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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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NEW EVIDENCE ON EMPLOYER PRICE-SENSITIVITY OF OFFERING HEALTH INSURANCE
January 2014
Working Paper Number:
CES-14-01
Economic incentives such as the preferential tax treatment of premiums and economies of scale encourage employers to provide health insurance through the workplace. The employer's decision to offer health insurance depends on how much workers value insurance relative to wages, and that value is likely to vary, given the composition of the establishment's workforce. Using the 2008-2010 MEPS Insurance Component augmented with information from other data sources, we generate new estimates of employers' price-sensitivity of offering insurance. Our results suggest that employers are sensitive to changes in the tax price of insurance, with very small employers exhibiting the largest price-sensitivity. Employer size, workforce composition, and local labor market conditions also influence the employer's decision to offer insurance. New evidence can inform policy discussions about the implications of broad-based reforms that change marginal tax rates as well as targeted strategies that address the tax-exempt status of premiums.
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A Guide to the MEPS-IC Government List Sample Microdata
September 2011
Working Paper Number:
CES-11-27
The Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) is conducted to provide nationally representative estimates on employer sponsored health insurance. MEPSIC data are collected from private sector employers, as well as state and local governments. While similar information is gathered from these two sectors, differences in the survey process exist. The goal of this paper is to provide details on the public sector including types of state and local government employers, sample design, general information on the data collected in the MEPS-IC, and additional sources of information.
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Declines in Employer Sponsored Coverage Between 2000 and 2008: Offers, Take-Up, Premium Contributions, and Dependent Options
September 2010
Working Paper Number:
CES-10-23
Even before the current economic downturn, rates of employer-sponsored insurance (ESI) declined substantially, falling six percentage points between 2000 and 2008 for nonelderly Americans. During a previously documented decline in ESI, from 1987 to 1996, the fall was found to be the result of a reduction in enrollment or 'take-up' of offered coverage and not a decline in employer offer/eligibility rates. In this paper, we investigate the components of the more recent decline in ESI coverage by firm size, using data from the MEPS-IC, a large nationally representative survey of employers. We examine changes in offer rates, eligibility rates and take-up rates for coverage, and include a new dimension, the availability of and enrollment in dependent coverage. We investigate how these components changed for employers of different sizes and find that declining coverage rates for small firms were due to declines in both offer and take-up rates while declining rates for large firms were due to declining enrollment in offered coverage. We also find a decrease in the availability of dependent coverage at small employers and a shift towards single coverage across employers of all sizes. Understanding the components of the decline in coverage for small and large firms is important for establishing the baseline for observing the effects of the current economic downturn and the implementation of health insurance reform.
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Health-Related Research Using Confidential U.S. Census Bureau Data
August 2008
Working Paper Number:
CES-08-21
Economic studies on health-related issues have the potential to benefit all Americans. The approaches for dealing with the growth of health care costs and health insurance coverage are ever changing and information is needed on their efficacy. Research on health-related topics has been conducted for about a decade at the Census Bureau\u2019s Center for Economic Studies and the Research Data Centers. This paper begins by describing the confidential business and demographic Census Bureau data products used in this research. The discussion continues with summaries of nearly 30 papers, including how this work has benefited the Census Bureau and its research findings. Some focus on data linkages and assessing data quality, while others address important questions in the employer, public, and individual insurance markets. This research could not have been accomplished with public-use data. The newly available data from the Agency for Healthcare Research and Quality and National Center for Health Statistics, as well as additional Census Bureau data now available in the Research Data Centers are also discussed.
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Using the MEPS-IC to Study Retiree Health Insurance
April 2006
Working Paper Number:
CES-06-13
This paper discusses using the restricted-access Medical Expenditure Panel Survey- Insurance Component (MEPS-IC) to study employer-sponsored retiree health insurance (RHI). This topic is particularly interesting given current events such as the aging of baby boomers, rising health care costs, new prescription drug coverage under Medicare, and changes in accounting standards for reporting liabilities related to RHI offerings. Consequently, employers are grappling with an aging workforce, evaluating Medicare subsidies to employers for offering retiree drug plans, facing rising premium costs as a result of rising health care costs, and trying to show profitability on financial reports. This paper provides technical information on using the MEPS-IC to study RHI and points out data issues with some of the measures in the database. Descriptive statistics are provided to illustrate the types of retiree estimates possible using the MEPS-IC and to show some of the trends in this subject area. Not surprising, these estimates show that employer offers of RHI have declined, greater numbers of retirees are enrolling in these plans, and expenditures for employer-sponsored RHI have been rising.
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Contributions to Health Insurance Premiums: When Does the Employer Pay 100 Percent?
December 2005
Working Paper Number:
CES-05-27
We identify the characteristics of establishments that paid 100 percent of health insurance premiums and the policies they offered from 1997-2001, despite increased premium costs. Analyzing data from the MEPS-IC, we see little change in the percent of establishments that paid the full cost of premiums for employees. Most of these establishments were young, small, singleunits, with a relatively high paid workforce. Plans that were fully paid generally required referrals to see specialists, did not cover pre-existing conditions or outpatient prescriptions, and had the highest out-of-pocket expense limits. These plans also were more likely than plans not fully paid by employers to have had a fee-for-service or exclusive provider arrangement, had the highest premiums, and were less likely to be self-insured.
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Employer-Provided Benefit Plans, Workforce Composition and Firm Outcomes
January 2005
Working Paper Number:
tp-2005-01
What do firms gain by offering benefits? Economists have proposed two payoffs: (i) benefits
may be a more cost-effective form of compensation than wages for employees facing high
marginal tax rates, and (ii) benefits may attract a more stable, skilled workforce. Both should
improve firm outcomes, but we have little evidence on this matter. This paper exploits a rich
new dataset to examine how firm productivity and survival are related to benefit offering, and
finds that benefit-offering firms have higher productivity and higher survival rates. Differences
in firm and workforce characteristics explain some but not all of the differences in outcomes.
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The Measurement of Medicaid Coverage in the SIPP: Evidence from California, 1990-1996
September 2002
Working Paper Number:
CES-02-21
This paper studies the accuracy of reported Medicaid coverage in the Survey of Income and Program Participation (SIPP) using a unique data set formed by matching SIPP survey responses to administrative records from the State of California. Overall, we estimate that the SIPP underestimates Medicaid coverage in the California populaton by about 10 percent. Among SIPP respondents who can be matched to administrative records, we estimate that the probability someone reports Medicaid coverage in a month when they are actually covered is around 85 percent. The corresponding probability for low-income children is even higher ' at least 90 percent. These estimates suggest that the SIPP provides reasonably accurate coverage reports for those who are actually in the Medicaid system. On the other hand, our estimate of the false positive rate (the rate of reported coverage for those who are not covered in the administrative records) is relatively high: 2.5 percent for the sample as a whole, and up to 20 percent for poor children. Some of this is due to errors in the recording of Social Security numbers in the administrative system, rather than to problems in the SIPP.
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