By Michael Tanner
Monday, April 28, 2014
Last week, the New York Times reported that the Census
Bureau would be significantly changing the questions and methods it uses to
determine who has health insurance. The redesign is an attempt to address some
of the flaws in the current design that have long troubled the agency. A
working paper from the Census Bureau had found that it provided an “inflated
estimate of the uninsured” and was prone to “measurement errors” that
diminished the reliability and usefulness of the measure.
The timing of this change could hardly be worse. The
massive coverage provisions of the health care reform have just taken effect,
and these new changes could make comparisons to past years difficult, or
meaningless. Another document from the agency explains that the questions would
elicit such different responses that “it is likely the Census Bureau will
decide that there is a break in the series for the health insurance estimates.”
As the Times reports, the differences in responses
between the two sets of questions are significant; in a trial run last year,
the percentage of people without health insurance was 10.6 percent with the new
questionnaire, compared with 12.5 percent using the old version, with similar
effects across all demographic groups.
Some defenders of the decision have pointed out that
these new questions will also give data for 2013, so there will be at least one
year of pre-ACA data to compare to. This is true, and having at least one data
point will be helpful to some extent, but what we really want to evaluate when
analyzing the law would be the longer term trend, for two reasons. One, there
is a decent amount of variation in these surveys that make single data points
less informative. Two, while the major coverage provisions of the law take
effect in 2014, the law has already been influencing the insurance market in
smaller ways since its passage, and more than half of the reduction in the
uninsured will occur after 2014, according to the Congressional Budget Office.
This is why having a stable baseline would be useful, so we could examine the
longer term trends in insurance coverage, and why now is close to the worst
time to incorporate this change. The Census Bureau acknowledged as much in a
paper, admitting that “[i]deally, the redesign would have had at least a few
years to gather base line and trend data.”
Some critics of the law have voiced some suspicion as to
possible political motivations for the timing of this change, seeing it as an
attempt to obscure the effects of the law and make it harder to get reliable
estimates. They cite the fact that some of the new questions were requested by
the administration, and that senior officials had knowledge and approved of
these pending changes.
I do not think conspiracy is the answer, but the real
reason for this Census change is just as troubling, if not more so:
incompetence.
The sheer amount of negative attention that these planned
changes have gotten likely outweighs whatever political gains the
administration could have hoped to capture in the first place. Aside from that,
there are numerous other organizations, like Gallup, that measure health
insurance coverage, so skeptics of the law will have other sources of data to
turn to. If anything, it would appear that the White House was trying too hard
to make sure they did not appear to be meddling in the affairs of the Census
Bureau, which had unwisely planned to roll out these changes at an inopportune
moment. Why this change was the line in the sand that the administration dared
not cross when it has shown no such restraint in delaying many aspects of the
law itself, such as the employer mandate, is hard to comprehend, but paints a
picture more of an administration flailing to put out fires as they arise,
rather than one even capable of pulling of the long term planning and
coordination required for such a scheme.
While it appears the administration could have intervened
and delayed the rollout of the new questions, they were not the driving force
behind the changes. If anything, this was a mistake of what they chose not to
do, rather than what they did.
These problems of coordination and competence within the
government, where one government agency appears to be proceeding along with
little to no regard or understanding for the broader context in which it
operates, is in some ways more troubling, especially when we are talking about
the massive new government foray into a sector that consumes almost 18 percent
of our economy.
If they cannot even coordinate the measurement of health
insurance effectively, how can they implement the law itself?
The administration has a chance to partially remedy their
mistake. Republicans in both chambers have already introduced legislation to
either delay the new questions or to use both sets concurrently for the next
few years to establish a better baseline to look at the effects of the law on
health insurance coverage.
Government, as inefficient and incompetent as it often
is, can sometimes make honest mistakes, which I think this likely is; however,
these mistakes should raise serious concerns about government’s abilities as it
seeks to spread into even more aspects of the economy and our lives.
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