Demand for health services are examined among Americans ages 65 and older using the Medical Expenditure Panel Survey. Analyses are provided of mode of residence, demand for paid health services in private settings, and the choice of type of nursing home using a common set of explanatory variables. The research shows that age, Medicare coverage, and the use of assistive technology are the strongest predictors of mode of residence. The second analysis shows that total expenditures for paid home health care (HHC) and hospital care do not decrease as expected when the percentage paid by individuals and/or their families increases. Finally, the third analysis suggests that the distribution of nursing home (NH) services is related to ability to pay.
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Medicare Coverage and Reporting
December 2016
Working Paper Number:
carra-2016-12
Medicare coverage of the older population in the United States is widely recognized as being nearly universal. Recent statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) indicate that 93 percent of individuals aged 65 and older were covered by Medicare in 2013. Those without Medicare include those who are not eligible for the public health program, though the CPS ASEC estimate may also be impacted by misreporting. Using linked data from the CPS ASEC and Medicare Enrollment Database (i.e., the Medicare administrative data), we estimate the extent to which individuals misreport their Medicare coverage. We focus on those who report having Medicare but are not enrolled (false positives) and those who do not report having Medicare but are enrolled (false negatives). We use regression analyses to evaluate factors associated with both types of misreporting including socioeconomic, demographic, and household characteristics. We then provide estimates of the implied Medicare-covered, insured, and uninsured older population, taking into account misreporting in the CPS ASEC. We find an undercount in the CPS ASEC estimates of the Medicare covered population of 4.5 percent. This misreporting is not random - characteristics associated with misreporting include citizenship status, year of entry, labor force participation, Medicare coverage of others in the household, disability status, and imputation of Medicare responses. When we adjust the CPS ASEC estimates to account for misreporting, Medicare coverage of the population aged 65 and older increases from 93.4 percent to 95.6 percent while the uninsured rate decreases from 1.4 percent to 1.3 percent.
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Reporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.
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Income Packaging and Economic Disconnection: Do Sources of Support Differ from Other Low-Income Women?
December 2013
Working Paper Number:
CES-13-61
Income packaging, or piecing together cash and non-cash resources from a variety of sources, is a common financial survival strategy among low-income women. This strategy is particularly important for economically disconnected women, who lack both employment income and public cash assistance receipt. Using data from the confidential Census Bureau versions of the Survey of Income and Program Participation, this study compares the use of public and private supports between disconnected and connected low-income women, controlling for differences in state welfare rules and county unemployment rates. Findings from bivariate comparisons and multilevel logistic regressions indicate that disconnected women utilize public non-cash supports at similar rates to connected women, but rely more heavily on private sources. Conclusions focus on the policy implications for outreach and program development.
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Manufacturing Firms' Decisions Regarding Retiree Health Insurance
June 2003
Working Paper Number:
CES-03-14
This study analyzes the firm's decision to offer and contribute to retiree health insurance. We apply a binomial probit model and an interval regression model to analyze the likelihood of offering and the proportion of costs contributed by the firm. Our findings indicate that while firm characteristics affect the probability that a firm offers retiree health insurance, financial performance and alternative insurance options significantly affect the firm's generosity towards its cost. This study expands on previous research by including potentially important policy-related measures to the more limited set of firm and workforce characteristics that have been typically employed.
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The Decline of Volunteering in the United States: Is it the Economy?
June 2025
Working Paper Number:
CES-25-41
This article investigates the complex interactions between local and national economic contexts and volunteering behavior. We examine three dimensions of local economic context'economic disadvantage (e.g., the percentage of families living in poverty), income inequality, and economic growth (e.g., the change in median household income) and the impact of a national/global economic jolt'the Great Recession. Analysis of data from the Current Population Survey's (CPS) Volunteering Supplement (2002-2015) reveals. Individuals who live in places characterized by economic disadvantage and economic inequality are less likely to volunteer than individuals in more advantaged, equitable communities. The recession had a dampening effect on volunteering overall, but it had the largest dampening effect on individual volunteering in communities with above average rates of income equality and higher rates of economic growth. While individuals living in rural communities were more likely to volunteer than their urban counterparts before the recession, rural/urban differences disappear after the recession.
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Immigrant Status, Race, and Institutional Choice in Higher Education
March 1998
Working Paper Number:
CES-98-04
This paper examines the postsecondary enrollment decisions of immigrant students, expanding on previous work by explicitly considering their choices among institution types and by examining differences across generations and racial/ethnic categories. Using data from the National Educational Longitudinal Study (NELS:88), we hypothesize that community colleges may play a more significant role in providing access to higher education for immigrants than for the native-born population. Our results support our hypothesis only among Asian immigrants. First-generation black immigrants have a higher probability of enrolling in private vocational schools, while second-generation Hispanics (and native blacks) have a higher probability of enrolling in both public and private four-year colleges and universities. Survey (1988)
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Employer Health Benefit Costs and Demand for Part-Time Labor
April 2009
Working Paper Number:
CES-09-08
The link between rising employer costs for health insurance benefits and demand for part-time workers is investigated using non-public data from the Medical Expenditure Panel Survey- Insurance Component (MEPS-IC). The MEPS-IC is a nationally representative, annual establishment survey from the Agency for Healthcare Research and Quality (AHRQ). Pooling the establishment level data from the MEPS-IC from 1996-2004 and matching with the Longitudinal Business Database and supplemental economic data from the Bureau of Labor Statistics, a reduced form model of the percent of total FTE employees working part-time is estimated. This is modeled as a function of the employer health insurance contribution, establishment characteristics, and state-level economic indicators. To account for potential endogeneity, health insurance expenditures are estimated using instrumental variables (IVs). The unit of analysis is establishments that offer health insurance to full-time employees but not part time employees. Conditional on establishments offering health insurance to full-time employees, a 1 percent increase in employer health insurance contributions results in a 3.7 percent increase in part-time employees working at establishments in the U.S.
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Response Error & the Medicaid undercount in the CPS
December 2016
Working Paper Number:
carra-2016-11
The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is an important source for estimates of the uninsured population. Previous research has shown that survey estimates produce an undercount of beneficiaries compared to Medicaid enrollment records. We extend past work by examining the Medicaid undercount in the 2007-2011 CPS ASEC compared to enrollment data from the Medicaid Statistical Information System for calendar years 2006-2010. By linking individuals across datasets, we analyze two types of response error regarding Medicaid enrollment - false negative error and false positive error. We use regression analysis to identify factors associated with these two types of response error in the 2011 CPS ASEC. We find that the Medicaid undercount was between 22 and 31 percent from 2007 to 2011. In 2011, the false negative rate was 40 percent, and 27 percent of Medicaid reports in CPS ASEC were false positives. False negative error is associated with the duration of enrollment in Medicaid, enrollment in Medicare and private insurance, and Medicaid enrollment in the survey year. False positive error is associated with enrollment in Medicare and shared Medicaid coverage in the household. We discuss implications for survey reports of health insurance coverage and for estimating the uninsured population.
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Planning Parenthood: The Affordable Care Act Young Adult Provision and Pathways to Fertility
January 2017
Working Paper Number:
CES-17-65
This paper investigates the effect of the Affordable Care Act young adult provision on fertility and related outcomes. The expected effect of the provision on fertility is not clear ex ante. By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives as well as through expanded options for obtaining pregnancy-, birth-, and infant-related care, and these may lead to decreased or increased fertility, respectively. In addition, the provision may also affect fertility indirectly through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. This paper considers the effect of the provision on fertility as well as the contributing channels by applying difference-in-differences-type methods using the 2008-2010 and 2012-2013 American Community Survey, 2006-2009 and 2012-2013 Centers for Disease Control and Prevention abortion surveillance data, and 2006-2010 and 2011-2013 National Survey of Family Growth. Results suggest that the provision is associated with decreases in the likelihood of having given birth and abortion rates and an increase in the likelihood of using long-term hormonal contraceptives.
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The Rural/Urban Volunteering Divide
June 2025
Working Paper Number:
CES-25-42
Are rural residents more likely to volunteer than those living in urban places? Although early sociological theory posited that rural residents were more likely to experience social bonds connecting them to their community, increasing their odds of volunteer engagement, empirical support is limited. Drawing upon the full population of rural and urban respondents to the United States Census Bureau's Current Population Survey (CPS) Volunteering Supplement (2002-2015), we found that rural respondents are more likely to report volunteering compared to urban respondents, although these differences are decreasing over time. Moreover, we found that propensities for rural and urban volunteerism vary based on differences in both individual and place-based characteristics; further, the size of these effects differ across rural and urban places. These findings have important implications for theory and empirical analysis.
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