The American Community Survey and Health Insurance Coverage Estimates

Possibilities and Challenges for Health Policy Researchers

This article explores the American Community Survey (ACS) and its emerging role as a data source of health insurance coverage to researchers and policy-makers. Over the past 10 years, the U.S. Census Bureau developed the ACS to inform health services research of official government estimates of the uninsured previously gathered each decade by the Current Population Survey (CPS). The article gathers that the ACS will lead to a better understanding of insurance coverage changes over time. 

Some of the ACS’ strengths include:

  • A larger sample size. The ACS sample size is 30 times larger than the CPS sample size, drawing a sample of 3 million U.S. addresses. This allows for more precise estimates at local and state levels of the uninsured and those eligible for public programs.
  • A clear, point-in-time measure. CPS measures uninsurance at any point in time over a given year, while ACS refers to coverage at the interview’s specific point of time.
  • Specific questions. The ACS asks about specific insurance coverage of each person within a household, opposed to a generic household question of coverage on the CPS.
  • A larger scope. The ACS is fielded to a larger population, including responses from nursing facilities, dormitories and prisons, as well as Puerto Rico.

The drawbacks to the ACS are the strong points of the CPS. The 30-year history of the CPS confirms trends over time. Additionally, the CPS better details the health insurance measurement, validating the information gathered as accurate.