Friday, June 5, 2009

Does Council Of Economic Advisers Read Appendices

It is difficult to understand why the President's Council of Economic advisers (CEA) and the press continue to report 45.7 million as uninsured when the US Census Bureau, which was responsible for the original survey number 45.7 million, says that the number is not valid and grossly over reports the number of uninsured.

The CEA report states on page 7, the same page as the chart of uninsured by age:
In 2007, 45.7 million Americans did not have health insurance. About one out of every six U.S. residents under the age of 65 is currently without health insurance.

The data is from a US Census Bureau survey, "Income, Poverty, and Health Insurance Coverage in the United States: 2007, Current Population Reports, Consumer Income" released August 2008.

Surveys, however, are notoriously unreliable. The Census Bureau itself, in Appendix C of the survey report responsible for the 45.7 million of uninsured, questions the validity of that number.

The Census Bureau states in Appendix C on page 59 of the report:

Quality of Health Insurance Coverage Estimates

National surveys and health insurance coverage.

Health insurance coverage is likely to be under reported on the Current Population Survey (CPS). While under reporting affects most, if not all, surveys, underreporting of health insurance coverage … appears to be a larger problem than in other national surveys that ask about insurance.

Because the CPS is largely a labor force survey, interviewers receive less training on health insurance concepts than labor concepts. Additionally, many people may not be aware that a health insurance program covers them or their children if they have not used covered services recently.

The Census Bureau cites in the same appendix a research project it undertook with the University of Minnesota to look at the Medicaid numbers in the survey versus actual Medicaid enrollees. The research found, "A key finding indicating survey response error … was that 16.9 percent of people with … Medicaid coverage reported … that they were uninsured."

Medicaid under reporting alone reduces the 45.7 million by 7 million. The Census Bureau looked at Medicaid because it had computerized records of Medicaid enrollees readily available.

The Census Bureau survey also does not ask the person if they currently have insurance. It asks them about the previous year. Researchers who have looked at the other categories of the uninsured also have found that the Census numbers grossly over report the uninsured.

Additionally, one of the biggest problems with the survey, which is also mentioned in the report appendix, is that it is a snapshot at a specific point in time. People who have a short waiting period before coverage begins, such as a 30 day waiting time at a new job, etc., indicate that they are uninsured. Researchers who have followed up on people reporting no health insurance have found that most of them have insurance within a few months.

The number of truly long-term uninsured in the US is much smaller than 45.7 million..

There is nothing wrong with the President and the CEA promoting universal health care, but it is politically shortsighted to use an invalidated number.

It really calls into question the credibility of all the numbers that this Administration is providing on health care.

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