The State Health Access Data Assistance Center (SHADAC) published its annual report “State Level Trends in Children’s Health Insurance Coverage” and it is an excellent state resource on children’s health coverage rates. Similar to Georgetown’s annual report on children’s health insurance, SHADAC reports on state-by-state coverage rates for children and provides additional data on children’s uninsurance rates over time (2010-2014) by income, race/ethnicity, and disability status at the state level.

SHADAC found that uninsurance rates for children with a disability declined significantly from 5.4% in 2013 and 4.2% in 2014. SHADAC attributes this decline with an increase in private coverage for this group of children. Notably, more than half (52.6%) of all children with a disability have public coverage.

There are a few differences between SHADAC’s reported data and CCF’s reported data – including age of children, data source, and income groups – that I have highlighted below. SHADAC has created an accurate and thorough data report and the explanation below serves as high-level talking points to explain the differences between the two studies.

Summary of Differences Between CCF and SHADAC Reports on Children’s Coverage Rates in 2014

Data Source

Both CCF and SHADAC use Census data from 1-year estimates of the 2014 American Community Survey (ACS). CCF uses pretabulated, summary tables from American Fact Finder (AFF). SHADAC, on the other hand, uses Public Use Microdata Sample (PUMS) data which provides the individual-level data points. In order to keep data confidential, PUMS includes only two-thirds of the cases contained in the larger dataset. PUMS allows researchers to generate more detailed and customized charts, but using a subset means the estimates are slightly different and slightly less reliable than AFF estimates.

Age

CCF reports uninsurance rates for children under 18 years of age (0-17 year olds). SHADAC reports uninsurance rates for children under 19 years of age (0-18 year olds). Because 18-year olds have higher rates of uninsurance than 0 through 17 year olds, their reported children’s uninsurance rate (6.3%) is slightly higher than CCF’s reported child’s uninsurance rate (6.0%) in 2014.

Children’s Poverty

CCF uses the poverty status provided by the Census. The Census determines an individual’s poverty status by comparing their income in the last 12 months to poverty thresholds that account for family size and composition, as well as various types of income. In the end, these end up being fairly close to the poverty levels that HHS uses.

In order to determine an individual’s poverty level and eligibility for various health programs, SHADAC uses a Health Insurance Unit (HIU) to define a family based on a new definition of the “family unit” to more accurately reflect an individual’s eligibility for various health insurance programs. Income is then divided by the federal poverty guidelines (FPG) used by the U.S. Department of Health and Human Services (HHS).

Elizabeth Lukanen, Deputy Director of SHADAC, helpfully gave the following example to illustrate how the HIU correction affects family income. Let’s say you have a family of four with two parents and two children. This family also lives with their uncle who is in his late twenties/early thirties. The Census would include all three adults (two parents and uncle) to determine the household’s income and assess federal poverty level.

We know, however, that the uncle is not expected to share a health care policy with the rest of the family. SHADAC removes the uncle’s income and considers him a separate health insurance unit from the family. This correction impacts adult health insurance rates more than children’s rates and generates more low-income households.

Also note that income breaks differ between the two studies. CCF breaks up children into four groups – children living in families with incomes below 100% of FPL, 100-199% of FPL, 200-299% of FPL, and above 300% of FPL. SHADAC breaks up children into three groups – children living in families below 138% FPG are “low-income,” between 139% and 400% FPG are “middle-income,” and above 400% FPG are “high-income.”

For more information, check out the methodology sections in both papers.