As the United States implements the Patient Protection and Affordable Care Act (ACA), 2014 marks an important year when policymakers and researchers will have their first opportunities to measure the effects of the law's core provisions designed to expand health coverage and access. Because many aspects of the law depend on decisions and actions at the state level, differences among the states provide fertile opportunity for better understanding the impacts of the ACA under a variety of circumstances. For example, approximately half of the 50 states have expanded their Medicaid programs while the other half have not. Additionally, the effects of the law may vary based on states' individual characteristics, such as their existing health insurance coverage, health care financing, and health care delivery systems, as well as their unique economic environments and the demographic and socioeconomic characteristics of their populations. In anticipation of the need to monitor the impact of the ACA, several federal surveys that historically have asked questions about health insurance coverage and access to health care services are being or have been revised to address the impact of health reform. This brief discusses federal surveys with questions on health coverage and access, focusing especially on recent changes to federal surveys that could be used to monitor the effects of health reform and compare those results across the states. We examine seven federal surveys that include questions on health insurance coverage and health access, of which five have been recently revised to include new questions and one is in the process of revision. While many states also conduct their own health surveys that could be used to examine the effects of health reform within their borders, this brief concentrates on federal surveys because of their potential for comparing the effects of health reform across states. We provide an overview of the following federal surveys: (1) American Community Survey (ACS) (2) Current Population Survey (CPS) (3) National Health Interview Survey (NHIS) (4) Medical Expenditure Panel Survey-Household Component (MEPS-HC) (5) Behavioral Risk Factor Surveillance System (BRFSS) (6) Survey of Income and Program Participation (SIPP) (7) National Survey of Children's Health (NSCH). This brief describes each of these surveys, including recent survey revisions; survey content related to health coverage, access and specific ACA provisions; survey design; sample sizes, including sample sizes by state; and how to obtain estimates and data.
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Monitoring the impacts of health reform at the state level