Databases for Estimating HEALTH INSURANCE COVERAGE FOR CHILDREN
A Workshop Summary
Thomas J. Plewes, Rapporteur
NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the Steering Committee for the workshop were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. HHSP23320042509XI between the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, and the National Academy of Sciences. Support of the work of the Committee on National Statistics is provided by a consortium of federal agencies through a grant from the National Science Foundation (No. SES-0453930). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Suggested citation: National Research Council. (2010). Databases for Estimating Health Insurance Coverage for Children: A Workshop Summary. Thomas J. Plewes, Rapporteur. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.
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STEERING COMMITTEE FOR A WORKSHOP ON EVALUATING DATABASES FOR USE IN THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ALLOCATION FORMULA
V. JOSEPH HOTZ (Chair),
Department of Economics, Duke University
LYNN A. BLEWETT,
School of Public Health, University of Minnesota, and State Health Access Data Assistance Center
National Opinion Research Center and University of Chicago
LISA C. DUBAY,
Bloomberg School of Public Health, Johns Hopkins University
Colorado Department of Health Care Policy and Financing, Denver
CHRIS L. PETERSON,
Medicaid and CHIP Payment and Access Commission, Washington, DC
ERIC V. SLUD,
Department of Mathematics, University of Maryland
THOMAS J. PLEWES, Study Director
ANTHONY S. MANN, Program Associate
COMMITTEE ON NATIONAL STATISTICS 2010
LAWRENCE D. BROWN (Chair),
Department of Statistics, The Wharton School, University of Pennsylvania
JOHN M. ABOWD,
School of Industrial and Labor Relations, Cornell University
Department of Statistics, Iowa State University
Oracle, Phase Forward, Waltham, Massachusetts
V. JOSEPH HOTZ,
Department of Economics, Duke University
Department of Sociology, University of California, Berkeley
Department of Statistics, Indiana University
SALLIE KELLER, Director,
Science and Technology Policy Institute, Washington, DC
The Heller School for Social Policy and Management, Brandeis University
SALLY C. MORTON,
Department of Biostatistics, University of Pittsburgh
Division of Health Policy Research and Education, Harvard University
SAMUEL H. PRESTON,
Population Studies Center, University of Pennsylvania
Department of Statistics, University of California, Irvine
Joint Program in Survey Methodology, University of Maryland, and Survey Research Center, University of Michigan
Department of Health Care Policy, Harvard Medical School
CONSTANCE F. CITRO, Director
This report summarizes the proceedings of a workshop convened in June 2010 to critically examine the various databases that could provide national and state-level estimates of low-income uninsured children and could be effectively used as criteria for monitoring children’s health insurance coverage. The workshop was sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services, and convened by the Committee on National Statistics (CNSTAT), Division of Behavioral and Social Sciences and Education (DBASSE) of the National Research Council (NRC).
The workshop was organized by a steering committee composed of experts in administering and assessing the Children’s Health Insurance Program (CHIP) at the national and state levels, as well as experts in survey methodology and modeling. The committee provided invaluable guidance in developing the workshop, securing expert presentations, and facilitating the conduct of the workshop. Although the steering committee played a central role in designing and conducting the workshop, the members did not actively participate in writing this workshop summary.
The staff of ASPE and of the U.S. Census Bureau played an important role in preparing for and conducting the workshop. The work of Don Oellerich of ASPE and David Johnson of the Census Bureau in this preparation phase is especially recognized, as are the important information and comments they provided that enhanced the value of the event. As the person responsible for supervising the grant that supported this activity, Oellerich also served as the primary point of coordination between the steering committee and the Department of Health and Human Services.
The presentations in the workshop were designed to shed light on various aspects of the issues involved in evaluating the adequacy and appropriateness of databases for estimating health insurance coverage for children. The task of describing the overall context for the consideration of these issues fell to Chris Peterson of the Medicaid and CHIP Payment and Access Commission, a member of the steering committee. He discussed the evolution of the CHIP legislation and the more recent change in emphasis from use of coverage estimates for allocating funds to states to the purpose of assessing progress and performance overall that came with the reauthorization of CHIP in 2009. He described how the new health care reform legislation, known as the Patient Protection and Affordable Care Act, sets a new standard for the coverage data. Michael Davern, also a member of the steering committee, discussed the background of the major surveys that have been used to measure the health insurance coverage of children.
The first panel discussion focused on the use of administrative data for estimating the coverage of health insurance for children. David Baugh, who has responsibility for the Medicaid and CHIP databases at the Centers for Medicare & Medicaid Services (CMS), discussed the status of the major administrative data collections and a summary of recent programs to improve those key databases. A user’s perspective on the quality of the administrative data on CHIP was provided by David Rousseau of the Kaiser Family Foundation. Richard Strauss, of CMS, discussed the quality of the administrative and survey data used for programmatic purposes, including the allocation of funds to states, which was a major use of the data prior to the passage of the CHIP reauthorization in 2009.
In the second panel, Sharon Long of the Urban Institute, John McInerney of the Commonwealth Institute, and Lynn Blewett of the University of Minnesota (also a member of the steering committee) discussed the important state uses of administrative and survey data for state purposes, such as program management and evaluation. The third panel focused on modeling strategies for improving estimates, with presentations by Mark Bauder and Brett O’Hara summarizing the Census Bureau’s Small Area Health Insurance Estimation program and William Bell discussing the Census Bureau’s Small Area Income and Poverty Estimation model. Nathaniel Schenker of the National Center for Health Statistics discussed joint modeling of survey and administrative record data, using health-related data collections.
On the second day, workshop participants heard from John Czajka of Mathematica Policy Research, Inc., who discussed measuring income; Joanna Turner of the University of Minnesota, who discussed measuring health insurance coverage; and Genevieve Kenney and Victoria Lynch of the Urban Institute, who gave an overview of survey characteristics that
would commend or limit their use in estimating coverage of health insurance for children. Finally, we heard from Cindy Mann, director of Medic-aid and state operations at CMS, who put the work of the committee into an overall perspective and provided the workshop with a provocative wish list of data needs from the viewpoint of the administrator of CHIP. These presentations were uniformly well prepared, well presented, and provocative.
In the course of the workshop, several important issues were raised on the scope and content of the surveys and administrative databases, which are ancillary to coverage issues. Those topics included the need to collect data on the health and other socioeconomic characteristics of children by insurance status, and the benefits available to children within their insurance coverage (e.g., dental and mental health coverage), special therapies, and the like. In view of the concentrated focus of the workshop on means of estimating coverage, these issues were not explored in any depth. However, these important issues of scope and content should be considered in any future review of these data sources.
The steering committee also acknowledges the excellent work of the staff members of CNSTAT and the NRC for their support in developing and organizing the workshop and preparing this report. This report was prepared under the direction of Constance Citro, director of CNSTAT. Tom Plewes served as study director as well as rapporteur for the workshop. The steering committee was ably assisted in all administrative arrangements by Anthony Mann, also on the CNSTAT staff. Anthony played a major role in preparation of this workshop summary.
This workshop summary was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical comments that assist the institution in making its report as sound as possible, and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
The panel thanks the following individuals for their review of this report: Martha Heberlein, Georgetown Center for Children and Families; Leighton Ku, Center for Health Policy Research, School of Public Health and Health Services, The George Washington University; and Paul W. Newacheck, Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco.
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the con-
clusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Lisa Lynch, The Heller School for Social Policy and Management, Brandeis University. Appointed by the NRC, she was responsible for making certain that the independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author and the NRC.
V. Joseph Hotz, Chair
Steering Committee for a Workshop on Evaluating Databases for Use in the Children’s Health Insurance Program (CHIP) Allocation Formula
Monitoring Children’s Health Insurance Coverage Under CHIPRA Using Federal Surveys
Health Insurance Coverage in the American Community Survey: A Comparison to Two Other Federal Surveys
Using Uninsured Data to Track State CHIP Programs
Small-Domain Estimation of Health Insurance Coverage