Health reform implementation

O-Care data is muddied by Census

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The Census Bureau is changing the way it calculates the number of people with health insurance, a move researchers say could obscure the true impact of ObamaCare.

The bureau is overhauling the questions on its annual health insurance survey to make sure people understand that they are being asked whether they had coverage in the previous year.


But the shift in methodology means that researchers will be comparing apples and oranges if they try to weigh data from the start of ObamaCare to the years after the initial launch, a so-called “break in trend.”

The change was first reported Tuesday by The New York Times and the timing was widely questioned by health researchers and journalists, who count on consistent data from the agency in order to write about ObamaCare.

“Altering the questions right now so that we can’t measure what’s going on is terrible,” Aaron Carroll wrote on the influential healthcare blog “The Incidental Economist.”

Carroll is a professor of pediatrics at Indiana University School of Medicine and one of the blog’s editors.

“If [the questions] were so bad they needed altering, a few years ago would have been better. Or, a few years from now. But right now? It’s killing me,” he said.

Republican lawmakers attacked the change as the latest in a series of moves by the administration to hide the numbers on ObamaCare.

“This administration seems to always have some excuse for why it can’t provide clear data to show, for all the chaos the law caused, how many uninsured people actually gained coverage,” said Brendan Buck, a spokesman for Speaker John Boehner (R-Ohio).

“We may never know [how many gained coverage] — and the administration seems just fine with that,” added House Energy and Commerce Committee Chairman Fred Upton (R-Mich.).

Administration officials said the changes were not political and argued they would address problems with the survey that academics have pointed out for years.

“There’s consensus that the [Census] was never good at measuring the uninsured,” Kaiser Family Foundation senior vice president Larry Levitt tweeted on Tuesday.

One flaw in the survey was that respondents would report whether they had insurance at the time they were contacted, rather than addressing whether they had coverage in the previous year, according to a 2013 regulatory notice by the Census Bureau.

The questionnaire has been redesigned to break this pattern, officials said.

The updated system also asks whether respondents obtained health coverage on the ObamaCare exchanges and whether the federal government subsidized their plans.

Responding to the outcry over the change in methodology, the Obama administration noted that the changes to the survey were announced in the Federal Register in 2013 and received public comment at that time.

Officials also pointed to one crucial comparison with the pre-ObamaCare era that will still be possible in spite of the shift.

A report that will be released this fall will use a new methodology in counting how many people had health insurance each month last year, particularly in the fall, as plan cancellations swept the market.

Then, the next report will provide comparable data on what happened after ObamaCare’s coverage expansion took full effect this year, between the exchanges and new Medicaid recipients.

That 2013-2014 comparison is important for understanding how many people gained health coverage in the law’s first enrollment period.

So far, that number has been hard to calculate, especially because people are entering and exiting the exchanges all the time based on qualifying life events like marriage or job loss.

The administration tends to report figures that are cumulative rather than a snapshot of how many people remain in the exchanges at any given time.

Last week, outgoing Health and Human Services Secretary Kathleen Sebelius announced that enrollments in ObamaCare had surpassed 7.5 million people.

An additional 3 million people had enrolled in Medicaid between Oct. 1 and Feb. 28, the administration recently said.

In total, the Congressional Budget Office (CBO) estimated Monday that 12 million additional people have obtained health insurance this year who would not have had it without the healthcare law.

But the budget scorekeepers did not raise its total projected exchange enrollment figure past 6 million for 2014.

A complex average, the CBO estimate reflects people who will enter and leave the exchanges over the course of 2014.

The number reflects the number of people who will pay for their coverage, while the administration reports enrollment as people who merely chose plans.

Tuesday marked another important day in the enrollment process. April 15 was the final chance for people who said they struggled with to sign up for plans.

The end of the special enrollment period means the administration can now tabulate the total number of people who picked plans on the exchanges since Oct. 1.

New numbers are expected this week, but they will likely only reflect sign-ups that took place through March 31, the end of the official six-month enrollment period.

This story was updated at 7:55 p.m.

Tags Boehner Health insurance John Boehner Kathleen Sebelius Patient Protection and Affordable Care Act
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