Employment-Related Health Insurance: Federal Agencies' Roles in Meeting Data Needs
Wiatrowski, William, Harvey, Holly, Levit, Katharine R., Health Care Financing Review
The United States Federal statistical system is highly decentralized. Many of the Nation's statistical programs are carried out by agencies such as the Bureau of Labor Statistics (BLS) and the National Center for Health Statistics who have as their principal mission the collection, analysis, and dissemination of official statistics. In other cases, agencies such as CMS carry out statistical activities in conjunction with primary missions to provide services or enforce regulations. Coordination across these diverse agencies and their statistical programs is the responsibility of OMB's Statistical Policy Office, which sponsors a number of interagency groups to focus on specific areas of activity that cut across agency lines.
A case in point involves surveys on employment-based health coverage. The results from these surveys are used in many ways, most notably in measuring the growth and structure of the economy, assessing changes in the compensation of employees, and addressing public health concerns. While these statistics provide a wide variety of information about health insurance availability, options, usage, benefits, costs, funding methods, impacts, and participating entities, it has become increasingly clear that substantially improved coordination of these data collections is essential.
In spring 1998, OMB created the Interagency Committee on Employment-Related Health Insurance Surveys (hereafter referred to as the committee) to coordinate statistical activities across the agencies involved in this area. The work of this committee serves as an excellent model for effective interagency cooperation and coordination and provides a useful illustration of how agencies can work together both to fulfill their own data needs as well as address the needs of the broader data user and policy communities. The improvements already resulting from the committee's work will align survey data elements, concepts, and definitions to facilitate analyses of employer-provided health benefits and other forms of non-wage compensation across series. Coordinating surveys also has the potential to reduce respondent burden and conserve funds by eliminating redundant requests for information. Producers and users of data stand to benefit from reviewing the activities the committee has undertaken to improve data on employer-related health insurance, the substantial accomplishments already achieved, and the challenges remaining.
Employer-provided health insurance covered approximately 62 percent of Americans in 1998 (U.S. Bureau of the Census, 2001). Employers and employees spent $357 billion in premiums for this coverage (Agency for Healthcare Research and Quality, 2001; U.S. Office of Personnel Management, 2001), which in turn paid for almost one-third of all health care. (2) Overall health care expenditures are expected to more than double by 2008 (Heffler et al., 2001). Escalating health care spending potentially places future employer-sponsored health insurance coverage at risk for the Nation's working and retired population as some employers eliminate coverage (especially for retirees), introduce more restrictive plans, or transfer more costs--which may not be affordable--to workers and retirees.
These risks put employer-sponsored health insurance at the center of health policy debates. In turn, high priority is placed on Federal Government efforts to insure that information to support employer-provided health insurance policy decisions is available when needed. As a result, several Federal agencies currently sponsor or conduct surveys that collect data on employment-based health coverage; at the same time, during the past decade policymakers and researchers increasingly have called for additional data to inform understanding and decisions.
The committee was formed to address these gaps and to better coordinate existing survey efforts. This group represents Federal agencies from the Departments of Labor, Health and Human Services, Commerce and Treasury, Small Business Administration, and OMB that provide and/or use health care data. …