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2014 HEALTH INSURANCE COVERAGE ESTIMATES SHADAC Webinar Featuring U.S. Census Bureau Experts September 22, 2015, 2:00 PM EDT You will be connected to broadcast audio through your computer. You can also connect via telephone: (866)-831-1467, Conference ID 33756928 Slides and handouts at: www.shadac.org/2015DataReleaseWebinar
Technical Items
• For those dialing in: Phones automatically muted • Submit questions using the chat window at any
time during the webinar • Problems:
• Call Readytalk’s help line: (800) 843-9166 • Ask for help using the chat feature
• Download the slides at www.shadac.org/2015DataReleaseWebinar
• Webinar archive will be posted on SHADAC’s website • E-mail notice will be sent to participants
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Presenters
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Jennifer Cheeseman Day U.S. Census Bureau
Kathleen Call SHADAC
Joanna Turner SHADAC
Marina Vornovitsky U.S. Census Bureau
CPS and ACS
Current Population Survey (CPS) • 2014 estimates released September 16, 2015
American Community Survey (ACS) • 2014 estimates released September 17, 2015
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Design Differences
CPS ACS Method Survey of civilian non-
institutionalized population
Survey of U.S. population (including group quarters)
Annual housing units interviewed
About 76,000 About 2.3 million
Geography Nation, states Nation, states, sub-state
Mode Phone and in-person Mail, phone, in-person, and internet
Uninsurance: Measure
Uninsured all year Point-in-time
Point-in-time
Uninsurance: Years available
1987 to 2014 February - April 2015
2008 to 2014
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Re-designed in CPS ASEC 2014
Guidance on When to Use Each Source
CPS ACS Trends
1987 to 2012 2013 forward
2008 forward
State estimates
Sub-state estimates N/A 1-yr for pop > 65,000 5-yr for all geographic areas including: All counties Zip-code tabulation areas
Small sub-populations N/A
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CPS AND ACS ESTIMATES
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Changes in the rate of health insurance coverage reflect:
• Economic trends
• Demographic shifts
• Policy changes, such as the Affordable Care Act (ACA)
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Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements, and 2008 to 2014 1-Year American Community Surveys.
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Percentage of People by Type of Health Insurance Coverage: 2014
*Military health care includes TRICARE and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) as well as care provided by the Department of Veterans Affairs and the military. Source: U.S. Census Bureau, Current Population Survey, 2015 Annual Social and Economic Supplement. 10
Change in Percentage of People by Type of Health Insurance Coverage: 2013 to 2014
Note: Between 2013 and 2014, there was not a statistically significant change in the percentage of people covered by employment-based health insurance or military health care. *Military health care includes TRICARE and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) as well as care provided by the Department of Veterans Affairs and the military. Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements.
Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Uninsured Rate by Single Year of Age: 2013 and 2014
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Uninsured Rate by Work Experience, Ages 18 to 64 Years: 2013 and 2014
Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements. 18
Uninsured Rate by Household Income: 2013 and 2014
Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements. 19
Uninsured Rate by Race and Hispanic Origin: 2013 and 2014
20 Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements.
Uninsured Rate by Nativity: 2013 and 2014
21 Source: U.S. Census Bureau, Current Population Survey, 2014 and 2015 Annual Social and Economic Supplements.
Source: U.S. Census Bureau, 2014 1-Year American Community Survey.
Uninsured Rate by State: 2014
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Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys.
Decrease in Uninsured Rate by State: 2013 to 2014
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*Medicaid expansion status as of January 1, 2014. Source: U.S. Census Bureau, 2014 1-Year American Community Survey.
Uninsured Rate by State and Medicaid Expansion Status: 2014
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*Medicaid expansion status as of January 1, 2014. Source: U.S. Census Bureau, 2014 1-Year American Community Survey.
Decrease in Uninsured Rate by State and Medicaid Expansion Status: 2013 to 2014
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Uninsured Rate by Poverty Status and Medicaid Expansion of State for
Adults Aged 19 to 64 Years: 2013 and 2014
*Medicaid expansion status as of January 1, 2014. Source: U.S. Census Bureau, 2013 and 2014 1-Year American Community Surveys. 26
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0
2
4
6
8
10
12
14
16
18
20
2008 2009 2010 2011 2012 2013 2014
Men
Women
Difference
Figure 1. Uninsured Rates for Men and Women: 2008 to 2014
Source: U.S. Census Bureau, American Community Survey 2008 to 2014
Men Lag Behind Women in Health Insurance Coverage (Blog)
-5
0
5
10
15
20
25
30
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75Age
Figure 2. Uninsured Rates for Men and Women by Single Year of Age: 2014
Men
Women
Difference (men's rate - women's rate)
+
Source: U.S. Census Bureau, American Community Survey 2014
0
20
40
60
80
100
19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64
Percent
Age
Men with private insurance
Women with private insurance
Men with government coverage
Women with government coverage
Figure 3. Private and Government Health Insurance Coverage for Men and Women of Working Age: 2014
Source: U.S. Census Bureau, American Community Survey 2014
0
5
10
15
20
19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64
0
5
10
15
20
19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64
0
5
10
15
20
19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64
Age
Men Women
Figure 4. Type of Government Health Insurance Coverage for Men and Women of Working Age: 2014
VA Care
Men
Women
Medicaid
Men Women
Medicare
Percent
Source: U.S. Census Bureau, American Community Survey 2014
Accessing estimates
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Updated health insurance page http://www.census.gov/hhes/www/hlthins/index.html
CPS:
ACS: American FactFinder (AFF) summary tables
• http://factfinder2.census.gov
Limited set of state estimates available in the annual report
ACS Public Use Data Release: 2014 Estimates Public use Microdata Sample (PUMS) available October 27
• 1% public use microdata sample (1% of population)
• The smallest identifiable geographic unit is the Public Use Microdata Area (PUMA,) containing at least 100,000 persons • PUMAs are generally groups of counties or parts of
counties, but there are exceptions • PUMAs do not cross state boundaries
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Upcoming ACS Data Releases: 5-Year
2010-2014 5-year estimates for all geographic areas
• American FactFinder release: December 10 • PUMS: January 21
The 3-year ACS data products are discontinued; there will not be estimates for 2012-2014
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RE-DESIGNED CPS Implemented for the 2013 estimates
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Question Changes: Health Insurance Coverage Complete redesign of question series – based on over a decade of research Improved measure of all year coverage Added point-in-time measure (February – April) New questions to measure:
• Exchange participation, • Receipt of subsidies, • Employer offered health insurance coverage
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Question Changes: Income Separation of ‘source’ and ‘amount’ questions – dual pass approach Tailored skip patterns More detailed interest, dividends, and retirement questions Income range follow-up for “don’t know” or “refused” income amounts
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Health Insurance Coverage in the United States: 2013 (released last year) Income Items Health Insurance Items Source: U.S. Census Bureau, August 2015, Technical Meeting on Release of Income, Poverty, & Health Insurance
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Traditional income questions
Re-designed health insurance questions
Re-designed income questions
68,000 addresses
30,000 addresses
98,000 addresses
Health Insurance Coverage in the United States: 2014 2013 2014 Source: U.S. Census Bureau, August 2015 Technical Meeting on Release of Income, Poverty, & Health Insurance
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Traditional income questions (68,000 addresses)
Re-designed health insurance questions (98,000 addresses)
Re-designed income questions (30,000 addresses)
Re-designed health insurance questions (98,000 addresses)
Health Insurance Coverage in the United States: 2014 (crossed by income/poverty)
2013 2014 Source: U.S. Census Bureau, August 2015 Technical Meeting on Release of Income, Poverty, & Health Insurance
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Traditional income questions
Re-designed health insurance questions
Re-designed income questions (30,000 addresses)
Re-designed health insurance questions (98,000 addresses)
Comparing 2013 with 2014 estimates
In August 2015, Census Bureau released • Full set of detailed income and poverty tables
from the re-designed sample (30,000 addresses) • Select 2013 health insurance coverage tables
from the full sample 2013 2014
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Traditional income questions (68,000 addresses)
Re-designed health insurance questions (98,000 addresses)
Re-designed income questions (30,000 addresses)
Re-designed health insurance questions (98,000 addresses)
2013 Estimates: Summary
Income and Poverty comparisons: 2013 and earlier years comparisons: Use traditional income (68,000 addresses sample for 2013)
2013 and 2014 comparisons: Use re-designed income (30,000 addresses sample for 2013, full file in 2014)
Health Insurance Coverage comparisons: 2013 and 2014 comparisons: Use Full File (98,000 addresses sample for 2013 and 2014) (except when crossed by income or poverty – limited to 30,000 addresses in 2013)
All 3 files available from CPS Table Creator • http://www.census.gov/cps/data/cpstablecreator.html
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“Bridging” the 2013 income estimates
Census Bureau used statistical techniques to develop a “bridge” between the traditional and redesigned income questions in 2013
• This creates a full 2013 file with redesigned income
• Comparisons available in the appendices in the report Income and Poverty in the United States: 2014
Public use income consistent research file:
• http://www.census.gov/housing/extract_files/toc/data/
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Health Insurance Coverage: New Content Point-in-time estimates available (Feb-Apr 2015)
• Comparison with National Health Interview Survey (NHIS) • http://www.cdc.gov/nchs/data/nhis/health_insurance/NC
HS_CPS_Comparison092015.pdf
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Health Insurance Coverage: New Content Point-in-time estimates: Research File
• http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2013/current-coverage.html
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ITEM NAME POSITION TYPE LENGTH H_SEQ 1 Char 5 Household Seq Number PPPOSOLD 6 Char 2 Person seq within HH NOW_ANYCOV 8 Char 1 Recode: Did person have any type of health insurance coverage at the time of the interview? 1 = covered/insured 2 = not covered/uninsured Recode is based on the following variables: if NOW_COV_HI = 1 or NOW_MCARE = 1 or NOW_MCAID = 1 or NOW_CHAMP = 1 then assign 1 else assign 2 Where NOW_COV_HI indicates current private health insurance NOW_MCARE indicates current Medicare coverage NOW_MCAID indicates current Medicaid, CHIP, or other government coverage NOW_CHAMP indicates current military coverage, TRICARE, VA Care, CHAMPVA
Health Insurance Coverage: New Content OUTTYP Extract: Research File
• http://www.census.gov/hhes/www/hlthins/data/incpovhlth/2013/current-coverage.html
To replicate the estimates shown in the report, data users need an additional variable, not included on the 2014 and 2015 public use data files. For more information: http://www.census.gov/hhes/www/hlthins/methodology/programming/cps/estimates.html
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ITEM NAME POSITION TYPE LENGTH H_SEQ 1 Char 5 Household Seq Number PPPOSOLD 6 Char 2 Person seq within HH OUTTYP 8 Char 2 Type of health insurance, covered by someone outside household 0 = Does not have coverage through someone outside household 1 = Employer-based insurance plan 2 = Direct-purchase insurance plan 3 = Other insurance plan through someone outside household I_OUTTYP 10 Char 1 Allocation flag for OUTTYP 0 = Not allocated 1 = Allocated
Health Insurance Coverage: New Content Not available yet:
• Exchange participation • Receipt of subsidies • Plan changes during year • Employer offered health insurance coverage
(take up)
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SHADAC RESOURCES
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SHADAC Data Center Releases
Updating with: • 2014 ACS • 2014 CPS • 2013 CPS from
income consistent full file
http://datacenter.shadac.org/
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2014 ACS Tables: State & County Estimates Tables from American FactFinder (AFF) showing 2013-2014 change in uninsured rates for states and counties • www.shadac.org/2014ACSTables
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MN Population Center Releases (IPUMS) CPS data will be available soon ACS data files will be released in about 1-2 weeks after available from the Census Bureau SHADAC Health Insurance Unit (HIU) and Federal Poverty Guidelines (FPG) variables for CPS and ACS will be available soon http://www.ipums.org
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