(Bloomberg) — For several months now, whenever the topic of enrollment in the Affordable Care Act came up, I've been saying that it was too soon to tell its ultimate effects. We don't know how many people have paid for their new insurance policies, or how many of those who bought policies were previously uninsured. For that, I said, we will have to wait for Census Bureau data, which offer the best assessment of the insurance status of the whole population.
Other surveys are available, but the samples are smaller, so they're not as good; the census is the gold standard. Unfortunately, as I invariably noted, these data won't be available until 2015.
I stand corrected: These data won't be available at all. Ever.
No, I'm not kidding. I wish I was. The New York Times reports that the Barack Obama administration has changed the survey so that we cannot directly compare the numbers on the uninsured over time.
The changes are intended to improve the accuracy of the survey, being conducted this month in interviews with tens of thousands of households around the country. But the new questions are so different that the findings will not be comparable, the officials said.
An internal Census Bureau document said that the new questionnaire included a "total revision to health insurance questions" and, in a test last year, produced lower estimates of the uninsured. Thus, officials said, it will be difficult to say how much of any change is attributable to the Affordable Care Act and how much to the use of a new survey instrument.
"We are expecting much lower numbers just because of the questions and how they are asked," said Brett J. O'Hara, chief of the health statistics branch at the Census Bureau.
I'm speechless. Shocked. Stunned. Horrified. Befuddled. Aghast, appalled, thunderstruck, perplexed, baffled, bewildered and dumbfounded. It's not that I am opposed to the changes: Everyone understands that the census reports probably overstate the true number of the uninsured, because the number they report is supposed to be "people who lacked insurance for the entire previous year," but people tend to answer with their insurance status right now.
But why, dear God, oh, why, would you change it in the one year in the entire history of the republic that it is most important for policy makers, researchers and voters to be able to compare the number of uninsured to those in prior years? The answers would seem to range from "total incompetence on the part of every level of this administration" to something worse.
Yes, that's right, I said "every level." Because guess who was involved in this decision, besides the wonks at Census?
The White House is always looking for evidence to show the benefits of the health law, which is an issue in many of this year's midterm elections. The U.S. Department of Health and Human Services and the White House Council of Economic Advisers requested several of the new questions, and the White House Office of Management and Budget approved the new questionnaire. But the decision to make fundamental changes in the survey was driven by technical experts at the Census Bureau, and members of Congress have not focused on it or suggested political motives.
