Meeting the Need for State-Level Estimates of Health Insurance Coverage: Use of State and Federal Survey Data

OBJECTIVE: Critically review estimates of health insurance coverage available from different sources, including the federal government, state survey initiatives, and foundation-sponsored surveys for use in state policy research. STUDY SETTING AND DESIGN: We review the surveys in an attempt to flesh out the current weaknesses of survey data for state policy uses. The main data sources assessed in this analysis are federal government surveys (such as the Current Population Survey's Annual Social and Economic Supplement, and the National Health Interview Survey), foundation-supported surveys (National Survey of America's Families, and the Community Tracking Survey), and state-sponsored surveys. PRINCIPAL FINDINGS: Despite information on estimates of health insurance coverage from six federal surveys, states find the data lacking for state policy purposes. We document the need for state representative data on the uninsured and the recent history of state data collection efforts spurred in part by the Health Resources Services Administration State Planning Grant program. We assess the state estimates of uninsurance from the Current Population Survey and make recommendations for a new consolidated federal survey with better state representative data. CONCLUSIONS: We think there are several options to consider for coordinating a federal and state data collection strategy to inform state and national policy on coverage and access

The Effect of Income Question Design in Health Surveys on Family Income, Poverty and Eligibility Estimates

OBJECTIVE: To compare systematic differences between an “omnibus” income measure that asks for total family income amounts with a central survey item and an aggregated income measure that sums specific amounts of income obtained from multiple income sources from everyone within a family. DATA SOURCE: The 2001 Current Population Survey-Demographic Supplement (CPS-DS). Data were collected from 78,000 households from February through April 2001. STUDY DESIGN: First, we compare the omnibus family income to the aggregated family income amounts for each family. Second, we use the various aggregated family income sources to predict whether there is a mismatch between the omnibus and aggregated family income amounts. Finally, we assign a new aggregated amount of income that is restricted to be within the range of the omnibus amount to observe differences in poverty rates. DATA COLLECTION: Data were extracted from University of Michigan's ICPSR website. PRINCIPAL FINDINGS: There is a great deal of variation between the omnibus family income measure and the aggregated family income measure, with the omnibus amount generally being lower than the aggregated. As a result, the percent of people estimated to be in poverty is higher using the omnibus income item. CONCLUSIONS: Health surveys generally rely on an omnibus income measure and analysts should be aware that the income estimates derived from it are limited with respect to poverty determination, and the related concept of eligibility estimation. Analysts of health surveys should also consider matching respondents or multiple imputation to improve the usability of the data

The Impact of Medicaid Enrollment on Veterans Health Administration Enrollees' Behavioral Health Services Use

ObjectiveTo examine Veterans Health Administration (VA) enrollees' use of VA services for treatment of behavioral health conditions (BHCs) after gaining Medicaid, and if VA reliance varies by complexity of BHCs.Data sources/study settingVA and Medicaid Analytic eXtract utilization data from 31 states, 2006-2010.Study designA retrospective, longitudinal study of Veterans enrolled in VA care in the year before and year after enrollment in Medicaid among 7,249 nonelderly Veterans with serious mental illness (SMI), substance use disorder (SUD), posttraumatic stress disorder (PTSD), depression, or other BHCs.Data collection/extraction methodsUtilization and VA reliance (proportion of care received at VA) for BH outpatient and inpatient services in unadjusted and adjusted analyses.Principal findingsIn adjusted analyses, we found that overall Veterans did not significantly change their use of VA outpatient BH services after Medicaid enrollment. In beta-binomial models predicting VA BH outpatient reliance, veterans with SMI (IRR = 1.38, p < .05), PTSD (IRR = 1.62, p < .01), and depression (IRR = 1.36, p < .05) had higher reliance than veterans with other BHCs after Medicaid enrollment.ConclusionsWhile veterans did not change the amount of VA outpatient BH services they used after enrolling in Medicaid, the proportion of care they received through VA or Medicaid varied by BHC