Factors associated with accurate reporting of public and private health insurance type

Objective: To examine factors associated with accurate reporting of private and public health insurance coverage. Data sources: Minnesota health plan enrollment records provided the sample for the Comparing Health Insurance Measurement Error (CHIME) study, a survey conducted in 2015 that randomly assigned enrollees to treatments that included health insurance questions from the American Community Survey (ACS) or the redesigned Current Population Survey Annual Social and Economic Supplement (CPS). Study design: Reverse record check study that compared CHIME study survey responses to enrollment records of coverage type (direct purchase on and off the Marketplace, Medicaid, or MinnesotaCare), service use, subsidy receipt, and duration of coverage from a major insurer. Data collection methods: Using matched enrollment and CHIME survey data and logistic regression, we examined correlates of accurate insurance type reporting, including characteristics of the insurance coverage, the covered individual, respondent, and family. Principal findings: Reporting accuracy across treatment and coverage type is high (77%–84%). As with past research, accurate reporting of public insurance is higher for people with characteristics consistent with eligibility for public insurance for both survey treatments. For the ACS treatment, reports of direct purchase insurance are more accurate for enrollees who receive a premium subsidy. Conclusions: Given the complexity of health insurance measurement and frequently changing policy environment, differences in reporting accuracy across treatments or coverage types are not surprising. Several results have important implications for data editing and modeling routines. First, adding premium and subsidy questions in federal surveys should prove useful given the finding that subsidy receipt is associated with reporting accuracy. Second, across both survey treatments, people whose opportunity structures (race, ethnicity, and income) match public program eligibility are accurate reporters of this coverage. This evidence supports using these commonly collected demographic variables in simulation, imputation, and editing routines.