# Presentation: 093404

## An Overview of the Small Area Health Insurance Estimates Program

- Joanna Turner, Robin Fisher,
- and David Waddington
- U.S. Census Bureau
- September 23, 2004

## Motivation for Estimates of the Uninsured

- Broad interest in health insurance coverage issues
- Not a question on the decennial census or the American Community Survey (ACS)
- State Children’s Health Insurance Program (SCHIP)

## Small Area Income and Poverty Estimates (SAIPE)

- Model-based estimates of median household income and poverty for states, counties, and school districts
- Uses survey data, administrative records, and decennial census data
- Estimates evaluated favorably by National Academy of Sciences NAS panel
- Estimates used by Department of Education and Health and Human Services

## Small Area Health Insurance Estimates (SAHIE)

- Extend SAIPE knowledge and methodologies to the area of health insurance coverage
- Estimates for all states and counties
- Estimates for various age groups
- Estimates of Mean Squared Error

## Experimental Estimates

- State
- Number of uninsured children 0-18 in households with income     200% of the Federal Poverty Threshold (SCHIP)
- County
- Total number of uninsured

## ModelCounty Total Insured

- Hierarchical Bayesian linear model

## Model (2)County Total Insured

- Response Variable:
- Insured Rate: Insured/Population
- Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS)
- 3 year average
- Log scale

## Model (3)County Total Insured

-      is the random effects term
-      is the sampling error term
- True Log Insured Rate is represented by

## Model (4)County Total Insured

- Predictor Variables:
- Administrative Records
- Tax data
- Medicaid Statistical Information System (MSIS): enrollment
- Food Stamp Program: number of participants
- Census 2000: demographic variables

## Variable SelectionCounty Total Insured

- IRS proportions  between multiples of FPT:
- (100%, 130%)
- (200%, 300%)

- Proportion eligible for Medicaid:
- Children ages 0-18
- Adults ages 35-64
- Hispanics
- Blacks

## Variable Selection (2)County Total Insured

- Census 2000
- Total Population
- Proportion Hispanic

- Food Stamps
- Number of participants

## ResultsCounty Total Insured

- Overall Fit is good
- Examination of p-values and plots
- Mean posterior coefficient of variation is about 6.0%

## Conclusions

- Research is promising
- Refine state and county models
- Model forms and data
- In the meantime, sum counties.
- We expect to produce experimental estimates for public examination soon

## Future Plans

- Include other groups
- Age groups
- SCHIP: 0-18,    200% Federal Poverty Threshold
- Model validation

## Questions for SDC

- Is there interest in these estimates?
- Would you like a chance to comment on the estimates before we move to producing them on a regular basis?

## Questions for SDC (2)

- Are you aware of data appropriate for validation of these estimates?
- What if there are administrative records available for some areas but not others?

## Further Reading

- “Health Insurance Estimates for States” by Robin Fisher and Jennifer Campbell
- “Health Insurance Estimates for Counties” by Robin Fisher and Joanna Turner

## Further Reading (2)

- “Small Area Estimation of Health Insurance Coverage from the Current Population Survey’s Annual Social and Economic Supplement and the Survey of Income and Program Participation” by Robin Fisher and Joanna Turner
- Available in November, 2004

## SAIPE website

- _[http://www.census.gov/hhes/www/saipe.html](http://www.census.gov/hhes/www/saipe.html)_
- SAHIE website coming in Spring 2005

## Contact Information

- (301) 763-3193
- hhes.sahie@census.gov