Estimating the Number of Individuals in the U.S. Without Health Insurance. Employer Sponsored Insurance (ESI) Adjustments

01/31/2005

Due to changes in the CPS over time, as well as Census assumptions in recoding the unadjusted data, there were significant discontinuities in the ESI estimates that needed to be adjusted for, in order to be able present a consistent time series. Our three main issues are: age of ESI policy holder, addressing coverage from outside the household, and addressing duplicate coverage at the person level.

Our first ESI adjustment was to enforce a consistent minimum age for ESI policy holders. Census coding prior to March 1995 did not permit ESI policy holders to be under age 15. The new questions that begin in March 1995 do not have this rule in place, and as a result the ages for some policy holders seem unreasonably low. For consistency, we have instituted a rule that states a person must be at least age 18 (unless married) to be considered an ESI policy holder, otherwise they are changed to be a dependent. This adjustment was done for all years, and while it does not affect the level of total ESI coverage, it does show a very small shift from policy holders to dependents.

The goal of our second ESI adjustment was to consistently define whether coverage from outside the household was employer sponsored or non-group in nature. After 1995, Census coding rules placed anyone with coverage from outside the household, who was age 15 or older, into private non-group status. We looked at family characteristics, such as the presence alimony, child support, or multiple persons with outside coverage, in order to determine when group coverage was likely and reassigned these cases as ESI. In doing so, the goal was to keep families together under one ESI policy when there were several persons in a family with outside coverage. The effect was to increase the number of persons with employer-sponsored group coverage by about a million persons each year (a less than one percent change).

Our final ESI adjustment, which was only applied to the pre-March 1995 surveys, enabled us to better identify non hierarchical private insurance coverage. The coding rules that Census employed prior to March 1995 did not allow identification of spouses who had coverage both in their own name and as a dependent. By looking at the raw data from March 1995 forward we were able to notice trends in duplicate coverage and impute them back onto the earlier years. While absolute (net) counts of covered persons did not change, the gross counts of those covered did change in order to take into affect the duplicate coverage issue.

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