One of the big unknowns about Obamacare is what effect it has
had on reducing the number of uninsured in America. Over the last
few months, we’ve seen a number of attempts to measure this, but
they’ve all been relatively narrow surveys that for a variety of
reasons don’t provide a complete picture. As a result, many
analysts on both sides of the debate generally agreed that the best
way to answer this question would be to use information gathered by
the Census Bureau, which provides some of the most consistent,
comprehensive data on the nation’s uninsured.
Well, now it looks like we won’t be able to use the Census to
determine the health law’s effects on insurance coverage over time.
That’s because the Bureau is in the process of radically altering
the way it asks questions about insurance status. The update will
render useless comparisons between data reported last year and data
reported this year,
according to The New York Times.
The Census
Bureau, the authoritative source of health
insurance data for more than three decades, is changing
its annual survey so thoroughly that it will be difficult to
measure the effects of President Obama’s health
care law in the next report, due this fall, census
officials said.
The changes are intended to improve the accuracy of the survey,
being conducted this month in interviews with tens of thousands of
households around the country. But the new questions are so
different that the findings will not be comparable, the officials
said.
An internal Census Bureau document said that the new
questionnaire included a “total revision to health insurance
questions” and, in a test last year, produced lower estimates of
the uninsured. Thus, officials said, it will be difficult to say
how much of any change is attributable to the Affordable Care Act
and how much to the use of a new survey instrument.
The Times reports that the update was not politically
motivated, and that it was made in the interests of gathering more
accurate data. The old survey methodology is said to have been
prone to measurement errors that overestimated the number of
uninsured; the new data supposedly corrects that problem.
Now, to be clear, the change will give us one year of
pre-expansion data: The new measurement methodology
will start with 2013, which means we’ll be able to compare last
year’s insurance pre-coverage-expansion stats with this year’s.
That will give us some sense of the changes under the Affordable
Care Act. But there are still big problems with the timing of the
transition. As Aaron Carroll notes, it still
destroys the long-term trendline. The trend info would have had
a lot of value generally, and also would have set the 2013 results
in a helpful context. Now it’s going to be difficult to discern the
impact of the upheavals that we saw in the health insurance market
in 2013, which featured, among other things, large unexplained
spikes in coverage, and the cancellation of millions of individual
insurance policies.
This is infuriating and unfortunate. Ignore, for a moment, how
politically convenient it is. It’s just poor social measurement.
If the interest is in getting the best and most useful data
possible, then we should want a time series without breaks or
alterations, one that can be used to reliably compare the years
before and after the single largest and most controversial policy
change intended to affect the provision of health insurance in the
last four decades. One might think that creating a consistent
measure for this effect would be a priority for people whose job is
to create socially useful guides to the makeup of the nation’s
population. Apparently not. The data may be more accurate going
forward, but it will be far less useful for measuring this crucial,
once-in-a-generation transition.
As to whether this is politically motivated, there’s no evidence
that it is. And I would be surprised if this move were
intentionally cooked up simply to obscure the figures. But back
in 2009, the White House moved to exert more direct control
over the Census Bureau and its operations. What that means is that,
at the very least, the White House should have been
involved. If the Obama administration was truly concerned about
transparency in measuring the impact of the health law, then its
officials should have known about the change, should have noted it
publicly before the end of the open enrollment period, and should
have pushed to stop or delay it.
Because as it stands now, we simply won’t have the robust
information set we need to confidently assess the impact of the
Affordable Care Act on the uninsured over time. Nor will we have a
good picture of exactly how Obamacare is affecting various types of
coverage—the particular ways in which people are, or aren’t,
accessing health insurance under the law.
These aren’t the sort of questions you can answer based on first
principles, or what feels right. You need robust measurements.
Solid Census Bureau data, taken consistently over time, would have
helped answer these questions. But it appears that’s not something
we’re going to have. Instead, we’ll be left with ongoing arguments
and unanswered questions, especially if the administration
continues to keep mum on other critical unanswered questions about
the law. A decade from now, we’ll be able to definitively determine
that Obamacare was a thing, that happened, and did something, and
cost some money. But that may be as much as we can know.