Abstract:
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The American Community Survey (ACS) is an essential tool for monitoring changes in health insurance coverage that resulted from the Affordable Care Act (ACA). However, like all surveys the ACS imperfectly measures health insurance coverage type. Importantly, the ACA will likely affect the quality of health insurance measurement in the ACS. Reasons include (1) the use of a "no wrong door" policy to determine both marketplace subsidy and Medicaid eligibility (2) the varied implementation of the marketplaces (state-based, federally facilitated or federal-state partnership) and (3) the implementation of the Medicaid expansion. This paper investigates how aggregated estimates of public coverage enrollment from the ACS compare to administrative enrollment totals by state and year through 2014, the first year of full ACA implementation. We investigate if levels and changes over time in the discrepancy between the ACS and administrative sources are correlated with state level policy variation in ACA implementation (i.e. Medicaid expansion, exchange type, etc.).
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