OMB Memo

Generic Clearance Collection Request:

Cognitive Testing for Additional Questions on the Medical Expenditure Panel Survey – Insurance Component

Request: This letter is to inform you of our plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725). The Census Bureau plans to conduct telephone respondent pretest interviews on additional proposed questions for the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC). The MEPS-IC is a self-administered mail out/mail return survey conducted by the Census Bureau for the Agency for Healthcare Research and Quality (AHRQ) on an annual basis. Data from the survey are used to create national and state level estimates on employer sponsored health insurance coverage. These estimates are used to track industry trends and examine how these trends have changed health insurance coverage over time. Policymakers at the national and state level use the data to assess the status of employer-sponsored health insurance throughout the U.S. and monitor the impact of laws governing health insurance. Researchers, policy analysts, and other government agencies also use the data for a variety of analyses.

This survey is conducted by the Census Bureau under the authority of Title 13 U.S.Code (U.S.C.), Section 8(b), on behalf of the Agency for Healthcare Research and Quality, whose collection authority is Section 913 of the Public Health Service Act (Title 42, U.S.C., Section 299b-2). Section 9 of Title 13 U.S.C. ensures the confidentiality of data reported by private companies. The protocol for this pretest was developed by the U.S. Census Bureau with input from AHRQ. Further information regarding the MEPS-IC can be found at this website: https://meps.ahrq.gov/survey_comp/Insurance.jsp

Purpose: The pretest is divided into two sections: Section 1 and Section 2. Both sections of the pretest are a mutually exclusive and respondents will only be asked questions from either Section 1 or Section 2. The purpose of Section 1 is to determine the respondent’s interpretation of and ability to answer proposed questions that would collect additional data from businesses and government units. The pretest, which is sponsored by AHRQ, will include questions about deductibles, maximum out-of-pocket expenses, copayments, and coinsurance for out-of-network providers, in addition to a question on optional coverage services. Respondents will be asked these questions for a plan they reported on their original response to the 2019 MEPS-IC form. For Section 2, a separate sample of nine respondents will be asked follow-up questions regarding the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or Individual Coverage Health Reimbursement Arrangement (ICHRA) they offered in 2020. These respondents will be selected based on their response to the 2020 MEPS-IC form, since this topic was first introduced in 2020. The Census Bureau will prepare a report that outlines the findings of the pretest and discusses the possibility of adding new questions in subsequent survey years. This report will be used by the Census Bureau and AHRQ to make informed decisions for 2021 questionnaire design.

Population of Interest: The population of interest are respondents to the MEPS-IC survey. The MEPS-IC is an annual sample survey, with the sample consisting of approximately 40,000 private industry establishments and 4,000 state and local governments.

Timeline: Testing will occur from May to September 2020.

Language: Testing will be conducted in English only.

Method: For Section 1 of the pretest, staff from the Health Surveys Branch (HSB) will conduct up to 50 telephone interviews. For Section 2 of the pretest, which relates to QSEHRAs/ICHRAs only, HSB staff with conduct a target of 9 interviews. Interviews are aimed at understanding the way that respondents interpret survey items that are being presented to them, in order to understand and reduce potential measurement error. The interviews will follow a semi-structured interview protocol (Attachment A). Additionally, PIA will be communicated to all participants prior to the evaluation about the privacy, confidentiality and burden associated with participation (Attachment B). Training of the HSB staff will be conducted by Susanna Winder, a survey statistician, who will oversee the work of the HSB staff and will also conduct pretest interviews.

Sample: We plan to conduct 50 interviews for Section 1 of the pretest and an additional 9 interviews for Section 2. HSB will sample from the 2019 MEPS-IC for recruiting for Section 1, and from the 2020 MEPS-IC for Section 2. The samples will include contact information and a size indicator for the organization. We will contact potential participants via phone, explain the nature of our research, and ask them to participate in our study. The sample of participants will be those who are able to be contacted and who agree to participate in the study. Efforts will be made to sample respondents with a variety of sizes and types (i.e., industries) of organizations, though the sample will ultimately be dependent on who chooses to participate in the research. Participants will be informed that their response is voluntary and that the information they provide is confidential and will be seen only by Census Bureau employees and those with special sworn status. Respondents who are interested in participating will be given the choice of scheduling the interview for a future date, or having the interview take place at that moment.

Recruitment: Cases to be selected for this pretest will include responding units from the 2019 and 2020 MEPS-IC that offered health insurance. Cases will be selected to cover both private industry establishments and government establishments. Respondents will be informed that their participation is voluntary. The interviews will not be audio recorded.

Use of incentives: Monetary incentives for participation will not be offered.

Length of interview: We expect that each interview will last no more than 20 minutes (60 cases x 20 minutes per case = 20 hours). Additionally, to recruit respondents we expect to make up to 5 phone contacts per completed case. The recruiting calls are expected to last on average 3 minutes per call (5 attempted phone calls per completed case x 60 cases x 3 minute per case = 15 hours). Thus, the estimated burden for this project is 35 hours (20 hours for interviews + 15 hours for recruiting).

Enclosures: Enclosed are a copy of the draft MEPS-IC testing protocol with proposed new questions (Attachment A) . Attachment B contains the PIA content that will be communicated to respondents prior to the evaluation to inform them about privacy, confidentiality and burden associated with participation.

Contact: The contact person for questions regarding data collection and analysis of the pretest is listed below:

Temika Holland

Data Collection Methodology & Research Branch

Economic Statistics and Methodology Division

U.S. Census Bureau

Washington, D.C. 20233

(301) 763-5241

Temika.holland@census.gov

CC:

Nick Orsini          (DIR) with enclosures

Carol Caldwell             (ESMD)    “          ”
Diane Willimack             (ESMD)     “          ”
Amy Anderson Riemer  (ESMD)     “          ”

Kristin Stettler (ESMD) “ “

Danielle Norman (PCO) “ ”

Mary Lenaiyasa (PCO) “ “

Jennifer Hunter Childs (ADRM) “ “

Jasmine Luck (ADRM) ” “

Marleen Livesay (HSB) “ “

Susanna Winder (HSB) “ “

Belitza Rojas Lopez (HSB) “ “

Karen Davis (AHRQ) “ “ (Karen.Davis@ahrq.hhs.gov)

David Kashihara (AHRQ) “ “ (David.Kashihara@ahrq.hhs.gov)