lations. This empirical application estimated participation rates using administrative data from NBCCEDP (the numerator) and uninsured low-income women ages 40-64 at the state and county levels (the denominator) (O’Hara, Tangka, and Bauder, in review).

The SAHIE program is currently exploring how to take best advantage of the American Community Survey (ACS) data. Full production of the ACS in 2006 allowed it to replace the decennial census sample data (i.e., the long form). Beginning in 2008, the ACS included a health insurance question. As a result, there are annual ACS health insurance estimates for all geographic areas with a population of 65,000 or more (U.S. Census Bureau, 2009). The ACS contains approximately 30 times the number of addresses as a single-year CPS ASEC. Direct survey estimates, based on a 5-year accumulation from the ACS, for geographic areas with population of 20,000 or less will not be available until 2013.

This paper assesses an ACS-based SAHIE model in two ways. First, we compare the variances of state estimates of a CPS-based SAHIE model and an ACS-based SAHIE model. Second, the model is modified to obtain ACS model-based estimates for more income categories. The gains from model-based state estimates increase as the number of domains increases (e.g., the income categories). As yet, county-level estimates have not been explored. These potential changes to the model, based on the strengths of the ACS, are intended to create more useful or refined estimates of the uninsured populations for policy makers and other stakeholders.

BACKGROUND

Uninsured children are likely to use emergency room visits as a form of “free” primary care and to put off any use of medical services until a need must be met (Grumbach, Keane, and Bindman, 1993). Even when an uninsured child uses other care, access to and utilization of the care are lower than that of children with health insurance coverage (Newacheck, Hughes, and Stoddard, 1996). Children without health insurance coverage are more likely to have unmet medical needs that affect long-term health status compared with insured children (Newacheck et al., 2000). Being uninsured increases the risk of having high out-of-pocket expenses for medical services. As a result, families with uninsured children are more likely to become impoverished when the child has a health event (O’Hara, 2004).

The first nationwide means-tested health insurance program was the Medicaid program. Created in 1965, Medicaid provides full and comprehensive health insurance coverage (as well as partial benefits). The target populations are poor and near-poor children, the disabled, and the elderly (Centers for Medicare & Medicaid Services, 2010). In 1997, a new means-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement