The U.S. Census Bureau added a question about health insurance coverage to the 2008 American Community Survey (ACS) leading to the release of the first set of estimates in September 2009. The purpose of adding health insurance content was to enable the U.S. Department of Health and Human Services and other federal agencies to more accurately distribute resources and better understand state and local health insurance needs.

Measuring health insurance coverage status in a survey is difficult because the topic is often confusing for survey respondents. Changing public programs, complex insurance and other health financing products, and employment benefits that vary over time make it difficult for even astute health consumers to interpret survey items. The optimal methods for collecting coverage data are not fully known. Given these difficulties it is not surprising that health insurance estimates vary widely between surveys and often disagree with administrative records (Congressional Budget Office, 2003 and Davern et al). Also, surveys that undergo design changes have been shown to impact the estimates of coverage (Nelson, 2001). Survey mode, reference period, coverage definitions, and overall survey complexity contribute to these variations.

The purpose of this paper is to introduce data users to the ACS health insurance data and to foster an understanding of the methodological challenges of collecting these data on the ACS. The first section describes how the Census Bureau will disseminate the data. The second section provides a brief overview of the ACS so that data users can understand the context of these new data. That section also discusses how the health insurance question was structured. The third section briefly covers challenges in collecting health insurance coverage in the ACS. The final section presents results from a preliminary evaluation of the new data. Study goals were to identify any anomalies apparent in the data, study reporting patterns, and show key estimates from the ACS alongside estimates from the Annual Social and Economic Supplement to the Current Population Survey (CPS ASEC) and the National Health Interview Survey (NHIS). The study was not meant to be comprehensive. The full report of the study is forthcoming.