MEPS: A National Information Resource to
Support Health Research and Inform Policy
and Practice
Steven B. Cohen PhD
Joel W. Cohen PhD & Jessica C. Banthin PhD
Presentation
 AHRQ mission
 MEPS overview
 Program outreach and impact
 Research Update
 Modeling and Simulation Studies
 MEPS Data Products and Dissemination
AHRQ Mission Statement
To improve the quality, safety, efficiency,
and effectiveness of health care for all
Americans.
AHRQ A
Activities
ti iti
 Knowledge Creation
– Creating data, research findings and tools
 Synthesis and Dissemination
– Disseminating information to multiple
stakeholders to improve the system
 Implementation
– Partnering with stakeholders to implement
proven strategies for health care
p
improvement
Medical Expenditure Panel
Survey (MEPS)
Annual Survey of 14,000 households:
provides national estimates of health care
use, expenditures,
di
iinsurance coverage,
sources of payment, access to care and
health care quality
Permits studies of:
 Distribution
Di t ib ti
off expenditures
dit
and
d sources off
payment
 Role of demographics, family structure,
insurance
 Expenditures for specific conditions
 Trends over time
MEPS Components
 Household Component (HC)
 Medical Provider Component (MPC)
 Insurance Component (IC)
MEPS Household Component
Sample Design
Oversampling of policy relevant domains
1996
Minorities (Blacks & Hispanics)
1997
Minorities
Low income
Children with activity
y limitations
Adults with functional limitations
Predicted high
g expenditure
p
cases
Elderly
1998--2001
1998
Minorities
2002--2008
2002
Minorities, Asians, Low Income
2009+
Minorities, Asians
14,000 households; ~32,000 persons
HC - Purpose
 Estimates annual health care use and




expenditures
p
Provides distributional estimates
S
Supports
t person and
d family
f il llevell
analysis
Tracks changes in insurance coverage
and
a
de
employment
p oy e t
Longitudinal design; linkage to NHIS
Key Features of MEPS
MEPS--HC
 Survey of U.S. civilian noninstitutionalized population
 Sub
Sub--sample of respondents to the National Health
Interview
I t i
Survey
S
(NHIS)
–
Linkage to NHIS
 Oversample of minorities and other target groups
 Panel Survey – new panel introduced each year
– Continuous data collection over 2 ½ year period
– 5 inin-person interviews (CAPI)
– Data
D t from
f
1st
1 t year off new panell combined
bi d with
ith
data from 2nd year of previous panel
MEPS Overlapping Panels
(Panels 13 and 14)
MEPS Household
Component
MEPS Panel 13 2008-2009
1/1/2008
NHIS
2007
Round 1
1/1/2009
Round 2
Round 3
NHIS
2008
Round 1
Round 4
Round 2
Round 5
Round 3
MEPS Panel 14
2009-2010
Round 4
Round 5
MEPS - Integrated Survey
Design Features
 National Health Interview Survey
serves as sample frame for
Household Component
C
 Linked survey of medical providers
 Linkages to secondary data sources
 Census Bureau Business Register
serves as Insurance Component
sample frame
Evaluation of Accuracy of MEPS after
Adjustments for Survey Nonresponse
 MEPS has overlapping panel design: 1st year of new




panel combined with data from 2nd year of previous
year’s panel to yield annual data
Multiplicative response rates: product of NHIS RR and
MEPS RR (multiplicative function of round specific RR:
3 rounds for new panel/5 rounds for old panel)
Detailed adjustments for survey nonresponse:
NHIS to MEPS round 1/MEPS round 1 to round 3: to
derive annual estimates for year t
MEPS round 3 to round 5: annual estimates for year
t+1.
Medical Provider
C
Component
t
Purpose
 Compensate for household item
nonresponse
 Gold standard for expenditure estimates
 Greater accuracy and detail
 Imputation source
 Supports methodological studies
Medical Provider
C
Component
t
Targeted Sample
 All associated hospitals and associated
physicians
 Sample of associated office
office--based physicians
 All associated home health agencies
 All associated pharmacies
p
Data Collected
 Dates of visit
 Diagnosis and procedure codes
 Charges
Ch
((exceptt R
Rx)) and
d payments
t
Collection of Rx Data in
MEPS
 ~8,000 pharmacies sampled annually
– data on prescribed medicines purchased by
h
households
h ld
 Data obtained:
– Medication Name
– National Drug Code (NDC)
– Quantity Dispensed
– S
Strength
e g a
and
d Form
o
– Sources of Payment
– Amount Paid by Each Source
Sources of Expenditure Data
by Event Type
Event type
OB: Physician
OB NonOB:
Non
N -Physician
Ph i i
IP
OP
ER
DN
RX
HH: Agency
HH: Paid independent
OM
HC
yes
yes
yes
yes
yyes
yes
no*
no
no
yes
yes
MPC
yes
no
yes
yes
yyes
no
yes
yes
no
no
MEPS Insurance
Component
Annual survey of 40,000 establishments
National and State Level estimates of employer
sponsored coverage:
 Availability
y of health insurance
 Access to health insurance
 Cost of health insurance
 Benefit and payment provisions of private
health insurance
Published Estimates from the
MEPS--Insurance Component
MEPS
 Each year the MEPSMEPS-IC produces 280 tables of
State-level estimates for private
Stateprivate--sector employers:
– Premiums,
Premiums
– Contributions,
– Enrollments,
– Take
Take--up rates, and
– Other (i.e., percent of employees with a choice
of p
plans))
 Survey began in 1996 with estimates for 40 States
 Since 2003,
2003 estimates are available for all States
Current Capacity
AHRQ’s MEPS data and research findings
provide national and state specific estimates
of:
f
 the uninsured population – by length of time,
availability of offers, income level
 the characteristics of employer sponsored
coverage – availability, employee take up,
premium costs (employer/employee)
 health care utilization, expenditures, source of
payment, and health status profiles by
iinsurance
nsurance coverage status
Research
esea c o
on Health
ea t Insurance
su a ce
 Tracks overall health insurance status of the
U.S. p
population
p
– Estimates of uninsured by population
characteristics
– Duration of spells of uninsurance
– Trends in estimates of the uninsured
 More focused research examines
– Factors
ac o s assoc
associated
a ed with insurance
su a ce take
a e up
– Financial consequences of being uninsured
– Relationship between uninsurance and health
status
MEPS
Definition and estimation of uninsured
 Types of estimates of uninsured – calendar
yyear focus:
1. First half of calendar year
2 Annual profiles
2.
3. Two consecutive years
4 Point in time
4.
5. Long
Long--term uninsured: 4 consecutive years
 As
A a longitudinal
l
it di l survey MEPS can examine
i
health insurance dynamics, changes in
coverage and spells without insurance
coverage,
Health insurance status of civilian
noninstitutionalized population under age
65,first half 1996-2009
Private
Public only
Uninsured
80
70
60
68.7
69.2
70.4
70.4
69.9
69.1
67.9
67.1
65.8
64.9
65.0
63.1
61.7
61.8
19 0
19.0
19 5
19.5
20 6
19 4 20.6
19.4
22.0
21.0
15.2
15.6
15.6
Percent
50
40
30
19 2 18.9
19.2
17.8
17.9
18.2
18.8
18.5
18 8
18.8
20
10
12.1
11.9
11.8
11.7
11 9
11.9
12 1
12.1
13 5
13.5
14 2
14.2
16.3
16.3
17.1
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: Center for Financing, Access, and Cost Trends, AHRQ, Medical Expenditure Panel Survey, Household Component
Summary Tables 1996–2009
MEPS, 1996–2009:
Number of uninsured, under age 65
Any time in year
First half of year
Full reference period
80
Num
mber in milllions
64.0
64.0
60.9
60
44 5
44.5
44 2
44.2
42.0
60.4 62.6
42.6 43.8
64.1
45 7
45.7
64.2
64.0 65.8
47 0
45 9 47.0
45.9
48.1
66.7
49.8
68.3
50.1
70 7
70.7
53.5
74 4
74.4
57.4
55.3
40
20
31 6
31.6
33.3
32 3
32.3
30 1
30.1
32 3
32.3
33 0
33.0
33 7
33.7
34.8 36.0
36.5 37.4
39.9
40.7
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel
Survey, 1996–2008 Full-Year Files and 1996–2009 Point-in-Time Files
Economic Research
Infrastructure
 Data infrastructure to support intramural, extramural
work on cost and financing, efficiency and quality,
access, disparities.
– Significant intramural expertise and activity
– Large and growing use by extramural researchers
 Data Center onon-site for work with MEPS
 The link between research and data
– Substantive expertise reflected in design of AHRQAHRQ-
sponsored data resources and tools
– Maintain and increase quality
quality, integrity
integrity, and relevance
through researcherresearcher-informed data improvements,
substantive and technical assistance
Assistance to Congress on Coverage
Trends and Cost
 Provision of AHRQ research findings to inform
health policy
– national
ti
l estimates
ti t off the
th long
l
term
t
uninsured
i
d
– estimates of the number of uninsured children
eligible for CHIP
– state estimates of the availability and cost of
employer sponsored coverage
– concentration of health care expenditures
 Fast
Fast--track responses to requests from CBO, CRS,
Senate and House Committees and
Congressional staff
Support for Health Reform
Recent Collaborations
 Chronic Disease Cost Calculator
– CDC, National Association of Chronic Disease
Directors,
Directors National Pharmaceutical Council
– MEPS
MEPS--based tool to calculate prevalence
prevalence--based
state--specific Medicaid and total cost estimates
state
for heart disease, stroke, hypertension, congestive
heart failure, diabetes, and cancer
– Currently expanding to additional conditions
– http://www.cdc.gov/chronicdisease/resources/calculat
or/index.htm
/i d ht
MEPS Informs Consumers’ Checkbook
G id to
Guide
t Health
H lth Plans
Pl




Annual
publication
Rates every
plan available
to federal
employees
and retirees
Compares
likely cost of
various plan
options to
employee
Example:
Estimated
2007 cost to
average
familyy of 4
with head of
household
under 55
years of age
Approximate
pp
Yearly
y Cost to You ($)
Plan
Cod
e
Plan Name
Yearly
Premiu
m ($)
If Your
Health Care
Usage were
Low
If Your
Health Care
Usage were
Average
If Your
Health
Care
Usage
were High
Yearly Limit
on Cost to
You
Excluding
Dental ($)
Local Plans
E35
Kaiser-St
1210
1420
2670
4800
8880
E32
Kaiser-Hi
2480
2590
3340
4680
7230
JP2
M.D. IPA
2190
2340
3300
5170
7990
JN5
Aetna Open
Access
AccessBasic
1420
1630
3090
5900
8880
JN2
Aetna Open
Access-Hi
3080
3260
4570
7100
10540
222
Aetna
A
t
HealthFund
CDHP
1310
1310
3770
7700
13260
2G2
CareFirst
BlueChoice
2250
2480
3680
6030
10510
R
Research
hU
Uses off the
h
Medical Expenditure Panel Survey
Advancing
Excellence
in Health
Care
Research Objectives
 Provide analytic oversight of survey
 Guide
G id construction
t
ti off analytic
l ti files
fil
 Conduct policy relevant research
 Provide technical assistance
Research Areas
 Health insurance
 Use and expenditures
 Access, quality and satisfaction
 Health status and health behaviors
 Informing policy
Health Insurance Status of Adults Ages 21-64:
December 2006
Any insurance
Individual Market
Employment-related
Public Coverage
90
78.3
80
70
P
Percent
60
69.5
70.6
67.5
65 6
65.6
85.2
82.5
53.6
50
40
30
20
10
4.2
9.9
9.3
9
3
3.2
10.2
3.9
15.3
61
6.1
0
21-29
30-44
45-54
55-64
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the
Medical Expenditure Panel Survey, 2006.
Distribution of Workers by Plan Choice
Availability, 2006
Not offered insurance
Offered a choice of plans
Offered 1 plan
70
58.4
P
Percent
60
50
42.2
35.23
40
30
2 9
25.59
22.56
16.01
20
10
0
From own job
Source: MEPS-HC, 2006
Through an HIEU
Offer Rates For Majority Low
Low--Wage
Establishments vs.
vs Others
100
90
80
P
Percent
70
60
50
> 50% low
<= 50% low
No low
`
40
30
20
10
0
< 25
25-99
100 to 999
1000+
Source: Medical Expenditure Panel Survey-Insurance Component, 2006
Distribution of enrollment by Single, Employee+1,
and
d Family:
F il 2001 tto 2008
Perce
ent of e
enrolle
ed
employ
yees
2001
100
80
60
40
20
0
50.2
46.3
2008
318
8
17.3
36.4
31.8
3
8
T
Type
off coverage
36
Health Insurance Premiums Employee/Employer
y
y Contributions for
Single Coverage 1996 - 2008
2008
2006
2004
2002
2000
1998
1996
$882
$788
$723
$671
$606
$565
$498
$450
$420
$383
$320
$342
$3,504
$3,330
$3,268
$3,034
$2,875
$2,624
$2,391
$2,205
$1,905
$1,791
$1,731
$1,650
Employee
Contribution
From 20062006-2008:
Total premiums
i
increased
d6
6.5%
5% &
employee
contributions
increased 11.9%,
(continuing trend
from previous
years).
Employer
Contribution
AHRQ MEPS Insurance Component Tables 19961996-2008
Health Insurance Premiums Employee/Employer Contributions for
Family Coverage 1996 - 2008
2008
2006
2004
$3,394
$8,904
$2,890
$2
890
$2,585
$2,438
$2,283
2002
$1,987
$1 741
$1,741
2000 $1,614
$1,438
1998 $1,382
$1,305
1996 $1,275
$1 275
$8,491
$8
491
$8,143
$7,568
$6,966
$6,482
$5 768
$5,768
$5,158
$4,620
$4,208
$4,027
$3 679
$3,679
Employee
Contribution
Employer
Contribution
From 20062006-2008:
Total premiums
increased 8.1% &
employee
p y
contributions
increased 17.8%,
(continuing trend
from previous
years)
years).
AHRQ MEPS Insurance Component Tables 19961996-2008
Distribution of Expenditures
by Sources of Payment,
Payment 1996 & 2007
1996
996
2007
007
7.9%
7.9%
8 7%
8.7%
8 6%
8.6%
44 6%
44.6%
17.7%
42.4%
16.2%
24.8%
%
21 3%
21.3%
Private
Medicare
Out-of-pocket
Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality:
Medical Expenditure Panel Survey, 1996 and 2007
Medicaid
Other
Distribution of Expenditures
by Type of Service,
Service 1996 & 2007
1996
996
2007
007
6% 3%
7%
4% 2%
8%
31%
39%
12%
21%
35%
32%
Inpatient
Dental
Ambulatory
Home Health
Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality:
Medical Expenditure Panel Survey, 1996 and 2007.
Prescribed Meds
Other
Out-of
Outof--pocket Expenditure
greater than 10% of Income
18
16
14
Percent
12
10
women
men
8
6
4
2
0
18-29
30-44
45-64
65+
Age
Source: Household Component of the Medical Expenditure Panel Survey, 2006
T
Trends
d in
i Concentration
C
t ti
Percentage
e of exp
penditu
ures
1977
100
90
80
70
60
50
40
30
20
10
0
1987
1996
2007
97 97 97 97
70 70 69
55 56 56
38 39 38
27 28 28
65
50
33
23
Top
p 1% Top
p 2% Top
p 5% Top
p 10% Top
p 50%
Population ranked by expenditures
Source: National Medical Care Expenditure Survey, 1977; National Medical Expenditure Survey, 1987; Medical
Expenditure Panel Survey, 1996 and 2007.
15 Highest Cost Conditions, 2007
($ in billions)
 Cancer ($98)
 Hyperlipidemia ($31)
 Trauma ($83)
 Back Problems($30)
 Heart Disease ($82)
 Upper GI Disorders
 Mental Disorders ($61)
 Pulmonary Conditions
($51)
 Diabetes ($41)
 Hypertension($41)
 Osteoarthritis ($40)




($25)
Cerebrovascular
disease ($25)
Kidney Disease ($24)
Skin Disorders ($22)
Other Circulatory
Conditions ($20)
$
Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality:
Medical Expenditure Panel Survey, 2007
Effect of Obesity on
Per Capita Cost
Cost, by Insurance
Medical Expenditures in $2008
$6,452
$7,000
$6,000
$$4,871
,
$4,729
$5,000
$4,000 $3,442
$3 000
$3,000
$2,000
$1,000
$0
All Persons Medicare
$3,208
$3,101
$2,187
$1,961
$1
961
Normal Weight
Obese
Medicaid
Private Ins
Payer
Source: Finkelstein et al., “Annual Medical Spending Attributable to Obesity: Payer-and ServiceSpecific Estimates,” Health Affairs (July 2009).
Prescription Drug
Expenditures 20052005-2006
From Donohue, Huskamp, and Zuvekas, “Dual Eligibles With Mental Disorders And Medicare Part D:
How Are They Faring?” Health Affairs May/June 2009.
Percen
nt
Access to Care: Reasons for barriers to care among
those under age 65 who had difficulty obtaining care,
by insurance status, 2007
100
90
80
70
60
50
40
30
20
10
0
87.5
8
5
52.4
44.6
17.5
8.1 11.9
Had difficulty Unable to afford
Private <65
Public <65
Uninsured
49 3
49.3
41.3
13 0 19.6
13.0
15
3.2
Insurance
reasons
Other reasons
Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and
Quality: Medical Expenditure Panel Survey, 2007.
Type of Treatment for Adults
with Diagnosed Diabetes
10.6%
2 4%
2.4%
87.0%
Medication
Diet, No Medication
No Treatment
Source: Steven C. Hill, Merrile Sing, and G. Edward Miller. “Adults with diagnosed and untreated diabetes: Who are they? How
can we reach them?” Poster presentation at the 137th APHA Annual Meeting, Philadelphia, November 9, 2009.
Authors’ calculations from the Medical Expenditure Panel Survey, Diabetes Care Supplement, 2000 through 2006.
Distribution of adult diabetics receiving
recommended diabetes tests, 2007
All tests
No tests
1 or 2 tests
Don't know
6.1%
32.9%
57.7%
3.3%
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, MEPS
HC-107: 2007 Full Year Population Characteristics File
Journal Articles Using
MEPS
AHRQ Modeling
M d li
and Simulation Efforts
Overview
Division of Modeling and Simulation activities to
support health reform:
 Microsimulation models for policy impacts
 Reconciliation of MEPS expenditure estimates
to National Health Expenditure Accounts
(NHEA)
 Additional data products & tools
 Basic Research
MEPS--HC: Data Products
MEPS
 MEPS is one
one--stop data source for many key
components of health policy microsimulation
models
d l
 Virtually all major health models use MEPS
data in some way – most often they use the
individual level medical expenditure data
 The Modeling Division produces several data
products and tools to enhance MEPS utility for
policy
li simulation
i l ti ((available
il bl iin th
the D
Data
t C
Center)
t )
MEPS--HC: Augmented Data
MEPS
 Federal and state income tax simulations (from




NBER TAXSIM)
2002 data aligned to NHEA and projected
forward to 2016
2007 reconciliation in progress
Imputed employer contributions (regression
(regression-based IC models)
Other enhancements:
– Fully imputed immigration, citizenship, simulated
documentation status through 2009
Importance of Reconciling
MEPS to NHEA
 Benchmarked,
Benchmarked projected data are critical to all
models and questions
 NHEA and
d MEPS provide
id the
th two
t
mostt
comprehensive estimates of health care
spending in the U.S.
US
 Reconciling estimates from both sources serves
as an important quality assurance exercise for
both.
 Augmented
A gmented MEPS files include
incl de expenditures
e pendit res
adjusted for survey underreporting and more
Simulated Taxes
 MEPS collects detailed income and asset
data that support
pp simulation of federal,
state, payroll, and property taxes
 Simulations produce estimates of: tax
payments, marginal tax rates
 Send
S dd
data
t fil
files to
t NBER’s
NBER’ TAXSIM
 Make
a e further
u t e refinements
e e e ts a
and
d
calculations inin-house
Estimation of Tax Subsidies
 Use
U NBER TAXSIM model
d l tto compute
t




Federal, State, FICA marginal tax rates
Evaluate earnings from all sources: main jobs
jobs,
secondary jobs, spouse, unearned income
Incorporate
p
family
y composition
p
and home
ownership
Compute MTR over an increment to worker
incomes equal to the average employer
contribution.
Simulate state and federal taxes for each
worker using state tax laws in effect in each
state in the worker’s Census region.
Table 8. Comparing Full Wage Offset
Premium vs OOP Premium Burdens,
ESI Family Policies,
Policies Medians,
Medians 20062006-07
20
16.6
15.2
13.1
15
10
5
5.7
4.9
4
11 5
11.5
3.6
10.5
6.4
3.5
2
0
133-199% 200-249% 250-299% 300-349% 350-399%
Median-OOP
Median
OOP
400+%
Median-FW
Median
FW
FW Premium Burden = tax
tax-adjusted
adjusted employer contribution
added to numerator and denominator
MEPS-HC: Basic Research
MEPSto Inform Policy Simulations
Elasticities are key parameters in most
microsimulation models:
 Premium
P
i
elasticity
l ti it off ttaketake
k -up (Blumberg,
(Bl b
Nichols, Banthin)
 Tax
Tax--price elasticity of group coverage
(Selden&Bernard)
 Tax
Tax--price elasticity of self
self--employed (Selden)
 Tax subsidies, winners
winners--losers, and within
within--firm
incidence of employer contributions
(Bernard&Selden)
 Burden of health care (Banthin&Bernard)
– Within
Within--year burdens (Selden)
Table 2. Premium Burdens for NonNon-Group,
Median and 75th Percentiles,
Percentiles 20062006-07
Premium
P
i
Burdens
B d
= percentt off family
f il income
i
spentt on
out of pocket premiums
Table 3. Total Burdens for NonNon-Group,
Median and 75th Percentiles
Total
T
t l Burdens
B d
= percentt off family
f il income
i
spentt on
premiums plus out of pocket expenses for health care
Table 10. Percent of Persons Whose Current
Nongroup Premiums Exceed PPACA Limits
AHRQ Simulation
Si
l ti Models
M d l
Modeling Division develops and maintains
y simulation models:
two key

KIDSIM & its related PUBSIM
– Eligibility
Eligibilit for public
p blic programs

Employer_SIM
– Employer behavior,
behavior decisions to offer
offer,
estimates of tax expenditures for ESI
KIDSIM
 Detailed statestate-specific Medicaid and CHIP
eligibility simulations for children and parents
 Yields estimates of eligible uninsured children
 Model used to estimate
– Track progress over time
– take
take--up rates
– crowd
crowd--out rates
– Simulate switching & take up under reforms
– Net costs of public coverage for children
 Currently updating to 2009
Children Eligible for Public
Coverage,
Coverage 19971997-2005 KIDSIM
E lig ib le C h ild re n
(m illio n s )
50
40
All Eligible
Medicaid Eligible
CHIP Eligible
30
20
10
0
1997 1999 2001 2003 2005
P e r c e n t E lig ib le w h o a r e
U n in s u r e d
Percent Eligible but Uninsured
Children,
Children 20002000-2005 KIDSIM
25.0%
All Eligible
M di id Eligible
Medicaid
Eli ibl
CHIP Eligible
20.0%
15.0%
10.0%
2000 2001 2002 2003 2004 2005
Results 1
Table 2: Estimates of the Status of Currently Eligible or Enrolled Children Under a Simulated
Medicaid Expansion
p
to 133%
% of FPL
Groups
Medicaid
M-CHIP
S-CHIP
Combined
Number of currently
eligible children (in
millions) switching to
Medicaid
21.2
21
2
(0.9)
0.6
0
6
(0.1)
1.7
1
7
(0.2)
23.5
23
5
(0.9)
Percentage of currently
eligible
li ibl children
hild
switching to Medicaid
93.4
(0.9)
22.3
(3.1)
15.2
(1.3)
64.6
(1.3)
Number of currently
enrolled children (in
millions)) switching
g to
Medicaid
15.0
(0.8)
0.3
(0.1)
0.9
(0.1)
16.2
(0.7)
Percentage of currently
enrolled children
switching to Medicaid
94.8
(0.8)
32.6
(4.9)
22.5
(1.9)
78.3
(1.0)
SOURCE: Authors’ calculation using data from the 2004-2005 Medical Expenditure Panel Survey (MEPS)
NOTES: The numbers in parentheses are the standard errors, adjusted to account for the complex design of MEPS.
Sensitivity Analysis: Results 2
Table 5: Estimates of the Status of Currently Eligible or Enrolled Children Under a Simulated Medicaid
Expansion to 133% of FPL, using an alternative definition of families based on tax rules.
Groups
Medicaid
M-CHIP
S-CHIP
Combined
Number of currently
eligible children (in
millions) switching to
Medicaid
20.1
(0.8)
0.6
(0.1)
1.7
(0.2)
22.5
(0.9)
Percentage of currently
eligible children
switching to Medicaid
88.8
(0.8)
22.5
(3.0)
16.0
(1.4)
61.9
(1.3)
Number of currently
enrolled children (in
millions) switching to
Medicaid
14.5
(0 6)
(0.6)
0.3
(0 1)
(0.1)
0.9
(0 1)
(0.1)
15.7
(0 7)
(0.7)
Percentage of currently
enrolled children
switching
it hi tto M
Medicaid
di id
91.8
((0.8))
33.5
((4.9))
23.0
((1.9))
76.2
((1.1))
SOURCE: Authors’ calculation using data from the 2004-2005 Medical Expenditure Panel Survey (MEPS)
NOTES: The numbers in parentheses are the standard errors, adjusted to account for the complex design of MEPS.
PUBSIM
 Builds on KIDSIM for all nonnon-elderly
adults (esp. childless adults)
 Detailed statestate-specific Medicaid, CHIP
and state funded programs - eligibility
simulations
 Simulated disability
y status based on
health and employment status
 Will simulate expansion of Medicaid to
133% poverty
Employer--Sim Model
Employer
 MEPS IC: establishment level data
 MEPS HC: individual level data
 Synthetic workforces: use MEPS HC workers
to ‘populate’
populate MEPS IC establishments
 Resulting database contains
– Establishment
Establishment--level information
– Full distribution of worker characteristics:
 Do workers have spouses with offers? Children with public
eligibility?
 Health status of workers and their families
 Family income (all sources) and marginal tax rate
Linking Workers to Establishments
Variable Category
Level / Type of Information Used
Location
State, Census region / division
Industry
2 Digit NAICS / collapsed codes
Multi-location firm?
Y/N indicator
Establishment size
Number of employees in ranges
Establishment offers insurance?
Y/N indicator

Draw a sample of 300+ workers that match each
establishment on these characteristics.
 Include 100+ low
low, medium and high wage workers
workers.
 Workers are sampled with replacement.
Raking Workers Weights
Variable Category
Level / Type of Information Used
Sex
% Female
Age
% Age 50 plus
Union
% In union
Wage
% Low, medium, high wage
Insurance eligibility
% Eligible
Plan type
% In single, emp +1, family plans
Fulltime
% Fulltime

0/1 variables for MEPS HC workers
 Percent distributions in MEPS IC establishments.
 Iteratively
y adjust
j
MEPS HC sample
p weights
g
until worker
characteristics match estab. % distributions.
Summary Statistics
 Synthetic workforces (in principle) can be used to
construct summary statistics, for each establishment
for any employee characteristic from the MEPS HC.
HC
 Quality depends on correlation between the HC
characteristic and variables used in linking and raking
raking.
 Marginal tax rates are strongly related to many of the
variables available to construct synthetic workforces
workforces.
Average Subsidy per Worker
by Establishment Wage Mix (2006)
3000
2500
2006 $
2000
1500
1000
500
0
Low
dle
Mid
h
Hig
Oth
er
Predominant Wage Level
MEPS IC and HC: Selden & Gray, Health Affairs 2006
Incidence and Equity in Health
Care Financing
Tuesday, June 29
11:30--1pm
11:30
Incidence and Equity in Health Care
Fi
Financing
i
Room 207
Thomas Selden,
Selden, Agency for Healthcare
esea c a
and
d Qua
Quality
ty
Research
Equity in the Finance and Delivery of
Healthcare in the United States
P
Percen
ntage of Pre
e-Tax
Income
Combined Burdens by Financing
Source and Income Decile
50
45
40
35
27
30
20
23 22
21 21
20
19 18
17
10
0
All
1 2 3 4 5 6 7 8 9 10
Deciles
OOP
Premiums
Soc Ins
Oth Tax
Inc Tax
Medical Expenditure Panel Survey
DISSEMINATION OF
INFORMATION AND DATA
PRODUCTS
MEPS Dissemination
 Website
 An onon-line interactive statistical
computer system (MEPS
(MEPS--NET)
 Data
D t center
t ffor use off nonnon-public
bli data
d t
 Workshops
p
MEPS Website
www meps ahrq gov
www.meps.ahrq.gov











Overview of MEPS and Frequently Asked Questions
(FAQs)
Staff Reports using MEPS
 Findings/Statistical
Fi di
/St ti ti l Briefs/Chart
B i f /Ch t books
b k
Data Tables of Estimates
Public Use Files (microdata)
MEPSnet Interactive Query Tool
Survey Methodology Reports
Survey Questionnaires and Other Collection Materials
Data product availability and ordering information
MEPS data workshop information and schedule
Mailing
g list,, List server and ee-mail for technical
assistance
Data Center Information
Data User Workshops
 Information will be posted on Workshops
and Events section of web site
 For inquiries please ee-mail:
Workshopinfo@ahrq.hhs.gov
Micro Data Files
 Public Use Files (Microdata) –
Available for downloading from web
site (Household survey only)
 Restricted Access Files (Microdata)
– MEPS
MEPS--HC – Available for Use at AHRQ
Data Center
– MEPS
MEPS--IC – Available for Use at Census
Research Data Centers
For more information go to
www.ces.census.gov
C t t IInformation
Contact
f
ti
 MEPS ee-mail address -
MEPSPD@ahrq.gov
 MEPS Information Coordinator:
– (301) 427427-1406
AHRQ Data Center
 Provides researchers access to nonnon-public




use MEPS data (except directly identifiable
information)
Located in Rockville, MD
Applications/procedures on MEPS web site
User fee of $300.00
$300 00 includes up to 2 hours
of programming. Additional programming
support available at $108.00/hour.
Fee waived for full
full--time student
MEPS Data Available at
Census Bureau RDC’s
 Research Data Files will be accessible at
the 9 regional Census Bureau RDC’s
RDC s
(NY,NC, MI, IL, MD, CA, MA)
 AHRQ will approve projects
 Will require Census Bureau Special Sworn
Status
 Census user fees will apply
Data Center Questions
 Contact Data Center Administrator by
e-mail at:
CFACTDC@AHRQ.HHS.GOV