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Behind the Numbers: Health Insurance

On September 16th, the Census Bureau will release new data on poverty, income, and health insurance in the United States in 2014. As a preview to this red-hot data, we outline what we expect to learn about health insurance — including the first year of Affordable Care Act (ACA) implementation.

Where does this data come from?

Once a year, the Census Bureau includes additional questions on health coverage and income within their monthly Current Population Survey. This supplement is known as the Annual Social and Economic Supplement (ASEC). The ASEC questions regarding health insurance explore whether each member of the respondent household had insurance coverage throughout the previous calendar year, and if so, what kind of coverage. According to the Census Bureau, the ASEC is the most widely used source of data on health insurance coverage in the U.S.

The Census Bureau conducts this survey in March and asks respondents about their insurance coverage over the entire previous year. It then takes several months to clean up the data and prepare it for release to the public in September. This means that the data released this month were collected in March, but reflect insurance coverage in 2014 — which was the first year Americans could enroll in coverage made available through the ACA.

This will be the second year that the Census Bureau has used updated health insurance questions, which are designed to improve the survey’s estimates of health insurance rates.  The data from last year will provide a baseline for understanding changes in health insurance related to the ACA, but it cannot be compared to ASEC releases prior to 2014.

In a rapid follow-up to the ASEC data, the Census Bureau will release data from the American Community Survey on September 17th. This data provides state and local level information on health insurance coverage, and can be compared to previous years, including 2013 and earlier.

What will the data tell us?

We will be able to use the ASEC data to find out how many people in the United States held health insurance during 2014 and what type of coverage they had (employer-sponsored insurance, Medicaid, Medicare, other government insurance, Marketplace coverage or other private health insurance). We can also break these numbers down by sex, age, race and ethnicity, and income, among other categories. The ability to analyze health insurance by these factors gives us a better picture of who does not have health coverage, as well as a better idea of who relies on different types of insurance the most. Such an understanding is important for researchers and policy makers who are trying to ensure that all populations have access to affordable health coverage and high quality care.

Don’t we already know how many people are covered by the ACA?

The ACA includes several provisions that make health insurance more affordable and more accessible for millions of Americans — most notably, premium tax credits to help with health insurance premiums, health insurance Marketplaces that offer comprehensive health coverage at prices that do not discriminate based on gender or health status, and expanded eligibility for Medicaid coverage in most states. These major components of the ACA have been operational since January 2014.

Through other data sources, we know that ACA implementation has led to sharp declines in the national uninsurance rate, with total uninsurance falling below 10 percent [PDF]. We can also look to the Marketplace enrollment reports to see that 9.9 million Americans held Marketplace coverage as of June 30, 2015, and we know from Medicaid enrollment data that 13.1 million [PDF] individuals have enrolled in Medicaid since full implementation of the law began.

Although the ASEC data is unlikely to mirror these most recent numbers since it looks at an earlier time frame in ACA implementation, it will supply important information about health insurance coverage. It will provide insight into key dynamics in health insurance that these other data sources do not capture — such as the relative roles of employer-sponsored coverage, Marketplace coverage, and Medicaid and the Children’s Health Insurance Program. And it will be important to see changes from the 2013 baseline in this widely-used data source. All of these data sources contribute to our understanding of how the ACA is working for women and their families.