• Estimates need to support disaggregation into fine subpopulations—demographic splits by race, ethnicity, age, and poverty status, along with geographic splits by county (or at least some substate areas); and
  • Access to microdata, in order to achieve this fine-grained analysis, is critical.

Call suggested that state policy makers are most interested in data on the characteristics of the uninsured—what they look like demographically and where they may be concentrated geographically. Uninsured children are of particular interest: how many children in each county are eligible for Children’s Medicaid (CHIP) or State Children’s Health Insurance Program (SCHIP) assistance? And, though questions of eligibility for Medicaid have been of interest for years, interest has certainly been heightened among states looking at the effects of the federal Patient Protection and Affordable Care Act (PPACA).2 Call noted that these kinds of analyses have been done for years and that the states have relied heavily (or exclusively) on the federal government as a source of information. However, budget pressures and constraints are particularly acute at the state level, increasing the demand for reliable information about uninsurance and public program eligibility (and the effects of policy changes on that eligibility).

For their analyses, Call noted that SHADAC can draw from a variety of federal survey data sources, including three specialized health surveys: The National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS; both conducted by the National Center for Health Statistics3 [NCHS]) and the Household Component of the Medical Expenditure Panel Survey (sponsored by NCHS and the Agency for Healthcare Research and Quality). However, the requirements listed above are such that the principal sources for analysis are the ACS and the Current Population Survey (CPS), both surveys conducted by the Census Bureau (with the CPS sponsored jointly by the Census Bureau and the Bureau of Labor Statistics).

Prior to 2008, SHADAC relied extensively on the CPS—and the CPS retains some solid advantages. Chief among these are the consistency of the CPS data: the CPS’s longer-term inclusion of relevant questions permits trends to be analyzed back to 1986, and its data releases are generally very timely. CPS control variables are such that the data are also amenable to limited disaggregation to substate levels. But there are also major drawbacks, chief among these the relatively small sample size (and corresponding sample sizes for substate pop-

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2The Patient Protection and Affordable Care Act, P.L. 111-148, was signed into law on March 23, 2010. At the time of the workshop, key provisions of the law were under review by the U.S. Supreme Court. On June 28, 2012, the Court ruled in National Federation of Independent Business v. Sebelius that the core mandates under the act were constitutional as a valid exercise of the power of Congress to impose taxes.

3The Census Bureau is the data collection agent for the National Health Interview Survey (as well as the ACS), though the survey is sponsored and organized by the National Center for Health Statistics.



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