Using enrollment records to evaluate self-reports of monthly coverage in the redesigned current population survey health insurance module.

Abstract

To evaluate the veracity of self-reports of month-level health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS). The CHIME (Comparing Health Insurance Measurement Error) study used health insurance enrollment records from a large regional Midwest insurer as sample for primary data collection in spring 2015. A sample of individuals enrolled in a range of public and private coverage types (including Medicaid and marketplace) was administered the CPS health insurance module, which included questions about month-level coverage, by type, over a 17-18-month time span. Survey data was then matched to enrollment records covering that same time frame, and concordance between the records and self-reports was assessed. Sample was drawn by the insurer's informatics specialists and Census Bureau interviewers conducted the survey. Following data collection, updated enrollment records were matched to the survey data to produce a person-level file of coverage by type at the month-level. For 91% of the overall sample, coverage status and type were reported accurately for at least 75% of observed months. Results varied somewhat by stability of coverage. Among those who were continuously covered throughout the 17-18 month observation period (which comprised 64% of the overall sample), that level of reporting accuracy was observed for 94% of the sample; for those who had censored spells (34% of the overall sample), the figure was 87%; and among those with gaps and/or changes according to the records (2% of the overall sample), for 82% of the group at least 75% of months were reported accurately. Findings suggest that reporting accuracy of month-level coverage in the CPS is high and that the survey could become a valuable new data source for studying the dynamics of coverage, including the Medicaid unwinding.