Databases for Estimating Health Insurance Coverage for Children A Workshop Summary (2010) / Chapter Skim
Currently Skimming:
8 Monitoring Children's Health Insurance Coverage Under CHIPRA Using Federal Surveys--Genevieve Kenney and Victoria Lynch
8 Monitoring Children's Health Insurance Coverage Under CHIPRA Using Federal Surveys--Genevieve Kenney and Victoria Lynch
Pages 65-82
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 65... ...
This paper assesses possible data sources for monitoring the impacts of CHIPRA on children's health insurance coverage. The following section provides background on CHIP, CHIPRA, and other recent federal policy changes that also have important implications for Medicaid and CHIP coverage for children and their parents.
|
From page 66... ...
. Importantly, gains in health insurance coverage appear to have translated into improve ments in access to care and increased preventive care receipt among children (Davidoff et al., 2005; Kenney and Change, 2004; Kenney and yee, 2007)
|
From page 67... ...
Although the questions of interest will expand to reflect the broader, comprehensive reforms adopted under PPACA relative to CHIPRA, the data issues discussed here will still be relevant for assess ing PPACA. MONITORING CHILDREN'S COVERAGE UNDER CHIPRA As indicated above, CHIPRA gave states new tools, incentives, and resources to expand health insurance coverage to low-income children.
|
From page 68... ...
. In order to monitor children's coverage under CHIPRA, the following types of questions regarding children's health insurance coverage and participation in Medicaid and CHIP need to be addressed: • Did uninsured rates fall among children following enactment of CHIPRA?
|
From page 69... ...
To address these questions, valid state and national survey estimates of insurance coverage are needed for the period prior to CHIPRA (to establish a baseline) and for several years following the implementation of CHIPRA-related policies but before the major provisions of PPACA are enacted.
|
From page 70... ...
Census Bureau American FactFinder Table B27001. Health Insurance Coverage Status by Age for the Civilian Noninstitutionalized Population.
|
From page 71... ...
is 2007, and those show a range from 3.7 million in the NHIS to 7.9 million in the MEPS (Cohen et al., 2007) .5 Not only is there disagreement about how many children lack health insurance coverage at a particular point in time nationally, but state-level estimates vary across surveys as well (Blewett and Davern, 2006; Call et al., 2007)
|
From page 72... ...
, which may help define relevant concepts and help respondent recall coverage details; • asking about periods without coverage and when the child last had coverage (for use in estimating full-year uninsurance) and why it stopped (potentially helping the respondent to recall more details required to determine the child's true coverage status)
|
From page 73... ...
There is an early release that enables some important coverage evaluations before the survey is fully prepared; however, it is still about 9 months after the interviews are completed, it does not include published estimates for children aged 0-18 separately, and it does not provide valid estimates by income. Current Population Survey The CPS has historically played an important role in monitoring coverage.
|
From page 74... ...
; • a question on directly purchased coverage that emphasizes that it is not related to a current or former employer; • asking for detailed information about coverage, including who is the policy holder, who is covered by the same policy, who is covered by someone outside the household, and employer contributions; • asking several times about any other type of coverage not yet talked about; • verifying the absence of insurance coverage; • logical coverage edits performed by the Census Bureau to correct some likely reporting errors; • asking about citizenship, place of birth, family relationship, sup ports from people outside the household, firm size, as well as income and employment-related factors, which are some of the important variables needed to simulate eligibility in Medicaid and CHIP; • asking about health status; • has been in production for many years and with attention to main taining a credible time series; and • the release of estimates and public-use files with state identifiers 5 to 6 months after the data are collected. The most critical limitation of using the CPS to monitor coverage is the known measurement error with the coverage questions because of confusion, recall bias, and other issues with the retrospective reference period (Pascale, Roemer, and Resnick, 2009)
|
From page 75... ...
American Community Survey The ACS, an annual survey designed to provide intercensal estimates of the information contained on the decennial census long form, added information on health insurance coverage in 2008. Although the ACS is still too new of a resource for studying trends in children's health insurance coverage, it has a number of important strengths relative to the other surveys: • The most important strengths of the ACS are its very large sample and its sample frame (which samples every county and census tract in the country)
|
From page 76... ...
In particular, family relationship information is not directly available for analysis, making it much more difficult to identify health insurance units for eligibility simulations; there is no information on the child's general health status or the parents' firm size. And while the ACS sample is very large and its published estimates cover a variety of important geographic areas, the sample released for public-use data is smaller and excludes many geo graphic identifiers (e.g., congressional districts)
|
From page 77... ...
; include more definitions of coverage types in the booklet of directions for mail respondents/interviewers and refer to their availability in the introduction to the health insur ance question; add questions on firm size and general health status, verification of uninsurance, any government assistance paying for health insurance premiums (primarily for use in recoding coverage) , and health insurance plan name (also pri marily for use in recoding coverage)
|
From page 78... ...
Assess how Massachusetts sample children with sub sidized and unsubsidized coverage through the Health Connec tor are being reported and use findings to refine data collection strategies aimed at identifying children who end up obtaining coverage through health insurance exchanges under reform. Reexamine terms used to describe coverage types in mail mode and assess respondent ability to correctly classify coverage; and o CPS, NHIS, and MEPS: Examine causal mechanisms for factors identified as predictors of Medicaid misreport.
|
From page 79... ...
to provide more information on changes in coverage; o CPS: Explicitly describe published estimates as approximately point in time or an average across the prior year; and o ACS, CPS, NHIS, and MEPS: Include estimates for the different policy-relevant definitions of "children," meaning both for chil dren aged 0-18 and 0-17. Release published estimates with an introduction that informs policy makers and other users about complexities, including the likely possibility that measuring cov erage is becoming more complex as the types and numbers of plans increase; the fact that the time frame for a person's cover age status is important because a person's health insurance status can change over time; the fact that how coverage type is defined is important because individuals may categorize their status dif ferently from technical definitions; and the fact that these com plexities are part of the reason estimates differ by survey.
|
From page 80... ...
. Estimates of health insurance coverage: Comparing state surveys with the Current Population Survey.
|
From page 81... ...
. The American Community Survey and health insurance coverage estimates: Possibilities and challenges for health policy researchers.
|
From page 82... ...
. A Preliminary Evaluation of Health Insurance Coverage in the 200 American Community Survey.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.