Experimental health insurance estimates for low-income and demographic groups by state

Since 1987, the Census Bureau has published state uninsured rates as part of the Current Population Reports series. Estimates for children under age 19 who are at or below 200 percent of the federal poverty level, all children aged 0–17, people under 65, and all ages are published on the website (Census Bureau 2007a). The Census Bureau's Small Area Health Insurance Estimates (SAHIE) program published county-level modeled estimates of the number of uninsured by age (0–17 and total) and, at the state level, number of uninsured by sex, age, race/ethnicity, and income-to-poverty ratios (Census Bureau 2007b). Data on health insurance coverage for all counties are not available elsewhere because the Census 2000 does not ask this question. The American Community Survey contains questions on this topic as of the 2008 survey. However, those data are not available yet. National surveys, such as the Annual Social and Economic Supplement (ASEC) of the Current Population Survey (CPS), do not have sufficient sample size or full representation in all counties to provide survey estimates at the county level. The limited state-level sample size in the CPS ASEC direct survey estimates means that partitioning age groups further into race, sex, and ethnicity categories results in unacceptably high variance. The SAHIE program publishes small area estimates for health insurance that incorporate age, race, sex, and Hispanic origin by income-to-poverty ratios. This project is partly funded by the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The main criteria of eligibility of the early detection program are that women are uninsured and have a low income. The CDC program will be enhanced by precise estimates for participation rates and identification of underserved populations at the state and the county level. One of the motivations for creating these estimates is to provide small area estimates for health insurance similar to the Small Area Income & Poverty Estimates (SAIPE) program. The SAIPE program has model-based estimates of poor persons by age. The geographies include states, counties, and school districts. The Department of Education uses these estimates to allocate Title 1 funds. Before the SAIPE estimates, the state estimates varied substantially and the county and school district estimates were only available from the decennial census. The goal of the SAHIE program is to produce similar estimates for the low-income uninsured population. When there are no alternative estimates of health insurance coverage for a small area, any of the small area techniques will give estimates of coverage rates for specific areas. This paper describes the usefulness of a particular small areas approach that is beneficial because it is consistent across states. These estimates fill a need for accurate uninsured estimates for states (Blewett and Davern 2006) as well as estimates by age, race, sex, and ethnicity. The focus on the state-level model, as opposed to the county-level model, is because of its capability to produce uninsured estimates by income groups.