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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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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Coverage and Agreement of Administrative Records and 2010 American Community Survey Demographic Data
November 2014
Working Paper Number:
carra-2014-14
The U.S. Census Bureau is researching possible uses of administrative records in decennial census and survey operations. The 2010 Census Match Study and American Community Survey (ACS) Match Study represent recent efforts by the Census Bureau to evaluate the extent to which administrative records provide data on persons and addresses in the 2010 Census and 2010 ACS. The 2010 Census Match Study also examines demographic response data collected in administrative records. Building on this analysis, we match data from the 2010 ACS to federal administrative records and third party data as well as to previous census data and examine administrative records coverage and agreement of ACS age, sex, race, and Hispanic origin responses. We find high levels of coverage and agreement for sex and age responses and variable coverage and agreement across race and Hispanic origin groups. These results are similar to findings from the 2010 Census Match Study.
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Exploring Administrative Records Use for Race and Hispanic Origin Item Non-Response
December 2014
Working Paper Number:
carra-2014-16
Race and Hispanic origin data are required to produce official statistics in the United States. Data collected through the American Community Survey and decennial census address missing data through traditional imputation methods, often relying on information from neighbors. These methods work well if neighbors share similar characteristics, however, the shape and patterns of neighborhoods in the United States are changing. Administrative records may provide more accurate data compared to traditional imputation methods for missing race and Hispanic origin responses. This paper first describes the characteristics of persons with missing demographic data, then assesses the coverage of administrative records data for respondents who do not answer race and Hispanic origin questions in Census data. The paper also discusses the distributional impact of using administrative records race and Hispanic origin data to complete missing responses in a decennial census or survey context.
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Assimilation and Coverage of the
Foreign-Born Population in Administrative Records
April 2015
Working Paper Number:
carra-2015-02
The U.S. Census Bureau is researching ways to incorporate administrative data in decennial census and survey operations. Critical to this work is an understanding of the coverage of the population by administrative records. Using federal and third party administrative data linked to the American Community Survey (ACS), we evaluate the extent to which administrative records provide data on foreign-born individuals in the ACS and employ multinomial logistic regression techniques to evaluate characteristics of those who are in administrative records relative to those who are not. We find that overall, administrative records provide high coverage of foreign-born individuals in our sample for whom a match can be determined. The odds of being in administrative records are found to be tied to the processes of immigrant assimilation - naturalization, higher English proficiency, educational attainment, and full-time employment are associated with greater odds of being in administrative records. These findings suggest that as immigrants adapt and integrate into U.S. society, they are more likely to be involved in government and commercial processes and programs for which we are including data. We further explore administrative records coverage for the two largest race/ethnic groups in our sample - Hispanic and non-Hispanic single-race Asian foreign born, finding again that characteristics related to assimilation are associated with administrative records coverage for both groups. However, we observe that neighborhood context impacts Hispanics and Asians differently.
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Understanding the Quality of Alternative Citizenship Data Sources for the 2020 Census
August 2018
Working Paper Number:
CES-18-38R
This paper examines the quality of citizenship data in self-reported survey responses compared to administrative records and evaluates options for constructing an accurate count of resident U.S. citizens. Person-level discrepancies between survey-collected citizenship data and administrative records are more pervasive than previously reported in studies comparing survey and administrative data aggregates. Our results imply that survey-sourced citizenship data produce significantly lower estimates of the noncitizen share of the population than would be produced from currently available administrative records; both the survey-sourced and administrative data have shortcomings that could contribute to this difference. Our evidence is consistent with noncitizen respondents misreporting their own citizenship status and failing to report that of other household members. At the same time, currently available administrative records may miss some naturalizations and capture others with a delay. The evidence in this paper also suggests that adding a citizenship question to the 2020 Census would lead to lower self-response rates in households potentially containing noncitizens, resulting in higher fieldwork costs and a lower-quality population count.
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Noncitizen Coverage and Its Effects on U.S. Population Statistics
August 2023
Working Paper Number:
CES-23-42
We produce population estimates with the same reference date, April 1, 2020, as the 2020 Census of Population and Housing by combining 31 types of administrative record (AR) and third-party sources, including several new to the Census Bureau with a focus on noncitizens. Our AR census national population estimate is higher than other Census Bureau official estimates: 1.8% greater than the 2020 Demographic Analysis high estimate, 3.0% more than the 2020 Census count, and 3.6% higher than the vintage-2020 Population Estimates Program estimate. Our analysis suggests that inclusion of more noncitizens, especially those with unknown legal status, explains the higher AR census estimate. About 19.8% of AR census noncitizens have addresses that cannot be linked to an address in the 2020 Census collection universe, compared to 5.7% of citizens, raising the possibility that the 2020 Census did not collect data for a significant fraction of noncitizens residing in the United States under the residency criteria used for the census. We show differences in estimates by age, sex, Hispanic origin, geography, and socioeconomic characteristics symptomatic of the differences in noncitizen coverage.
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Evaluating Race and Hispanic Origin Responses of Medicaid Participants Using Census Data
April 2015
Working Paper Number:
carra-2015-01
Health and health care disparities associated with race or Hispanic origin are complex and continue to challenge researchers and policy makers. With the intention of improving the measurement and monitoring of these disparities, provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 require states to collect, report and analyze data on demographic characteristics of applicants and participants in Medicaid and other federally supported programs. By linking Medicaid records to 2010 Census, American Community Survey, and Census 2000, this new large-scale study examines and documents the extent to which pre-ACA Medicaid administrative records match self-reported race and Hispanic origin in Census data. Linked records allow comparisons between individuals with matching and non-matching race and Hispanic origin data across several demographic, socioeconomic and neighborhood characteristics, such as age, gender, language proficiency, education and Census tract variables. Identification of the groups most likely to have non-matching and missing race and Hispanic origin data in Medicaid relative to Census data can inform strategies to improve the quality of demographic data collected from Medicaid populations.
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Producing U.S. Population Statistics Using Multiple Administrative Sources
November 2023
Working Paper Number:
CES-23-58
We identify several challenges encountered when constructing U.S. administrative record-based (AR-based) population estimates for 2020. Though the AR estimates are higher than the 2020 Census at the national level, they are over 15 percent lower in 5 percent of counties, suggesting that locational accuracy can be improved. Other challenges include how to achieve comprehensive coverage, maintain consistent coverage across time, filter out nonresidents and people not alive on the reference date, uncover missing links across person and address records, and predict demographic characteristics when multiple ones are reported or when they are missing. We discuss several ways of addressing these issues, e.g., building in redundancy with more sources, linking children to their parents' addresses, and conducting additional record linkage for people without Social Security Numbers and for addresses not initially linked to the Census Bureau's Master Address File. We discuss modeling to predict lower levels of geography for people lacking those geocodes, the probability that a person is a U.S. resident on the reference date, the probability that an address is the person's residence on the reference date, and the probability a person is in each demographic characteristic category. Regression results illustrate how many of these challenges and solutions affect the AR county population estimates.
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Measuring Income of the Aged in Household Surveys: Evidence from Linked Administrative Records
June 2024
Working Paper Number:
CES-24-32
Research has shown that household survey estimates of retirement income (defined benefit pensions and defined contribution account withdrawals) suffer from substantial underreporting which biases downward measures of financial well-being among the aged. Using data from both the redesigned 2016 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the Health and Retirement Study (HRS), each matched with administrative records, we examine to what extent underreporting of retirement income affects key statistics such as reliance on Social Security benefits and poverty among the aged. We find that underreporting of retirement income is still prevalent in the CPS ASEC. While the HRS does a better job than the CPS ASEC in terms of capturing retirement income, it still falls considerably short compared to administrative records. Consequently, the relative importance of Social Security income remains overstated in household surveys'53 percent of elderly beneficiaries in the CPS ASEC and 49 percent in the HRS rely on Social Security for the majority of their incomes compared to 42 percent in the linked administrative data. The poverty rate for those aged 65 and over is also overstated'8.8 percent in the CPS ASEC and 7.4 percent in the HRS compared to 6.4 percent in the linked administrative data. Our results illustrate the effects of using alternative data sources in producing key statistics from the Social Security Administration's Income of the Aged publication.
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