Number 6, August 2004



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Q&A with Mary Harrington, ERIU

Mary Harrington, a Research Investigator with ERIU and formerly with Mathematica Policy Research, Inc., has spent 14 years investigating different issues involving health insurance coverage for low-income populations. Harrington talks about the importance of researchers and policymakers looking at other data sources on the uninsured and not over-relying on Current Population Survey (CPS).

Q: What is the purpose of ERIU compiling Fast Facts?

A: We’re trying to make health policymakers and researchers with an interest in the uninsured aware of how much difference it can make when you look at statistics about the uninsured from different data sources and at different points in time or reference periods. Researchers and policymakers can use the Fast Facts data to answer numerous questions about the magnitude, characteristics, and distribution of the uninsured over different time frames and data sources.

Q: What do the Fast Facts show or highlight?

A: You notice there are differences between people who are uninsured for an entire year, the chronically uninsured, and those uninsured for some portion of the year. Also, the part-year uninsured includes people who cycle in and out of coverage as well as those who are insured for only a short time during the year. When bringing in information from the SIPP (Survey of Income and Program Participation) and MEPS (Medical Expenditure Panel Survey) data, instead of just looking at CPS data, we can actually distinguish between the chronically and part-year uninsured.

Q: Why is this important?

A: People who are uninsured for an entire year, the chronically uninsured, are distinct from those uninsured for some portion of the year. And the part-year uninsured includes people who cycle in and out of coverage as well as those who begin or end a spell without coverage during that year. Policies targeted to the chronically uninsured are likely to differ from the kinds of policies needed for those who change from one status to another and experience a brief period without insurance.

Q: Summarize the CPS, MEPS, and SIPP data sets, and how are they different?

A: The Bureau of the Census sponsors both the Current Population Survey and SIPP. MEPS is sponsored by the Agency for Healthcare Research and Quality. The CPS is a survey conducted annually on a cross section of the population, generating national estimates on different topics. It is really the best source of information on historic trends, as CPS has tracked information about the uninsured for many years. CPS is commonly used for data on the uninsured because its release is timelier. CPS information on the uninsured is supposed to measure the number or portion of people uninsured during the entire year. SIPP and MEPS aren’t the only other data sources available for statistics on the uninsured, but they are more commonly used. These are both set up as longitudinal surveys to interview the same households and the same individuals multiple times over the course of four years for SIPP, and two-and-a-half years for MEPS. As a result, there’s an opportunity with these two data sources to construct a profile of how people’s insurance/uninsurance status changes in a year.

Q: How do MEPS and SIPP paint a more comprehensive picture of the uninsured than CPS?

A: They allow us to look at the dynamics of coverage, how it changes over time. They allow us to look at and compare groups who are uninsured all year versus those who are uninsured for a portion of the year. Both of those things are not possible when you look at a data source like CPS.

Q: Do policymakers tend to think of the chronically uninsured when they craft policy solutions to address the uninsured problem?

A: I think so. I think there is a sense of higher priority given to individuals who are thought of as chronically uninsured. There isn’t enough recognition that there are plenty of people who experience gaps in coverage during the year, and that this group includes a lot of very vulnerable people as well.

Q: What specifically can MEPS and SIPP tell us that CPS can’t?

A: For some populations it doesn’t seem to matter which data source you use, as you’re able to tell a very similar story. But for certain groups, including children, the self-employed, Hispanics, and immigrants, it really does seem to make a difference when you look at the all-year vs. part-year distinctions. When looking at MEPS and SIPP we see children are particularly at risk for experiencing gaps in coverage throughout the year, and they are less likely than average to experience a lack of coverage throughout the entire year. Children are more likely to be covered under public programs, and turnover is greater in public programs than it is in employment-based and other private coverage. But it’s also the case that children who are covered as dependents under employment-based coverage experience more transitions through the year than adults. Those are the kinds of things you can tease out.

Q: What do you hope people better understand as a result of Fast Facts?

A: I hope that there will be a greater awareness of the part-year uninsured. And that the strategies we need to help solve the problem for those populations are going to differ from the strategies we would need to help solve the chronic uninsurance problem. Particularly as we think about policy solutions for the uninsured, we need to have data available that will allow policymakers to estimate the size of this population more precisely and to identify the characteristics of those chronically uninsured and those moving in and out of coverage. Not all research questions require the use of these alternative sources. Some research questions will still be best addressed through data from the CPS.

Things change about people over time. Income changes, employment status changes, wages change, family status changes over time. And so does insurance status. To the extent that someone loses and gains coverage and experiences those changes, we need to be mindful of that. If we define the population that we help in terms of who needs help on a given day, we’re going to miss a lot of people who are going to need help tomorrow or needed it yesterday.

Q: How could policies be more specifically targeted to address the different types of uninsured?

A: A person who lacks insurance throughout the year may very well benefit from policies that would expand public coverage or make affordable employer-based coverage available to them. Whereas the people who are cycling in and out of coverage during a year, and who are experiencing of periods of being uninsured, are going to benefit from policies that would either allow them to keep insurance once they get it.

Q: What do we need to keep in mind when we read about 43.6 million uninsured Americans?

A: We need to realize the number of people who are uninsured is much larger than 43 million. More than 60 million are uninsured at some time during the year, and the number can be as high as 80 million if you expand your view to a period of two years. Uninsurance touches an awful lot of people’s lives. This is not a uniformly unemployed, low-income group of people. It’s a very diverse population that includes working families who are middle-income and upper-income, as well as very vulnerable families and adults. This is a dynamic population, and we can’t lose sight of that. The 43.6 million we would identify on any given day are not necessarily the same 43.6 million that we would identify six months later. We need to start thinking about being uninsured as periods of uninsurance that people experience.

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Funded by The Robert Wood Johnson Foundation, ERIU is a five-year program shedding new light on the causes and consequences of lack of coverage, and the crucial role that health insurance plays in shaping the U.S. labor market. The Foundation does not endorse the findings of this or other independent research projects.