In addition to the extensively used Current Population Survey produced by the U.S. Census Bureau, several other surveys collect information on the number of people without health insurance. Because the findings from these surveys are often inconsistent, they can make the study of the uninsured population confusing. For example, it is well documented that the number of the uninsured has been rising, but it is still not entirely clear how many uninsured persons there are the United States and how long they remain uninsured.

The September EBRI Issue Brief reviews seven surveys that can be used to make nationally representative estimates of the uninsured and discusses why they produce different estimates. Accurately measuring and understanding who constitute the uninsured is crucial to being able to address the issue, the EBRI report notes -- especially given the various public policy proposals being made to deal with the uninsured (such as tax credit initiatives being floated by both the Republican and Democratic presidential candidates, George W. Bush and Al Gore).

"It is important to understand these differences for a number of reasons," said EBRI President and CEO Dallas Salisbury. "The projected cost of implementing policy proposals often depends on the estimates of the number of people the proposals will affect. For example, the allocation of funding for the State Children's Health Insurance Program (S-CHIP) depends heavily on the available estimates."

The seven major surveys addressed in the EBRI report are the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), Behavioral Risk Factor Surveillance System (BRFSS), the Community Tracking Study (CTS), the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the National Survey of America's Families (NSAF).

Among the report's findings:

• The CPS, which is conducted by the Census Bureau and is the most commonly used yardstick, suggests that 44.3 million Americans were uninsured in 1998. Estimates of the uninsured from the other surveys range from 19 million to 44 million, and vary depending on the time frame covered by the survey and other factors.
• Some of the surveys collect health insurance information in the context of obtaining general information on health care. Other surveys are focused on topics such as labor force participation and public assistance program participation, and measure health insurance coverage as a offshoot of the quantification process.
• The CPS has many strengths as a survey, but also has many weaknesses. For instance, it potentially asks individuals to recall the type of health insurance they had 14 months prior to being interviewed; some individuals may not understand the question and report the type of health insurance they have as of the interview date. Also, the CPS may not pick up all Medicaid recipients (the federal-state health care program for poor) because some states do not call the program "Medicaid." While the other surveys offer an alternative to the CPS, some are based on short telephone interviews, raising a question about the accuracy of the information obtained. In-person surveys, such as the CPS, SIPP, MEPS, and NHIS, allow interviewers to check the accuracy of survey participants' enrollment in health insurance programs.
• A number of states have started to question the validity of the uninsured estimates from the CPS and other surveys because of the small sample size in many states. As a result, some states have begun to conduct their own surveys to determine the number of uninsured residents. States that regularly conduct their own surveys include Florida, Massachusetts, Minnesota, New Mexico, Oregon, Vermont, and Wisconsin. Unfortunately, for a variety of reasons, the various state surveys are not easily comparable.
• Continued research is needed to increase understanding of the differences among the surveys and to improve on methodologies to count the uninsured, since the future of public programs (such as S-CHIP and other state and local initiatives to expand health insurance coverage) depends on the accuracy of these estimates.
• Whatever survey is used, the results show that a substantial number of Americans do not have any health insurance coverage, and the number has been growing.

EBRI Issue Briefs are monthly topical periodicals providing expert evaluations of employee benefit issues and trends, including critical analyses of employee benefit policies and proposals. Copies may be purchased for $25 prepaid by calling 202-775-9132.

EBRI is a private, nonprofit, nonpartisan public policy research organization based in Washington, DC. Founded in 1978, its mission is to contribute to, to encourage, and to enhance the development of sound employee benefit programs and sound public policy through objective research and education. EBRI does not lobby and does not take positions on legislative proposals.

SOURCE: Employee Benefit Research Institute

WEB SITE: http://www.ebri.org/