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Measuring changes in insurance coverage under the Affordable Care Act
Measuring changes in insurance coverage under the Affordable Care Act
- Collection:
- Health Policy and Services Research
- Author(s):
- Claxton, Gary, author
Levitt, Larry, author
Brodie, Mollyann, author
Garfield, Rachel, author
Damico, Anthony, author - Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body.
- Publication:
- Menlo Park, CA : Henry J. Kaiser Family Foundation, April 2014
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Data Collection
Data Interpretation, Statistical
Insurance Coverage -- statistics & numerical data
Insurance, Health -- statistics & numerical data
United States
United States. - Genre(s):
- Technical Report
- Abstract:
- Most of what we know about who has health insurance and what type of coverage they have comes from large federal surveys, which provide estimates of the number of people enrolled in different types of coverage, including those with no coverage, along with information about their household demographics and incomes. These surveys can be used to track changes in coverage for different types of people over time. The main advantages of these surveys are their large size and their sophisticated sampling and interviewing techniques, which allow detailed analysis of coverage and coverage changes for people in different demographic and income groups. Further, many federal surveys enable analysis at the state level for at least some states, which is important because ACA implementation (e.g., the availability of expanded Medicaid coverage or the existence of a state-operated Marketplace) will vary greatly across states. Their main disadvantage is that they do not provide rapid turnaround. Because of their size and complexity, there is always a lag between when they are fielded and when findings are published. The data needed to evaluate the coverage changes between 2013 and 2014 will not become available until 2015. In the interim, people will need to look to other sources of information. One is administrative data, such as the number of people who have enrolled through new health insurance marketplaces or the number of people who have enrolled in Medicaid. These data provide an incomplete picture since we do not know the enrollees’ coverage status prior to enrollment: Did they have insurance before and, if so, what type? It also is difficult to distinguish new enrollment from coverage changes that would have occurred in the absence of the law, since people’s job status and income change throughout the year. Also, while insurer filings to state insurance departments will report changes in total enrollment in the individual insurance market, there are currently no administrative data that provide detail on the individual market outside of the marketplaces. In addition, there is no source that captures the entire employer market, so there is no information to help us understand how things are changing in the market that covers the majority of nonelderly people. And most importantly, because people without insurance are not enrolled in anything, they cannot be counted in administrative data. Administrative data can provide clues about where to look for changes, but we do not have administrative systems that provide information about changes across types of coverage or changes in the number of people without insurance. The second interim source of information about health coverage is surveys by private entities, which ask about health insurance by type of coverage and track changes over time (or at least between a few points in time). This means that they provide some opportunity to look at changes across type of coverage as well as changes in the number of people who have any coverage. The main advantage of these surveys is their rapid turn around: indeed, several private surveys already have released findings that show that the number of people without health insurance has fallen between late 2013 and early 2014. Differences in approach and sampling mean that these surveys have different strengths and weaknesses and that their results may not be consistent or comparable. Below we discuss the details and timing of some of the private and federal surveys that will be used to look at how coverage has changed due to the ACA. Different surveys offer different information and insight into coverage under the ACA, and we discuss the contribution and challenges in each type of effort.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (16 pages, 1 unnumbered page))
- NLM Unique ID:
- 101634809 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101634809