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The American Community Survey and health insurance coverage estimates: possibilities and challenges for health policy researchers.

Article Excerpt
The American Community Survey (ACS) is poised to evolve from an unknown entity among the health service research community to one of the most critical data sources for state and local health insurance coverage policy researchers over the next few years. The ACS will be an important new resource for health policy research, with significant advantages over the Current Population Survey (CPS), the major U.S. survey currently used for this purpose (Blewett et al. 2004). However, there are significant challenges associated with using the ACS for health policy analysis that will need to be addressed.

The U.S. Census Bureau has been rolling out the new ACS over the past decade. The ACS was designed to replace the information that was traditionally gathered every 10 years as part of the decennial census "long form" and to improve intercensal estimates. The ACS is conducted every year and includes a wider range of content than the long form, and began including health insurance coverage in 2008 with the first health insurance estimates to be released in 2009. In contrast to most national surveys, the ACS will provide estimates at not only the state level, but also at substate levels of geography such as cities, counties, and even census tract levels (U.S. Census Bureau 2006a). In this paper, we highlight the strengths and weaknesses of the ACS relative to the CPS for use in health policy research.

OVERVIEW OF THE ACS

The ACS is an annual mixed-mode household survey that draws a sample of three million U.S. addresses (including households and institutional group quarters) per year (U.S. Census Bureau 2006a). This is roughly 30 times larger than the sample size of the Annual Social and Economic Supplement to the CPS, which also collects health insurance data (U.S. Census Bureau 2002). The ACS was designed by the Census Bureau to replace the Decennial Census "long form" that was given to a sample of 16 million U.S. households in Census 2000. The ACS collects its sample in all 3,141 counties (or county equivalents) in the United States every year. Starting in 2006, the ACS began collecting data from people living in institutionalized group quarters as well. The ACS became fully operational for residential addresses in 2005 and group quarters in 2006 (U.S. Census Bureau 2006a).

The ACS is conducted as a sequential mixed-mode survey. Sampled households are first sent an ACS questionnaire by mail and nonrespondents to the mail survey are contacted via telephone to complete the survey. Finally, a sample of remaining nonrespondents is selected for an in-person survey component. This sequential contact protocol results in a very high response rate of 96 percent for the ACS (versus 84 percent in the CPS). At the end of each year, all the data collected from the preceding year are processed into a single data file for each year. The annual ACS data products are therefore a rolling average of the preceding calendar year (U.S. Census Bureau 2006a, b).

ACS Survey Content and the ACS Health Insurance

The ACS contains most of the items that were included on the decennial census long form, including income (and the derived measure of poverty), disability status, marital status, education, occupation, home ownership, value of household, amount of mortgage on housing unit for owners or amount of rent paid for renters, and travel to work. See Table 1 for more details on the ACS content.

The ACS health insurance question will be asked about each person in the household separately. The question appears on the mail questionnaire as shown in Figure 1. (1) The health insurance question was developed by the Census Bureau after assessing several different possibilities in an attempt to maximize reliability while minimizing under-reporting and item nonresponse (Nelson and Ericson 2007) and preserving administrative simplicity. The ACS question asks about insurance at the time of the survey.

ACS Data Products and Release Schedule

The ACS will produce two main types of data products that will be released in late summer of each year: a set of predefined summary tables that make use of the information collected from all the respondents, and a 1 percent public use microdata sample (PUMS) (U.S. Census Bureau 2006a). The predefined summary tables will generally...

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