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

OBJECTIVE

To evaluate the veracity of self-reports of month-level health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS).

DATA SOURCES AND STUDY SETTING

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.

STUDY DESIGN

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.

DATA COLLECTION/EXTRACTION METHODS

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.

PRINCIPAL FINDINGS

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.

CONCLUSIONS

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.

Can antipoverty programmes save lives? Quasi-experimental evidence from the Earned Income Tax Credit in the USA

OBJECTIVE

To estimate the impact of state-level supplements of the Earned Income Tax Credit (EITC) on mortality in the USA. The EITC supplements the wages of lower-income workers by providing larger returns when taxes are filed.

SETTING

Nationwide sample spanning 25 cohorts of people across every state in the USA.

PARTICIPANTS

793 000 respondents within the National Longitudinal Mortality Survey (NLMS) between 1986 and 2011, a representative sample of the USA.

INTERVENTION

State-level supplementation to the EITC programme. Some, but not all, states added EITC supplementation to varying degrees beginning in 1986 (Wisconsin) and most recently in 2015 (California). Participants who were eligible in states with supplementary programmes were compared with those who were not eligible for supplementation. Comparisons were made both before and after implementation of the supplementary programme (a difference-in-difference, intent-to-treat analysis). This quasi-experimental approach further controls for age, gender, marital status, race or ethnicity, educational attainment, income and employment status.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was survival at 10 years. Secondary outcome measures included survival at 5 years and survival to the end of the intervention period.

RESULTS

We find an association between state supplemental EITC and survival, with a HR of 0.973 (95% CI=0.951-0.996) for each US$100 of EITC increase (p<0.05).

CONCLUSION

State-level supplemental EITC may be an effective means of increasing survival in the USA.