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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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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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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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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The Use of Administrative Records and the American Community Survey to Study the Characteristics of Undercounted Young Children in the 2010 Census
May 2018
Working Paper Number:
carra-2018-05
Children under age five are historically one of the most difficult segments of the population to enumerate in the U.S. decennial census. The persistent undercount of young children is highest among Hispanics and racial minorities. In this study, we link 2010 Census data to administrative records from government and third party data sources, such as Medicaid enrollment data and tenant rental assistance program records from the Department of Housing and Urban Development, to identify differences between children reported and not reported in the 2010 Census. In addition, we link children in administrative records to the American Community Survey to identify various characteristics of households with children under age five who may have been missed in the last census. This research contributes to what is known about the demographic, socioeconomic, and household characteristics of young children undercounted by the census. Our research also informs the potential benefits of using administrative records and surveys to supplement the U.S. Census Bureau child population enumeration efforts in future decennial censuses.
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The Utilization of Different Modes of Residence and Health Services by the Elderly
December 2001
Working Paper Number:
CES-01-14
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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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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Errors in Survey Reporting and Imputation and Their Effects on Estimates of Food Stamp Program Participation
April 2011
Working Paper Number:
CES-11-14
Benefit receipt in major household surveys is often underreported. This misreporting leads to biased estimates of the economic circumstances of disadvantaged populations, program takeup, and the distributional effects of government programs, and other program effects. We use administrative data on Food Stamp Program (FSP) participation matched to American Community Survey (ACS) and Current Population Survey (CPS) household data. We show that nearly thirty-five percent of true recipient households do not report receipt in the ACS and fifty percent do not report receipt in the CPS. Misreporting, both false negatives and false positives, varies with individual characteristics, leading to complicated biases in FSP analyses. We then directly examine the determinants of program receipt using our combined administrative and survey data. The combined data allow us to examine accurate participation using individual characteristics missing in administrative data. Our results differ from conventional estimates using only survey data, as such estimates understate participation by single parents, non-whites, low income households, and other groups. To evaluate the use of Census Bureau imputed ACS and CPS data, we also examine whether our estimates using survey data alone are closer to those using the accurate combined data when imputed survey observations are excluded. Interestingly, excluding the imputed observations leads to worse ACS estimates, but has less effect on the CPS estimates.
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