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WHAT INFORMATION IS NEEDED? 11 Unemployment Compensation Unemployment benefits may emerge as an important safety net program for people who previously relied on social welfare program benefits (e.g., people who lose their jobs and are not eligible for TANF because they have already received benefits for the maximum allowed period or do not meet other eligibility requirements). Household surveys have regularly collected information on receipt of unemployment insurance benefits, but additional information will be needed with which to simulate eligibility for such benefits, including a person's work activity in the year prior to the survey and characteristics of the employer. Medicaid Evaluations of the Medicaid program in an era of devolution will require more information from household surveys than has been collected. Accurate data will be needed on eligibility criteria, the type of plan for Medicaid participants (some plans may be available to nonparticipants), and plan provisions that affect costs to the recipient (e.g., copayment requirements). Currently, states are experimenting with all of these features of Medicaid, but the existing surveys do not distinguish among the many payment and plan options that are offered by state Medicaid programs. More generally, existing surveys do not provide information about the health care system in the United States, which is characterized by rapidly changing relationships between patients, providers, and insurance companies. The March CPS and SIPP have only very general questions about health insurance coverage. The NHIS asks more detailed questions about insurance plans using such traditional categories as fee-for-service, HMO, PPO, and IPA, but these categories no longer adequately describe how insurance risk is shared between provider and health plan, the degree of enrollee choice between and within plans, and other important features of health care systems. Obtaining detailed information about insurance coverage and payment plans will likely require obtaining responses from patients, providers, insurers, and employers. Such linkages are now carried out in MEPS, which draws its sample from NHIS, but MEPS has a relatively small sample size. OUTCOME MEASURES IN SURVEYS The need to develop a more comprehensive set of outcome and activity measures to evaluate the impact of recent changes to health and social welfare programs emerged as a common theme throughout the workshop. Not only is eligibility now linked to certain activities (e.g., work), but programs have much broader objectives than in the past. For instance, PRWORA specifically encourages states to reduce non-marital teenage pregnancies. Thus, in addition to standard indicators of income, poverty, and labor force attachment, a number of other outcome measures may be desired from national household surveys, such as measures of teenage out-of- wedlock births, detailed labor force participation and work activities, food and shelter insecurity, overall consumption levels, and mental and physical health status.9 Several workshop participants noted that existing surveys include many outcome measures, but others will need to be developed, particularly measures that indicate changes in the well-being of 9 Some measures may need to be obtained by analyzing other household surveys than the four discussed in this report. For example, the Consumer Expenditure Survey provides detailed measures of household consumption, although it currently has a small sample size (5,000 consumer units) that limits analysis for population groups and geographic areas.
