Income Data for Policy Analysis: A Comparative Assessment of Eight Surveys. Uninsured For a Full Year

12/23/2008

While the general similarities of point-in-time uninsured estimates and their relationship to relative income across surveys is heartening, point-in-time estimates reflect uninsured spells of varying durations, which differ in their policy priorities. Policymakers give highest priority to long-term uninsured spells, which are frequently defined by durations of a year or more. Five of the six surveys (all but the ACS, which did not start to measure health insurance coverage until January 2008) provide estimates of people without coverage for an entire year. With SIPP and MEPS, estimates of people uninsured for varying durations can be constructed from the monthly estimates discussed earlier, which are based on multiple interviews conducted over a given year. The remaining surveys rely on retrospective questions asking the respondent to think back over the past 12 months or prior calendar year.

As we saw with estimates of program participation over a 12-month period, the survey estimates of persons uninsured for a full year vary widely. For the population as a whole, SIPP is lowest at 8.2 percent while the CPS is highest at 14.8 percent (Table IV.31). The CPS estimate in fact compares closely to two of the three point-in-time estimates (for SIPP and NHIS). This property of the CPS uninsured estimates is well known among health policy researchers, and because of it the CPS uninsured estimates are widely—but not universally—interpreted and analyzed as if they referred to a point in time. The MEPS estimate of 11.8 percent stands midway between the SIPP and CPS estimates despite the longitudinal basis that it shares with the SIPP estimate. The NHIS estimate of 9.7 percent is closest to the SIPP estimate while the PSID estimate of 13.6 percent is closest to the CPS figure (and not far from the reduced sample CPS estimate). The very low estimate of Medicaid participation obtained in the PSID, as reported earlier, may play a role in this high uninsured rate. Whatever the source, the CPS and PSID uninsured rates are strikingly similar by poverty relative, which suggests that the overall PSID estimate would match the CPS even more closely if the PSID had more poor persons. The SIPP, MEPS, and NHIS uninsured rates also show similar patterns of decline by poverty relative. In every poverty class, SIPP is the lowest of the three, and MEPS is the highest.

TABLE IV.31

FULL-YEAR UNINSURED PERSONS BY POVERTY RELATIVE
Population and Poverty Relative CPS SIPP MEPS NHIS PSID CPS-X1
Millions of Persons
All Persons 282.55 281.08 283.30 283.71 261.45 274.44
(Poverty Relative)Under 100% 34.38 33.25 35.35 41.58 25.73 31.82
(Poverty Relative)100% to under 200% 51.81 56.25 52.14 53.91 40.85 49.81
(Poverty Relative)200% to under 400% 89.62 98.37 89.80 87.06 80.00 87.26
(Poverty Relative)400% and over 106.73 93.22 106.02 101.16 114.87 105.56
Persons Uninsured for the Prior Year (Millions)
All Persons 41.80 22.91 33.31 27.47 35.55 38.79
(Poverty Relative)Under 100% 10.36 5.97 7.67 8.47 8.01 9.15
(Poverty Relative)100% to under 200% 12.53 8.23 10.51 9.35 10.86 11.67
(Poverty Relative)200% to under 400% 12.34 6.92 10.20 6.99 9.96 11.62
(Poverty Relative)400% and over 6.57 1.78 4.93 2.65 6.71 6.34
Percent of Persons Uninsured for the Prior Year
All Persons 14.8 8.2 11.8 9.7 13.6 14.1
(Poverty Relative)Under 100% 30.1 18.0 21.7 20.4 31.1 28.8
(Poverty Relative)100% to under 200% 24.2 14.6 20.2 17.3 26.6 23.4
(Poverty Relative)200% to under 400% 13.8 7.0 11.4 8.0 12.4 13.3
(Poverty Relative)400% and over 6.2 1.9 4.7 2.6 5.8 6.0

Source: Mathematica Policy Research, from tabulations of the 2003 CPS ASEC supplement, the 2001 SIPP panel, the 2002 Full-year Consolidated MEPS-HC, the 2003 NHIS, and the 2003 PSID. Note:  Poverty and uninsured status refer to calendar year 2002, except for NHIS (the past 12 months).

1.The CPS-X estimates exclude all unrelated subfamilies and most secondary individuals (except unmarried partners of the householder) to mimic the population controls applied to the PSID.

Full-year uninsured rates among the elderly range from 0.4 to 0.8 percent across all of the surveys but the PSID, which finds 2.7 percent of the elderly population without coverage for all of 2002 (Table IV.32). This is still a very small fraction, however, and may reflect a misunderstanding of the question among a small share of respondents.

While the SIPP had a comparatively high point-in-time uninsured rate for children, this does not carry through to estimates of children without coverage for a year. SIPP and NHIS both show a little over 5 percent of children being without coverage for a full year while the CPS and PSID show more than twice this percentage, with MEPS falling between these extremes (Table IV.33). Uninsured rates by poverty relative are quite similar between SIPP and NHIS and between the CPS and PSID. MEPS exhibits the same general pattern as all four other surveys, with higher rates than SIPP in every poverty class, but continues to show a higher uninsured rate among the near poor than among the poor. Across all of the surveys the uninsured rates are fairly similar between these two subpopulations, reflecting, as we noted, the impact of public programs on children’s health insurance coverage.

Among nonelderly adults and all nonelderly persons, the PSID and CPS uninsured rates by poverty relative are in close agreement (Tables IV.34 and IV.35). The full-year uninsured rate for nonelderly adults in the CPS, 19.0 percent, nearly matches the NHIS point-in-time uninsured rate reported for this subpopulation in Table A.5. SIPP has the lowest full-year uninsured rate at 10.8 percent, followed by the NHIS at 13.2 percent. At 15.6 percent, MEPS is not much lower than the PSID (16.5 percent), but the MEPS uninsured rates are markedly lower below 200 percent of poverty. Overall, the importance of income in health policy analysis is underscored by the sharp differential that exists between the poor and near poor, on the one hand, and those above 400 percent of poverty on the other. For SIPP and NHIS, the 2 to 3 percent of people above 400 percent of poverty who were uninsured for the full year contrast with the 28 to 30 percent of the poor who were without coverage for an entire year. For MEPS the range is 5 to 34 percent, and for the CPS and PSID it stands at 7 to 42 percent. Nevertheless, the wide range of estimates of full-year uninsured nonelderly, from 9.2 to 16.7 percent, and even the difference between SIPP and MEPS (9.2 versus 13.3 percent), indicate that the measurement of income poses less of a problem for policymakers than the measurement of health insurance coverage.

TABLE IV.32

FULL-YEAR UNINSURED ELDERLY PERSONS BY POVERTY RELATIVE
Population and Poverty Relative CPS SIPP MEPS NHIS PSID CPS-X1
Millions of Persons
All Persons 65 and Older 34.22 33.95 34.15 34.22 29.95 33.94
(Poverty Relative)Under 100% 3.58 3.03 3.84 3.76 2.65 3.49
(Poverty Relative)100% to under 200% 9.58 8.56 9.72 9.10 5.44 9.49
(Poverty Relative)200% to under 400% 12.07 13.52 10.37 12.96 10.88 12.01
(Poverty Relative)400% and over 8.99 8.84 10.22 8.40 10.98 8.96
Persons Uninsured for the Prior Year (Millions)
Persons 65 and Older 0.26 0.14 0.16 0.26 0.82 0.25
(Poverty Relative)Under 100% 0.07 0.06 0.02 0.08 0.19 0.06
(Poverty Relative)100% to under 200% 0.08 0.04 0.07 0.09 0.11 0.08
(Poverty Relative)200% to under 400% 0.06 0.03 0.03 0.06 0.33 0.06
(Poverty Relative)400% and over 0.05 0.01 0.03 0.03 0.18 0.05
Percent of Persons Uninsured for the Prior Year
Persons 65 and Older 0.8 0.4 0.5 0.8 2.7 0.7
(Poverty Relative)Under 100% 1.9 2.1 0.5 2.1 7.3 1.7
(Poverty Relative)100% to under 200% 0.9 0.4 0.8 1.0 2.1 0.9
(Poverty Relative)200% to under 400% 0.5 0.2 0.3 0.5 3.1 0.5
(Poverty Relative)400% and over 0.6 0.1 0.3 0.3 1.7 0.5

Source:   Mathematica Policy Research, from tabulations of the 2003 CPS ASEC supplement, the 2001 SIPP panel, the 2002 Full-year Consolidated MEPS-HC, the 2003 NHIS, and the 2003 PSID. Note: Poverty and uninsured status refer to calendar year 2002, except for NHIS (the past 12 months).

1.The CPS-X estimates exclude all unrelated subfamilies and most secondary individuals (except unmarried partners of the householder) to mimic the population controls applied to the PSID.

TABLE IV.33

FULL-YEAR UNINSURED CHILDREN BY POVERTY RELATIVE
Population and Poverty Relative CPS SIPP MEPS NHIS PSID CPS-X1
Millions of Persons
All Children under 18 71.67 71.36 71.80 71.73 67.48 70.82
(Poverty Relative)Under 100% 12.03 12.78 12.47 14.29 9.68 11.63
(Poverty Relative)100% to under 200% 15.38 17.72 15.47 15.41 13.40 15.16
(Poverty Relative)200% to under 400% 23.19 24.58 24.49 21.67 21.25 23.01
(Poverty Relative)400% and over 21.06 16.28 19.36 20.36 23.15 21.03
Persons Uninsured for the Prior Year (Millions)
All Children under 18 8.05 3.81 5.54 3.73 7.69 7.86
(Poverty Relative)Under 100% 2.38 1.03 1.14 1.41 2.12 2.27
(Poverty Relative)100% to under 200% 2.80 1.53 1.74 1.29 2.44 2.75
(Poverty Relative)200% to under 400% 2.05 1.04 1.82 0.78 1.77 2.03
(Poverty Relative)400% and over 0.81 0.21 0.84 0.24 1.36 0.81
Percent of Persons Uninsured for the Prior Year
All Children under 18 11.2 5.3 7.7 5.2 11.4 11.1
(Poverty Relative)Under 100% 19.8 8.1 9.2 9.9 21.9 19.6
(Poverty Relative)100% to under 200% 18.2 8.6 11.2 8.4 18.2 18.2
(Poverty Relative)200% to under 400% 8.9 4.2 7.4 3.6 8.3 8.8
(Poverty Relative)400% and over 3.8 1.3 4.3 1.2 5.9 3.8

Source: Mathematica Policy Research, from tabulations of the 2003 CPS ASEC supplement, the 2001 SIPP panel, the 2002 Full-year Consolidated MEPS-HC, the 2003 NHIS, and the 2003 PSID. Note:  Poverty and uninsured status refer to calendar year 2002, except for NHIS (the past 12 months).

1.The CPS-X estimates exclude all unrelated subfamilies and most secondary individuals (except unmarried partners of the householder) to mimic the population controls applied to the PSID.

TABLE IV.34

FULL-YEAR UNINSURED NONELDERLY ADULTS BY POVERTY RELATIVE
Population and Poverty Relative CPS SIPP MEPS NHIS PSID CPS-X1
Millions of Persons
All Persons under 65 176.66 175.77 177.34 177.76 164.02 169.68
(Poverty Relative)Under 100% 18.77 17.44 19.03 23.53 13.40 16.70
(Poverty Relative)100% to under 200% 26.85 29.97 26.95 29.40 22.01 25.16
(Poverty Relative)200% to under 400% 54.36 60.27 54.93 52.42 47.87 52.25
(Poverty Relative)400% and over 76.67 68.09 76.43 72.40 80.74 75.57
Persons Uninsured for the Prior Year (Millions)
All Persons under 65 33.50 18.96 27.61 23.48 27.04 30.68
(Poverty Relative)Under 100% 7.91 4.88 6.51 6.98 5.70 6.82
(Poverty Relative)100% to under 200% 9.64 6.66 8.70 7.97 8.31 8.83
(Poverty Relative)200% to under 400% 10.23 5.85 8.34 6.14 7.86 9.54
(Poverty Relative)400% and over 5.71 1.57 4.06 2.39 5.17 5.49
Percent of Persons Uninsured for the Prior Year
All Persons under 65 19.0 10.8 15.6 13.2 16.5 18.1
(Poverty Relative)Under 100% 42.1 28.0 34.2 29.7 42.5 40.8
(Poverty Relative)100% to under 200% 35.9 22.2 32.3 27.1 37.7 35.1
(Poverty Relative)200% to under 400% 18.8 9.7 15.2 11.7 16.4 18.3
(Poverty Relative)400% and over 7.5 2.3 5.3 3.3 6.4 7.3

Source:   Mathematica Policy Research, from tabulations of the 2003 CPS ASEC supplement, the 2001 SIPP panel, the 2002 Full-year Consolidated MEPS-HC, the 2003 NHIS, and the 2003 PSID.Note: Poverty and uninsured status refer to calendar year 2002, except for NHIS (the past 12 months).

1.The CPS-X estimates exclude all unrelated subfamilies and most secondary individuals (except unmarried partners of the householder) to mimic the population controls applied to the PSID.

TABLE IV.35

FULL-YEAR UNINSURED NONELDERLY PERSONS BY POVERTY RELATIVE
Population and Poverty Relative CPS SIPP MEPS NHIS PSID CPS-X1
Millions of Persons
All Persons under 65 248.33 247.13 249.14 249.49 231.50 240.50
(Poverty Relative)Under 100% 30.80 30.21 31.50 37.82 23.08 28.33
(Poverty Relative)100% to under 200% 42.23 47.69 42.42 44.81 35.41 40.32
(Poverty Relative)200% to under 400% 77.56 84.85 79.42 74.10 69.12 75.25
(Poverty Relative)400% and over 97.74 84.37 95.80 92.76 103.89 96.60
Persons Uninsured for the Prior Year (Millions)
All Persons under 65 41.54 22.77 33.15 27.20 34.72 38.54
(Poverty Relative)Under 100% 10.29 5.91 7.65 8.39 7.81 9.09
(Poverty Relative)100% to under 200% 12.45 8.19 10.43 9.26 10.75 11.59
(Poverty Relative)200% to under 400% 12.29 6.90 10.17 6.92 9.62 11.57
(Poverty Relative)400% and over 6.52 1.78 4.90 2.63 6.53 6.29
Percent of Persons Uninsured for the Prior Year
All Persons under 65 16.7 9.2 13.3 10.9 15.0 16.0
(Poverty Relative)Under 100% 33.4 19.6 24.3 22.2 33.9 32.1
(Poverty Relative)100% to under 200% 29.5 17.2 24.6 20.7 30.4 28.7
(Poverty Relative)200% to under 400% 15.8 8.1 12.8 9.3 13.9 15.4
(Poverty Relative)400% and over 6.7 2.1 5.1 2.8 6.3 6.5

Source:   Mathematica Policy Research, from tabulations of the 2003 CPS ASEC supplement, the 2001 SIPP panel, the 2002 Full-year Consolidated MEPS-HC, the 2003 NHIS, and the 2003 PSID. Note: Poverty and uninsured status refer to calendar year 2002, except for NHIS (the past 12 months).

1.The CPS-X estimates exclude all unrelated subfamilies and most secondary individuals (except unmarried partners of the householder) to mimic the population controls applied to the PSID.

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