Since the New York Times’ Robert Pear reported that the Census Bureau was changing its annual survey “so thoroughly that it will be difficult to measure the effects of President Obama’s health care law in the next report,” critics have charged that any measurement of the law’s ability to reduce the number of uninsured is inherently unreliable.
“It never stops. Obama Administration now changing the CENSUS survey in order to hide failure of Obamacare,” Rory Cooper, the communications director for House Speaker John Boehner (R-OH), tweeted. “Trust the govt’s big data! All statistically designed to support Obama’s agenda,” Amanda Carpenter, senior communications advisor to Senator Ted Cruz (R-TX) added.
Part of this claim rests on the tone of new questions. Until February of 2014, Census asked Americans if they had coverage at any point in the prior year. Now, the survey asks if they were insured “at the time of the interview.” The change allows for a more accurate response, but it could also deflate the total number of uninsured and suggest a sharp drop in the number of people without health care coverage. A test conducted in 2012 using the new questions did place the percentage of people without health insurance at 10.6 percent, “compared with 12.5 percent using the old version,” and found that “the percentage of people with private coverage was statistically higher.”
But far from obscuring the effects of the law, the changes — which have been in development since the Clinton administration — could provide a more precise measurement for how many people actually benefited from reform.
Census officials first began consulting with outside researchers and economists about how to elicit more accurate information about Americans’ economic status — including insurance, income, and poverty information — in the late 1990s, out of concern that outside organizations like Gallup were using more targeted questions to present a more informed picture.
The actual process of developing the new questions began in the Bush administration, but was not publicly announced until 2009. In that year, Census declared its intention to test new questions about health status, income, and poverty; in the years that followed, the agency conducted two tests and analyzed their findings. By September of 2013, Census concluded that the new method is far more precise than the old and opened the matter to public comment. In 2014, the agency officially made the switch and has been asking respondents about their current health insurance coverage, as well as their coverage throughout the entire year of 2013, in surveys over the past three months (collecting data for the 2013 period).
“Results from two separate national test of the new questions in 2010 and 2013 showed that the new method captured health insurance coverage better than the old method,” Census said in a statement. “Specifically, it improved the respondent recall of when they were covered by health insurance and then works backwards through time about specific months of coverage.”
While the switch has upset some researchers, who argue that the new questions will complicate the process of studying trends in health care coverage from past years, the comparison between the 2013 baseline, the last year before the ACA was fully implemented, and 2014, when coverage first kicked in, will rely on the same exact questions. This will offer an apples-to-apples comparison for the first year of reform and build more accurate data for the larger study of trends in the years that follow.