Last week, the New York Times reported that the Census Bureau would be significantly changing the questions and methods it uses to determine who has health insurance. The redesign is an attempt to address some of the flaws in the current design that have long troubled the agency. A working paper from the Census Bureau had found that it provided an “inflated estimate of the uninsured” and was prone to “measurement errors” that diminished the reliability and usefulness of the measure.
The timing of this change could hardly be worse. The massive coverage provisions of the health care reform have just taken effect, and these new changes could make comparisons to past years difficult, or meaningless. Another document from the agency explains that the questions would elicit such different responses that “it is likely the Census Bureau will decide that there is a break in the series for the health insurance estimates.”
As the Times reports, the differences in responses between the two sets of questions are significant; in a trial run last year, the percentage of people without health insurance was 10.6 percent with the new questionnaire, compared with 12.5 percent using the old version, with similar effects across all demographic groups.
Some defenders of the decision have pointed out that these new questions will also give data for 2013, so there will be at least one year of pre-ACA data to compare to. This is true, and having at least one data point will be helpful to some extent, but what we really want to evaluate when analyzing the law would be the longer term trend, for two reasons. One, there is a decent amount of variation in these surveys that make single data points less informative. Two, while the major coverage provisions of the law take effect in 2014, the law has already been influencing the insurance market in smaller ways since its passage, and more than half of the reduction in the uninsured will occur after 2014, according to the Congressional Budget Office. This is why having a stable baseline would be useful, so we could examine the longer term trends in insurance coverage, and why now is close to the worst time to incorporate this change. The Census Bureau acknowledged as much in a paper, admitting that “[i]deally, the redesign would have had at least a few years to gather base line and trend data.”
Some critics of the law have voiced some suspicion as to possible political motivations for the timing of this change, seeing it as an attempt to obscure the effects of the law and make it harder to get reliable estimates. They cite the fact that some of the new questions were requested by the administration, and that senior officials had knowledge and approved of these pending changes.
I do not think conspiracy is the answer, but the real reason for this Census change is just as troubling, if not more so: incompetence.
The sheer amount of negative attention that these planned changes have gotten likely outweighs whatever political gains the administration could have hoped to capture in the first place. Aside from that, there are numerous other organizations, like Gallup, that measure health insurance coverage, so skeptics of the law will have other sources of data to turn to. If anything, it would appear that the White House was trying too hard to make sure they did not appear to be meddling in the affairs of the Census Bureau, which had unwisely planned to roll out these changes at an inopportune moment. Why this change was the line in the sand that the administration dared not cross when it has shown no such restraint in delaying many aspects of the law itself, such as the employer mandate, is hard to comprehend, but paints a picture more of an administration flailing to put out fires as they arise, rather than one even capable of pulling of the long term planning and coordination required for such a scheme.
While it appears the administration could have intervened and delayed the rollout of the new questions, they were not the driving force behind the changes. If anything, this was a mistake of what they chose not to do, rather than what they did.
These problems of coordination and competence within the government, where one government agency appears to be proceeding along with little to no regard or understanding for the broader context in which it operates, is in some ways more troubling, especially when we are talking about the massive new government foray into a sector that consumes almost 18 percent of our economy.
If they cannot even coordinate the measurement of health insurance effectively, how can they implement the law itself?
The administration has a chance to partially remedy their mistake. Republicans in both chambers have already introduced legislation to either delay the new questions or to use both sets concurrently for the next few years to establish a better baseline to look at the effects of the law on health insurance coverage.
Government, as inefficient and incompetent as it often is, can sometimes make honest mistakes, which I think this likely is; however, these mistakes should raise serious concerns about government’s abilities as it seeks to spread into even more aspects of the economy and our lives.
Michael D. Tanner is a senior fellow at the Cato Institute, heading research into a variety of domestic policies with particular emphasis on health care reform, welfare policy, and Social Security. His most recent white paper, "Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law," provides a detailed examination of the Patient Protection and Affordable Care Act (Obamacare) and what it means to taxpayers, workers, physicians, and patients.