Early PPACA census numbers coming in September

One challenge bureau survey programs face is that many consumers have no idea what kind of coverage they have, or whether the coverage they have should be described as public or private. Because of health insurance literacy problems, the gap between the number of people who say they have Medicaid coverage and the number who actually seem to have Medicaid coverage is large, officials say.

In 2008, for example, Medicaid program managers said they were covering about 50 million people. One Census Bureau survey, the Current Population Survey, found only about 38 million Medicaid enrollees.

Officials said long-term efforts to improve survey methods may cut the NHIS uninsured rate this year, by leading to an increase in the percentage of Medicaid enrollees counted, on top of any actual increase in Medicaid enrollment resulting from the PPACA Medicaid expansion program.

Michael O'Grady, a health policy expert who was previoiusly employed at the U.S. Department of Health and Human Services (HHS), said officials knew that critics could accuse them of artificially lowering the uninsured rate with survey process improvements. "However," he said, "if there's a better way to measure data on an important policy problem, and you don't do it for fear of political heat, it's professionally irresponsible."