Categorization of Health Insurance Coverage Type from Survey Questions after Health Reform: The Case of the Current Population Survey

Abstract

Measuring health insurance in surveys has always been challenging, and the Affordable Care Act (ACA) introduced considerable ambiguities. For example, the public/private line was blurred with the introduction of marketplace coverage, which is considered private coverage even though in some cases, it is partially or fully subsidized by the government. This study uses a rigorous design where administrative records are linked to survey data. We compare alternative algorithms that employ survey data points found in several major national surveys to categorize coverage type, focusing on the very difficult challenge of separating private marketplace coverage from public coverage. This is important, given researchers’ and policymakers’ need to produce estimates of public versus private coverage from survey data. Results indicate that integrating a data point on plan name reduces a more simplistic algorithm’s overestimation of marketplace coverage and results in significant improvements in accurate categorization across public and private coverage types.