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Early PPACA census numbers coming in September

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The Census Bureau is getting ready to show what the new public health insurance exchange and Medicaid expansion programs have done to the U.S. health insurance market.

Managers of one bureau survey effort, the National Health Interview Health Survey (NHIS), plan to post the results Sept. 16 of NHIS interviews conducted from January through March. The Sept. 16 data release is supposed to include the first Census Bureau count of the number of people who bought qualified health plan (QHP) coverage from a public exchange.

The NHIS early release will also give the data on the number of people who have high-deductible coverage with a health savings account or health reimbursement arrangement and the number who have high-deductible coverage without a personal health account.

The NHIS team conducted the interviews to be used in the September release while the first Patient Protection and Affordable Care Act (PPACA) individual QHP open enrollment period was still in progress. Results from interviews conducted from January through June — when the open enrollment period was over — are supposed to come out in December, bureau officials said today at a meeting.

One challenge bureau survey programs face is that many consumers have no idea what kind of coverage they have, or whether the coverage they have should be described as public or private. Because of health insurance literacy problems, the gap between the number of people who say they have Medicaid coverage and the number who actually seem to have Medicaid coverage is large, officials say.

In 2008, for example, Medicaid program managers said they were covering about 50 million people. One Census Bureau survey, the Current Population Survey, found only about 38 million Medicaid enrollees.

Officials said long-term efforts to improve survey methods may cut the NHIS uninsured rate this year, by leading to an increase in the percentage of Medicaid enrollees counted, on top of any actual increase in Medicaid enrollment resulting from the PPACA Medicaid expansion program.

Michael O’Grady, a health policy expert who was previoiusly employed at the U.S. Department of Health and Human Services (HHS), said officials knew that critics could accuse them of artificially lowering the uninsured rate with survey process improvements. “However,” he said, “if there’s a better way to measure data on an important policy problem, and you don’t do it for fear of political heat, it’s professionally irresponsible.”


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