristics), and by income categories (both 0-200 percent and 0-250 percent of the poverty threshold and the total poverty universe). For counties, SAHIE produces estimates by age, sex, and income categories (either 0-200 percent or 0-250 percent of the poverty threshold and the total poverty universe). Estimates from this model were released in 2009 with no significant changes from the year before. Before 2009, all of the SAHIE estimates were labeled “experimental.” For 2009, the SAHIE program had evolved to use a production model and production health insurance coverage estimates.
One of the SAHIE program goals is to accelerate its production process to publish estimates in a timelier manner. Currently, the modeled estimates are released in the summer, based on the most current 3 years of the CPS ASEC. The program goal is to release estimates based on current data in the early winter.
Evaluation of various model forms to produce SAHIE estimates is ongoing. The model-based estimates had smaller confidence intervals than the survey-only estimates for uninsured low-income children under age 18. In addition, the two estimates for a given state were close (O’Hara, 2008). The SAHIE numbers can also be used as a low-variance denominator for participation (or nonparticipation) rates for the uninsured popu-