Making Health Care Count: Health Policy Impacts of the U.S. Census
November 20, 2020
As decreed by the constitution, the United States must complete a census every ten years, and attempt to count every resident in the country. The census’s primary purpose is to apportion the number of seats for each state in the U.S. House of Representatives. However, the decennial count also shapes many health policy issues, including determining how billions of federal funds are distributed throughout the county, identifying historically underrepresented populations, and providing data sets for public health and health services researchers. This briefing provided an overview of how census data is collected, analyzed, and utilized, with a particular focus on how this process impacts health policy and public health. Panelists highlighted early insights from the 2020 census and discussed any opportunities and challenges policymakers should be aware of.
Speakers:
- Cara Brumfield, MPP, Senior Policy Analyst, Georgetown Center on Poverty and Inequality Economic Security & Opportunity Initiative
- Beth Lynk, Senior Director, Census Counts Campaign
- Andrew Reamer, Ph.D., Research Professor, George Washington Institute of Public Policy, George Washington University
- Tami Luhby, Senior Writer, CNN (moderator)
Presentation: Presentation
Event Resources
Key Resources
“Inaccurate Census Count Could Affect $1.5 Trillion in Federal Funding.” Luhby, T. Cable News Network (CNN). October 15, 2020. Available at http://allh.us/N3fv.
“Evaluating the Accuracy of the Decennial Census: A Primer on the Fundamentals of Census Accuracy and Coverage Evaluation.” O’Hare, W., Brumfield, C., Lee, J. Georgetown Law Center on Poverty and Inequality. October 2020. Available at http://allh.us/RtXa.
“Differential Privacy for Census Data Explained.” Underhill, W. National Conference of State Legislators. September 9, 2020. Available at http://allh.us/CakA.
“Responding to the Census Will Help Plan Health Care Programs for the Next Decade.” America Counts Staff. United States Census Bureau. July 13, 2020. Available at http://allh.us/dxMh.
“The Risks and Rewards of Conducting a Census in The Digital Age.” Brumfield, C., Lee, J. Georgetown Law Center on Poverty and Inequality. 2020. Available at http://allh.us/NbGU.
“Census 2020—a Preventable Public Health Catastrophe.” Cohen, G., Ross, C., Cozier, Y., et al. American Journal of Public Health. August 2019. Available at http://allh.us/hgGX.
“Protecting the Accuracy of the 2020 Census.” Citro, C. Issues in Science and Technology. August 2019. Available at http://allh.us/uA7h.
“Why a Fair and Accurate Census Matters to Thriving Private and Public Sectors.” Khan, S., Goldvale, C., Dutta-Gupta, I. Georgetown Law Center on Poverty and Inequality and The Leadership Conference Education Fund. Available at http://allh.us/twhd.
“The Census and Health Care.” Youdelman, M., Avanzo, B., Nerurkar, S. The Leadership Conference Education Fund. April 6, 2018. Available at http://allh.us/UGjb.
Additional Resources
“Developing the DAS: Progress Metrics and Data Runs.” United States Census Bureau. November 16, 2020. Available at http://allh.us/F8hq.
“2020 Census Research, Operational Plans, and Oversight.” United States Census Bureau. November 10, 2020. Available at http://allh.us/cu7k.
“Shortened Census Led to an Incomplete Count in Some Areas.” Henderson, T. Pew Research Center. November 4, 2020. Available at http://allh.us/BUED.
“230 Years and Counting: How Does the 2020 Census Compare to the 1790 Count?” United States Census 2020. November 2020. Available at http://allh.us/g8kj.
“Mapping Response Rates for a Fair and Accurate 2020 Census.” Center for Urban Research – The City University of New York. October 17, 2020. Available at http://allh.us/wyXN.
“Providing the Census Bureau With the Time to Produce a Complete and Accurate Census.” von Spakovsky, H. The Heritage Foundation. October 14, 2020. Available at http://allh.us/bK6D.
“2020 Census.” Georgetown Law Center on Poverty and Inequality. October 2020. Available at http://allh.us/bwDK.
“’A Brush With Catastrophe’: Inside the 2020 Census Meltdown.” Stanton, Z. Politico. September 10, 2020. Available at http://allh.us/HmVK.
“About the Bureau – Who We Are.” United States Census Bureau. September 24, 2020. Available at http://allh.us/G6Mq.
“2020 Census – High Risk Issue.” United States Government Accountability Office. September 10, 2020. Available at http://allh.us/mhnw.
“What Is Going On With the 2020 Census?” Zamarripa, C. National Conference of State Legislators. September 8, 2020. Available at http://allh.us/Edtk.
“Will the 2020 Census Numbers Be Good Enough, and How Soon Will We Know?” Mervis, J. Science and Policy. August 24, 2020. Available at http://allh.us/M8j4.
“Schedule Adjustments for U.S. 2020 Census.” Jarosz, B. Population Reference Bureau. June 2, 2020. Available at http://allh.us/BCcA.
“Census Count Has Implications for Public Health: Health Funding, Programs Depend on Accurate Enumeration.” Krisberg, K. The Nation’s Health. March 2020. Available at http://allh.us/uQyb.
“Most Adults Aware of 2020 Census and Ready to Respond, But Don’t Know Key Details.” Cohn, D., Brown, A., Keeter, S. Pew Research Center. February 20, 2020. Available at http://allh.us/eh6c.
“Why the 2020 Census Matters for Public Health: An Explainer.” Reichel, C. Harvard Kennedy School Shorenstein Center on Media, Politics and Public Policy. November 18, 2019. Available at http://allh.us/f6uv.
“A Fair Census Supports Shared Economic Opportunity.” Dutta-Gupta, I., Brumfield, C. Georgetown Center on Poverty and Inequality. October 16, 2020. Available at http://allh.us/rWGm.
“Why the Census Matters for Reproductive Health.” Georgetown Center on Poverty and Inequality. September 2019. Available at http://allh.us/KJm6.
“A Year Before the 2020 Census, Experts Share Four Key Insights.” Berube, A. The Brookings Institution. April 23, 2019. Available at http://allh.us/jHrC.
“What You Need to Know About the 2020 Census.” Wang, H. National Public Radio. March 31, 2019. Available at http://allh.us/mF3A.
“Can a Set of Equations Keep U.S. Census Data Private?” Mervis, J. Science. January 9, 2019. Available at http://allh.us/pNaM.
“Inaccuracies in the 2020 Census Enumeration Could Create a Misalignment Between States’ Needs.” Strane, D., Griffis, H. American Journal of Public Health. September 12, 2018. Available at http://allh.us/vnRE.
“The Census and Health Care.” Georgetown Law Center on Poverty and Inequality. April 6, 2018. Available at http://allh.us/Vd4U.
Experts
Speakers
Cara Brumfield
Georgetown Center on Poverty and Inequality Economic Security and Opportunity Initiative, Georgetown Law, Senior Policy Analyst
cb1542@georgetown.edu
Beth Lyn
Census Counts Campaign, Senior Director
lynk@civilrights.org
Tami Luhby
CNN, Senior Writer
tami.luhby@turner.com
Andrew Reamer
George Washington Institute of Public Policy, George Washington University, Research Professor
areamer@gwu.edu
Experts and Analysts
William Frey
Population Studies Center Institute for Social Research, University of Michigan, Research Professor and Metropolitan Policy Program, The Brookings Institution, Senior Fellow
bill.frey@usa.net
Indivar Dutta-Gupa
Center on Poverty and Inequality, Georgetown Law, Adjunct Professor of Law, Co-Executive Director
id141@georgetown.edu
Government
Robert Goldenkoff
Government Accountability Office, Director, Strategic Initiatives
goldenkoffr@gao.gov
Keith Hall
Congressional Budget Office, Director
keith.hall@cbo.gov
Ron Jarmin
U.S. Census Bureau, Deputy Director, Chief Operating Officer
ron.s.jarmin@census.gov
Chris Mihm
Strategic Issues, Government Accountability Office, Managing Director
mihmj@gao.gov
Benjamin Overholt
U.S. Census Bureau, Deputy Director for Data
benjamin.a.overholt@census.gov
Stakeholders
Eryn Hurley
National Association of Counties, Legislative Director
ehurley@naco.org
Jennifer Imo
National Association of Towns and Townships, Federal Director
jimo@TFGNET.COM
Jack Peterson
National Association of Counties, Director of Strategic Relations
jpeterson@naco.org
Steven Lopez,
UnidosUS, Health Policy, Director
slopez@unidosus.org
Wendy Underhill
National Conference of State Legislators, Elections and Redistricting, Director
wendy.underhill@ncsl.org
Transcript
(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)
0:06
Hello, everyone, and thank you for your patience. And thanks for joining today’s webinar, Making Health Care Count Health: Policy Impacts of the US. Census.
0:15
I’m Kathryn Martucci, director of policy and programs at the Alliance for Health Policy.
0:21
For those that are not familiar with the Alliance, welcome. We are a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues.
0:34
Want to take a moment to thank the National Institute for Health Care Management Foundation for sponsoring this event.
0:42
And remind everyone that you can join today’s conversation on Twitter using the hashtag #AllHealthLive, and follow us at @AllHealthPOlicy.
0:52
We want you all to be active participants in the discussion, so please get your questions ready.
0:58
You should see a dashboard on the right side of your web browser that has a speech bubble icon with a question mark.
1:05
You can use that speech bubble icon to submit questions you have for the panelists at any time. We will collect these and address them during the broadcast.
1:14
You can also chat any technical issues that you may be experiencing.
1:19
Also please be sure to check out our website, all health policy dot org, where you can find background materials that accompany this broadcast, including slide’s, a resource list, and an expert list.
1:31
And a recording of today’s session will be available there soon.
1:36
And now, I’m so pleased to introduce Tami Luhby to moderate today’s discussion.
1:41
Tammy is a senior writer at CNN. She covers healthcare and economy.
1:47
Prior to joining CNN in 2008, she worked at newsday, and Crain’s New York Business.
1:53
She also teaches journalism at the Columbia Graduate School of Journalism.
1:57
Tami, thank you for being here today, and I will turn it over to you.
2:01
Well, welcome, all. I’m honored to moderate such an expert panel on census and health policy matters. I have long used Census reports in my coverage of Health and Safety Net programs. And while I knew the decennial count was critical for determining the number of seats, each state gets in the House of Representatives. I was not as clear about its role in the vital programs such as Medicaid, food stamps, the children’s health insurance program, and other government assistance programs.
2:29
When the accuracy of the 2020 count was called into question earlier this fall, I thought it was important to explain the connection to readers.
2:37
I found out that federal, the federal government relies on data derived from the decennial census to distribute roughly one point five trillion dollars in funds for these programs along with more than 300 others.
2:50
The money goes to state and local governments, non-profits, businesses, and households across the nation.
2:56
Today, the Alliance for Health Policy has brought together three experts who can lay out in much more detail the connection between the census and these programs and how this year’s count will impact health policy in years to come.
3:09
Here with me today, to further discuss this case, are a group of esteemed experts.
3:15
First, we have Ms. Beth Lynk, a senior director at Census Counts campaign at the leadership conference on Civil and Human Rights.
3:23
In this role, that serves as the chief co-ordinator of the Census Counts campaign, developing a campaign that brings together community based organizations across a wide spectrum of advocacy to ensure communities the Census is historically missed, are counted in the 2020 census.
3:41
Next, I am pleased to be joined by doctor Andrew Reamer, research professor at George Washington Institute.
3:48
Doctor Reamer joined George Washington Institute in 2010, after six years at the Brookings Institution’s Metropolitan Policy program, and 20 years as a consultant in US Regional economic development and public policy.
4:02
And finally, we have Cara Brumfield, a Senior Policy Analyst at the Economic Security and Opportunity Initiative at the Georgetown Center on Poverty and Inequality.
4:13
Carol leads Research and Policy Development Projects on Issues related to Jobs, Education, and Democracy.
4:20
She also conducts research and technical assistance to ensure a fair and accurate count of marginalized communities in the decennial census.
4:29
Thank you for being here with us today.
4:31
Beth, let’s start with you to provide a quick 101 of how the census data is collected and analyzed.
4:38
Absolutely. And thank you so much, Tammy, for that wonderful introduction. And thank you to the Alliance for Health Policy for having this important discussion today about the 2020 Census. And the important role it has in ensuring health, equity, and funding and resources across the country. As was mentioned, I am the director of the Census Counts campaign, which was working with partners across the country, including social service, providers, healthcare providers, and advocates, cities, and counties to get out the count of until communities like young children, Communities of color, rural communities. Communities that have been historically missed in past, Censuses had an opportunity to participate in this 2020 census. Particularly right now, we know that the communities that have been historically left out and, and, and as a consequence, lose out on the resources and funding that their communities deserve.
5:38
Can be some of the same communities that need the most resources and support in this moment as they plan to rebuild and care for their communities in this Coburn 19 pandemic. So, really important that we get this Census, right? Because, if not, it’s gonna hurt everyone.
5:57
If we go to the next slide, I’m going to take us looking back a little bit about how the census data was collected and how it was impacted by the circumstances of this year. So, that the census is the one of the most complicated. And actually, the most complicated peacetime efforts that our country undertakes, it happens, it’s in the Constitution happens every 10 years, and is the counting of every person living in the United States. And really provides a snapshot of who we are in at any given moment in time, and you’ll hear a little bit more about how that data is use. It’s, as I mentioned, is incredibly complicated. There are a number of mechanisms to collect that data, but to simplify their opportunities for households to respond on their own, we call that sort of response.
6:52
There’s ways to reach folks who may be living in group quarters, like a college dorm, or a military barracks or in prisons and correctional facilities, and there are ways and opportunities to count people who may be housed or people experiencing homelessness and outreach that it takes place. As you can tell, just given the wide diversity of our country, the meticulous planning for a census takes a decade.
7:24
And that deployment is very sensitive, obviously, to the circumstances at a given moment, in our 2020, Census was not normal, as this year has not been normal, So the census starts in Alaska, in remote Alaska, and actually started in January. And then for the rest of the country, we had an opportunity to start to respond to the census in March of 2020. That’s also encoded in 19, Really started hitting the United States, Harvard, and so, as a result of that, in April and May, operations, or suspended in the Census Bureau, had to stop a lot of their work, stopped their outreach to rural communities, stop their hiring. That kind of took place over, what is the reference, state? So, the kind of moment we’re really trying to take that photo, or that portrait of the nation, which is April one.
8:18
And I was not until mid may that field operations and hiring were able to resume again, as a consequence of that door to door operation Enumeration, which counts people who did not yet respond on their own started in July and August.
8:37
And then the census, after a bit of confusion, and back and forth with the courts, the enumeration period ended in October, on October 15th, and it was previously scheduled to end, at the end of July. So as you can tell, if I’m going to the next slide, there were a number of things that impacted the timeline and challenge our ability to reach communities, and encourage households to respond to the Census. Coven 19. And that extended timeline was also impacted by natural disasters. Are hurricanes wildfires that impacted the field operations, provided uncertainty about when and how households could respond? We saw mail delays. And in some rural communities on the specific outreach for those communities was impacted. due to social distancing phone center capacity was reduced impacting some wait times in that period.
9:34
When That in person outreach was paused and confusion about how people are counted. So, for folks that were displaced due to economic reasons. Or for students that went home from college, that would normally have been counted at their college confusion about how they should be counted, where they should be counted, could ultimately impact the quality of the data that we see without robust data processing. We also saw impact of fear of government and timeline uncertainty as a result of some of the political machinations that were happening at the time and different political interference. If you go to the next slide, let’s talk about where we are right now and what we can expect.
10:20
So by statute and in the Constitution, the Census Bureau’s directed to produce apportionment numbers to the President right now. It’s outlined is December 31, 2024 apportionment and then the data used for redistricting would come no later than March 30th, 2020. There was major asterisks on both of those numbers because what we saw is, as a result of that impact from … on the data processing, while on the Census operations as a whole. But also, it has also impacted the Data Processing Timeline.
10:57
In April, the Census Bureau and the Administration went to Congress and said, Hey, we’re gonna need more time, that was since reversed from the administration and so there’s been a lot of concern that the Census Bureau will not have the time it needs to process and tabulate the data. In fact, experts within the Census Bureau, the Government Accountability Office, and the Commerce Inspector General have noted that without more time and the room time to process tabulate, the do the important work of checking that data quality and processing that data, we could have unacceptably fly data and data not an acceptable quality.
11:40
If we go to the next slide, you’ll just see here what this means and the impact on that timeline is that, uh, the the vital data tabulation and quality checks in this 20 20 year would be cut. That timeline would be cut in half from 26 weeks in 2021 weeks to do that processing in 2010 to 11 weeks in 2020. That’s why there is legislation, before Congress and the House and Senate, that’s supported in a bipartisan way to extend that timelines. And the Bureau has time to process it. We recently saw a news yesterday that experts within the Census Bureau are saying that that 11 weeks is untenable, and at this point they are the data scientists are projecting delivery of the apportionment data between January 26th and February sixth. So that is kind of where we are right now. So what’s next? And we go to the next slide.
12:43
You’ll just quickly see, I think it’s important for us all to remember that the census is not over while the opportunity to participate is done, important data quality checks are happening now, and need time and space for that to get done.
13:00
As I mentioned, there were a lot of different things that impacted census operations, and I can say, as an advocate of civil rights advocate, an advocate working together, the counts, We do have concerns about what impact that might have on the quality of the data. In, particularly on those marginalized communities. That’s why Congress has an opportunity to extend the statutory deadlines to give the Census Bureau at the time and space it needs. And that’s also why we’re calling for transparency of that process, so that we have information about the quality of that data, once we see it, how, how this process is going, and to ensure that we get quality data that communities across the country can rely on. So that, I think, if we is my last slide, and I’ll turn it back to you.
13:50
Tammy: OK. Thank you. And just to clarify, the redistricting data is due no later than March 30th of 2021. 20 21, Yes, that’s right. At this point, that is what is currently in statute. And as I mentioned, the Census, the that there is pending conversations about. And request to extend those two deadlines by 120 days each which would then put it to the end of July and put the apportionment data to the end of April.
14:24
But at this point, March 30th, 2021, OK, well, thank you very much for that very good explanation of a very complicated process, though now we’re going to have doctor Andrew Reamer discuss how Census data is utilized for apportionment and beyond.
14:45
Good afternoon, everybody. A pleasure to be here.
14:49
But I’ll talk about the roles of the decennial census, broadly speaking at each of which actually effects health, mental health and health policy. Next slide.
15:03
So broadly speaking, the cellular Census has has a number of roles. And I want to note that the centennial census it occurs because it’s in the Constitution. And the sole reason is too.
15:16
Count the number of people in each state to apportion their seats in the House of Representatives.
15:23
For the first census in 17 90, Congressman James Madison had the bright idea that, Hey, if we’re collecting all this information, we’re doing a headcount while. we get some information on the characteristics of the population.
15:34
So Congress can, let’s understand its constituencies better, and so that led to adding questions to the, to the census, which has been done for 230 years.
15:51
So the roles of the census are to one support democracy apportionment in the Constitution redistricting, as we said, and the enforcement of the Voting Rights Act, based on people’s race and ethnic characteristics.
16:06
And, again, you know, HIV’s has a health implication.
16:09
I think, know, people have lost sleep over recent events around our, managing our democracy.
16:20
And, in addition, if, when there’s a new president, there will be a change in health policy of all sorts, including around code.
16:30
The second is promote economic growth, and clearly, jobs are very important.
16:35
Come up elements in people’s physical and mental health.
16:39
Businesses use the data derived from the decennial census to make decisions about where to locate.
16:47
What goods and services to carry and to determine how well you’re doing. CNN, Tammy, and her colleagues, say they only know about the market penetration of CNN, because they have a denominator about the size of the population.
17:03
The third function of the census is to facilitate effective and efficient government that the data derived from the census are used to determine needs to design and manage programs to, as Tammy said, upfront, uh, allocate branch loans geographically as an end to evaluate how well programs have done.
17:29
And then the fourth is to enable social sites to enable scientists, social scientists, in academia, and in the government, too.
17:39
Understand the dynamics of our society is, as again, as we know, epidemiology is critical to combat the coronavirus and epidemiology require good relies on good population.
17:55
Next slide.
17:59
So the census is itself, Daniel says, rarely used for all the things I just mentioned, because it only happens once a decade.
18:10
And there’s only a handful of variables, age, ***, race, ethnicity, and actually, whether you own or rent where you’re living And that’s pretty much it.
18:22
But the Census decennial census is the basis or more current and detailed datasets that are used for all of the things. I mentioned the prior slide.
18:32
First is the annually updated population estimates because you want to write allocate money, for instance, based on the the the most recent population figures, not the 1 from 5 or 7 years ago.
18:47
So pop estimates really are taking the variables I mentioned for the decennial census and updating them how many people live base community by age, ***, race, and ethnicity.
18:58
The American Community Survey, which you might be familiar with, is a sample survey that it goes to a little over 2% of the population, every households every year, asking a wide variety of questions like income, occupation, educational attainment.
19:16
It’s from the ACS that we get poverty levels, for instance, which is critical variable in the allocation of funding.
19:24
And then the third major use of the decennial is to determine core based statistical areas with MSAs, metropolitan statistical areas.
19:35
These are data driven pictures of how we are living how we are grouped geographically and those are very important for all suits.
19:48
Social science and government analyzes, um, so, next slide, please.
19:56
I’m going to focus on what Tammy brought up at the beginning, the use of Census derived data, for the allocation of public funding.
20:05
I’d say public cause it, both the federal government and state governments rely on these data too.
20:12
Hand out the money geographically.
20:15
Here are the six primary uses of the data in allocating federal funding.
20:19
The one is determining eligibility.
20:23
And so, for instance, people on this webinar are, I’m sure are familiar with medically underserved areas and medically underserved populations based on census derived data.
20:34
If you want a community health center, you have to.
20:36
That would be a UA are serving in UP.
20:42
Households.
20:44
Eligibly can be determined by the area’s median income, which comes out of the American Community Survey and applicants can be their eligibility can be determined by the nature of the population that they serve.
20:58
Um, network adequacy, which is, you know, a term that I think people in health policy, it’s pretty unique to health policy.
21:06
Basically, Medicare parts C and D are operated on a basis of census population density data, depending on whether you’re an urban, suburban, or rural area.
21:21
That determines the requirements on you as a Part C or Part D provider.
21:27
Share allocation is probably the most easiest, is his stance, formula grants.
21:33
And there are many, many grants that Congress comes up with a number, and then the formula determines who gets what slice of the pie.
21:42
Some grants are based on all the entire population, regardless of characteristics, but most of them are based on a state or community share of a population sub, like children in poverty, or seniors.
21:59
Um, or, Irvin, urban adults over adults 21 and older in urban areas, which is a homelessness formula grant.
22:10
Then there are reimbursement rates.
22:12
The biggest program is Medicaid, which relies on the f.m.f.
22:20
fair rule, medical assistance percentage.
22:23
Chip, The Children’s Health Insurance Program does the same thing and a few other much smaller programs: Medicare Part A.
22:33
The reimbursement rates for hospitals, dependents, the area that you’re in and those areas are determined through the They use the census data.
22:43
Household voucher payments, for instance, section A payments to household.
22:49
Um to pay rent is based on the area’s area’s median income.
22:56
Then lastly is the well, there are many great programs that are formula grants that every state gets some money.
23:05
There are a number of much smaller programs where communities compete for a fixed pot of money.
23:11
And those applications are scored on the basis of a variety of specifications, including the population size of the community, the poverty rate.
23:23
For instance, a lot of USDA programs or score that you get more points if you’re a smaller community.
23:34
So that’s a quick overview of the uses of the decennial.
23:39
census derive data to allocate federal and state funding, is I will say that for a lot of these programs, right, the money, for instance, WIC women and Children, program.
23:51
The money goes to the state, state has to make decisions about where to, where to put the money, and they rely on census data themselves for them.
24:01
And with that, I’m done.
24:07
You’re on mute.
24:12
Thank you again. You laid that out very clearly for me a few weeks ago, and now for the audience here, so we will now turn to Cara, who will provide specific impacts of the census on health policy and Public Health.
24:26
Thanks, Tammy. So yeah, my name is Kara Brumfield, I’m a Senior Policy Analyst at the Georgetown Center on Poverty and Inequality. I’m very happy to be on this panel alongside some familiar faces.
24:39
And my sincere thanks to the Alliance for Health Policy for having me.
24:43
So I’m going to talk a little bit about key health policy and public health impacts of the decennial, like Tammy said.
24:50
So at a very basic level, the census offers an understanding of how many people live where and what some of their characteristics are. Like Andrew said, it also forms the basis of many other important surveys. Again, as Andrew alluded to ACS, CPS, both of those track factors that impact health, such as income and housing. Another great example, CDC’s data collection methodology for the National Health Interview Survey is based on the decennial census and is redesigned after every decennial.
25:24
So this information allows our democracies to our democracy to function. It allows us to fund programs appropriately.
25:32
And it allows us to get really important information. Health insurance data data on disability, helps us understand rates of disease and mortality. It helps us understand and address social determinants of health, and much more without fair and accurate census data. We can’t do any of these things well.
25:53
So let’s go to the next slide.
25:56
So I’m going to cover a few topics today, and I hope you’ll come away with a few key points. I’m going to try to describe how Census data provide a statistical backbone for public health data.
26:07
I’ll go into a couple of key concepts related to fairness and accuracy of Census data and talk about the importance of accurate population counts in particular for understanding health rates. And then finally, I’ll say just a little bit about how accurate Census data are central to responding to the culvert 19 pandemic.
26:27
Next slide.
26:29
So let me start with just a really quick, but important note about undercounts, like Beth said, the Census Bureau endeavors to count every person living in the United States, but it’s better at meeting that goal for subgroups of people than it is for other groups of people. And when a group isn’t counted fully, there’s an undercount, and when some groups are counted less fully than others, we see differential under accounts, and also, like Beth said, the folks that tend to be ever counted are the folks who tend to be in those marginalized groups.
27:00
Often, people of color, people in rural areas face challenges to being counted accurately, people experiencing homelessness, people experiencing poverty. And the literally does go on also young children.
27:13
Um, so one of the most important measures of how successful a census is, are these differential undercounts the extent to which one group has been undercounted compared to other groups. So you can see in this table here the net undercount for 2010, which was actually widely seen as a very accurate census. You can see that black people were undercounted, while white people were actually over counted.
27:38
Um, differential undercounts can have adverse effects for public health use cases and health rates are one important example.
27:48
Next slide.
27:51
So before I go into health rates, a little bit more, I wanted to show this map really quickly, this is a really cool research resource from CUNY. This is CUNY’s hard to count map and it’s showing self response rates there are really strong correlations between self response and the likely accuracy of a census. And so while the overall self response for 2020 actually slightly surpass the rate for the 2010 census, there are really deep disparities between groups and between geographic locations. So, if you’re curious, you can pull this up and check out what it looks like for your community.
28:28
This shows DC, where I live right now, and you can see some of that variation. And, as Beth said earlier, there’s a really important, in person, enumeration operation called non-response follow-up, which is designed specifically to help narrow these disparities in response rates. But unfortunately, the Bureau cut these door knocking operation short, Which we anticipate will almost certainly, or certainly undermine the quality that we see in the data when all of a sudden them.
28:57
So moving on to health rates and the next slide.
29:02
As I said, on a really basic level, the census tells us how many people live where and some of their characteristics, but if our census date or inaccurate, that can impact our understanding of rates of disease and mortality. And that’s because the census gives us the denominators for health rates.
29:19
So, a key question to consider is, how do these errors, how do these differential undercounts, and over accounts affect our understanding of social determinants of health?
29:31
How do they affect our understanding of health disparities between groups or between locations between communities? How do they impact our understanding of health trends over time?
29:46
All of these are really important questions that I think public health researchers and professionals should be thinking about. So, you can see this is a toy example here, and it shows just sort of demonstrates how systemic error in the denominator can result in systematic bias in rate estimation.
30:06
OK, so, next slide.
30:10
Um, so, of course, the link between Census data and health rates is incredibly important. But I also wanted to highlight just a few other use cases by briefly looking at how Census data are used and responded in responding to the covert 19 pandemic.
30:25
While the Census data are not directly in use since, they’re now a decade old, the annual estimates are often more useful like Andrew was saying.
30:37
But the 2010 census data forms the base where these annually updated population estimates as well as the basis for ACS, CPS other important surveys. So no one could say that the decennial census then is the backbone of our Federal Statistical System.
30:54
And when it comes to the club at 19 pandemic, the Census derived datasets help us to track Coburn 1009 outbreaks, estimate mortality and infection rates. Estimate community resilience, provide insights into where covert 19 related healthcare will be needed most, and guide all sorts of other decision making and resorts resource planning.
31:20
For example, ACS data are important in identifying counties with large at risk populations. And census data can help us know where, for example, our elders aren’t live in which communities they’re in, so that we can understand which communities might be most at risk.
31:37
And next slide.
31:42
So, this slide just shows one of the Census Bureau’s Covert 19 Impact Report. This is for the State of New York at my, my hometown. These reports are also available by county, and it just shows the types of critical information we get from the Census Bureau, though, as I noted before, they’re often not directly drawn from the Census, but from these other surveys or analyzes that come out of the Census. But the decennial serves as the Foundation. So I just wanted to show folks this so you can check it out and you can go to the Census Bureau’s website if you want to see what this looks like for your local area.
32:20
So to wrap up here, I’d like to thank my colleague, Adrian …, for preparing this presentation, though. he wasn’t able to make it today, unfortunately.
32:30
And yes, I’ll end there. Thank you so much.
32:34
Thank you so much, Kara. That was very helpful. So yes, now we’re going to move on to the Q and A discussion.
32:43
So I’ll kick it off while the, uh, organizers are gathering questions, and remember, if you use the questions panel for on the audience interface to submit your questions.
32:56
And let me start off with, and this can go to any one of our panelists, regardless of the current administration’s decision to shorten census collection time is the normal allotted time enough to conduct a wholistic count?
33:14
So, I can start with that. one thing I will say is, as I mentioned, that the census operational timeline, is something that is planned over the course of the decade, The leadership conference. And our Census task force work on the census over a decade and some of the other surveys, but work on the JSON Danielle, in terms of the composition of the questions that looking at the operational plan. And the 2020 operational plan was finalized a full year before we started before it was implemented.
33:50
The operational timeline usually spans and was projected to span between March of 2020 through the end of July and that included all of the different operations for enumeration, including that non-response follow-up door to door outreach. It’s a short period of time, and it’s a lot is packed in, but the reason it’s it’s such a kind of short period, is that reference date, which is April one.
34:21
And that’s listed in the Constitution, is the kind of moment that you really want that snapshot of the nation. So, for a practical matter, if you are counting your household and you have a baby born there on March 30th, you would count that baby in your household. If, unfortunately, you have someone that passes away on April second, they would still be counted because on April one, they were in the United States.
34:50
So, that’s what we mean when we get a snapshot. one of the challenges with the 2020 census is with the extended timeline. The further away you get from that reference states, the harder it is to ensure that there is integrity in that data collection. So, if you’re going door to door to households in September and saying, Hey, Who was living in your household on April 1, 2020, which is why our numerator, we’re asking, the further you get from that date, the harder it is to ensure that there’s integrity of that data just because things change. And certainly, in this year, things changed to a greater degree than in normal decades.
35:30
I would like to follow up on that. Thanks, Beth.
35:35
one, is that the time there’s an issue of time, there’s also an issue of quality.
35:41
And the answers to, to adequate time and sufficient quality will vary from decade to decade, because of pretty radical changes in information technology.
35:52
So, for instance, this this time around the Census Bureau, Beth mentioned non-response follow up people going knocking on doors.
36:01
Well, the Census Bureau doubled the productivity, I believe, death of the door knockers through.
36:10
Better scheduling through the software on their phones.
36:13
So they were able to do many more door knocks in the same amount of time.
36:20
Which, which is positive regarding quality quality.
36:24
So And, again, as Beth alluded, time is needed both to gather information, but you need sufficient time, and death really focused on that to actually process the data.
36:36
And big part of that is getting rid of duplications.
36:41
Betz showed us that in 20 10, the Census said we really hit the nail on the head of the, like The we were off by zeros.
36:51
Well, in terms of accuracy, but when you look under the hood, you see that 3% of the population was counted twice.
36:59
3% of the population was missed entirely so that duplicates canceled out. The people that were missed, and that’s how we got the perfect score.
37:09
This time we could have fewer duplications, fewer omissions, and at worst final score, because the improvements don’t match up.
37:20
And one of the advances this time around if someone does not answer the door refuses to talk what the …
37:32
has done in the past, this was impute the number of people and the characteristics of the people in that household based on what people look like in the neighborhood.
37:42
This time, there’s an intermediate step where Census Bureau is using records, administrative records with 25 different sources to kind of fill in the blanks.
37:52
It’s an open question.
37:53
Deaf can speak to us about how much that will improve the quality of the kill. But that is something that didn’t happen.
38:02
So I want to give those extra dimensions to the question.
38:08
Thank you. We have questions that are now coming in. Kara, one question for you.
38:13
How does the shortened time for the census affect allocation of state and federal health care resources?
38:23
Um, yeah, that’s a great question. I don’t know.
38:26
Andrew might have more to say on that, because you want to do that impressive research about federal funding and census.
38:35
Oh, the answer really is, to what extent does a short amount of time affect the accuracy of the census?
38:46
And if, for instance, New York City misses 20,000 people because of the act, because of the short timeframe, those people are gone from a decade, we don’t get them back in 20 30.
39:00
So, if New York missed 20,000 people, and there is an allocation of federal funding for various health programs based on the city’s population, share nationwide, it loses.
39:15
And so, um, one way also, to think about this, that whatever issues there are, with the accuracy of the census, there are winners and losers.
39:26
Because for a lot of these programs, Congress is allocating money.
39:30
Irrespective of the census numbers, it’s appropriating $10 billion, $15 million. So the question: Who gets what slice of the pie?
39:40
A community can be undercounted because of the short timeframe it they actually make money because the level of its undercount is below the national average.
39:51
And so basically, the back to it, the differential into account that Deb talked about, whatever, whatever ***** ups happened, whoever is has a above average amount of ***** ups, losers and whoever has below average ***** ups makes money.
40:11
And one thing just to add to that as a kind of looking to history in the 2010 Census in New Orleans followed It was a number of years after Hurricane Katrina. But a lot of displacement still have not kind of corrected itself. So, folks were still living elsewhere. And so, when New Orleans was counted, there was a significant, had, a significant, lower number than, in the following years, folks started coming back to the city.
40:42
And the result of that was that, that there was a huge deficit, particularly in education funding, but in healthcare, as well, where the demand was so much higher than the city had resources for as determined by the census data set by the 2010 census. And so it was really up to the city, to the state to try and make up that difference. And that’s one of the things that we’ll see. And I’m one of the reasons why cities, counties are so active in trying to make sure that their communities are counted. Because ultimately the, the impact is really going to be felt by the city leaders and in those city budgets. And then those county budgets, and so what? That will mean for, I think particularly in this colvin moment in Communities that are hit especially hard. … That are already stretched that are already seeing a lot of impact on a number of levels.
41:43
That could be another blow and there might not be the resources there to make up the difference. So, you know that just reiterating, again, that the quality checks and the data processing And tabulation having, we know this data is really messy. We won’t know the quality of the data until we see the data, but we know it’s really messy. And so for a number of reasons. And so it’s going to be important to have time to really look at that, to make sure that it’s as accurate and that it’s an acceptably accurate for folks across the country.
42:17
I’d like to add one other impact this for a big program, which is Medicaid.
42:24
So after every census, the weight population estimates work is that they take the decennial number and then each year after the decennial year, they add births. They subtract deaths based on vital records.
42:38
Then they make an estimate of migration.
42:42
At the end of the deck, so, that’s what’s happened since from 2010 to the present, right up to 20 19, when the 2020 numbers come through.
42:52
Census Bureau is going to toss out all those population Population estimates going back to 20 11.
42:58
And they’re going to replace them with taking, now, we have an Endpoint in 2010, 2020, and Interpolator so, after the 2010 Census, Arizona lost 4% of its population, and Hawaii game, 4% population Because population estimates suggest that the rest Medicaid is based on the prior three years, average per capita income.
43:25
If so, Arizona lost money in Medicaid because it got a lower population. So as per capita income went up in the richer than, in fact, it was.
43:38
So an immediate impact, once the numbers for the states coming out next September, is that numbers for 2018, 2019, get redone for every state.
43:47
And there are new F map formulas.
43:50
So if a steak is undercounted relative to the nation, it’s going to lose money immediately under Medicaid.
43:59
And actually to follow that up, using your research, Andrew, I had a paragraph in my story that said, then had texas’ population than undercounted by 1% in 2010. The state would have lost nearly $292 million in federal reimbursements for Medicaid and chip and fiscal 20 15 according to your research.
44:19
Pennsylvania would have received about $222 million less, and Florida would have been sent nearly $170 million less. so we’re talking about a lot of money here.
44:30
We have some additional questions coming in.
44:33
Can you discuss the hard to count areas and the pros and cons of using technology?
44:39
How did colvin teen impact the plan to do outreach versus public spaces, such as libraries, Grocery stores, etcetera.
44:50
Yeah. I can I can start, and I am definitely jump in all one of the things in a short time, I was trying to kind of stay streamlined. On the challenges that we lifted out, but one of the things before the pandemic hit, the country we were really concerned about is that this was the first high-tech census and this is the first census where the majority of folks across the country participated online. And it’s new tech, new technology. There were a lot of tests and, and checks. But, you know, there was a lot of concern about, you know, the impact, that that would have, particularly because we know, for communities of color, for rural communities and also in urban centers.
45:41
There are disparities in folks, connectedness to the, to the internet. And so, the digital divide was a really real challenge. That was of concern. But, also, in this moment, of a highly connected environment, where there’s concern about privacy and data security, in addition to just a historic levels of fear of government, particularly among those marginalized communities, me and a lot of concern of wood folks feel comfortable and utilizing the census website.
46:14
And where would there be a breakdown on unreached, and among hard to count communities? So, that was one of the reasons. And one of the missions of Census counts to educate communities about the importance of the census to get out in the field do direct outreach and engagement. We did a lot of work in 202019, going around to communities across the country, engaging stakeholders, talking to communities about why the census is important, Why we need to make a plan. Why we need to prepare.
46:48
Had a lot of plans working with the American Library Association, with local businesses, to set up hotspots, to do events, to support questionnaire assistance, when though, you know, in the early days of the pandemic, but it was very clear in person interaction, was not going to happen. So we shifted to using digital engagement, like phone banking, and text banking. There was digital canvassing happening on tribal communities, really innovative work by the National Congress of American Indians and their Indian Country Counts campaign. And in the latter days, I will say there were some mobile questionnaire assistance. So in person questionnaire assistance happening, outside of food banks, in Mississippi organization, called Southern Eco, did incredible work preparing their disaster response to the tornadoes that were impacting Mississippi, with having some census questionnaire assistance happening at the same time to encourage folks, hey, this is really connected because desk disaster dollars are connected to census participation. And so, make sure that we’re connecting.
47:57
So, we had to be really innovative to reach people, But I will say, we’re concerned, earned that and are seeing, as Karen mentioned, there’s a disparity that we see in self response rates. We know that, on average, hard to count tracks. And particularly, tracks of color have lower self response rates than other tracks. And that’s just a fact based off of what we can see from the data right now and so we do have concerns about the pandemic natural disasters and the kind of political climate had an impact on participation will also have an impact on the undercount.
48:38
I think care our next I’m sorry, Beth, our next question, I think you already answered it.
48:43
But I will ask if you want to add anything to it.
48:46
Can you share early indicators of what this year’s data is saying? What communities were greatly missed or undercounted due to displacement?
48:56
Yeah. I can see some of the things that I’m concerned about, and I’m sure others have. I think this is a really good question. Just to note that we won’t know the quality of the data, for sure, until we see the data right. But we are, there are a number of quality indicators that we’re looking at. I will also acknowledge Georgetown, has an incredible resource about data quality indicators from her care. And we’ll talk about, and the American Statistical Association has produced a guide of data, quality indicators that we’re really looking at as a standard to measure against from the outreach perspective. And then get out the current perspective on important quality indicators are, how did the operations function?
49:42
So, were there were there census operations that were planned that did not happen, or were there issues? We’ve been seeing some reports from enumerators, or from Census Bureau staff, that some things may not have worked as they should have. And so, we’re obviously looking at that closely. Self response data is another really important, kind of immediate quality indicator that we’re looking at. And ensuring that the Bureau has time to finish. All the different tabulation and data quality checks is going to be another important quality indicator as we look in this. And that’s why we’re really asking for transparency, because that’ll be important to know that they have a chance to do all the things that they, that the experts say they need to do.
50:29
Yeah, I’ll add to that. In terms of groups of people who have been displaced, it’s a really good point. Lots of folks have been displaced by some of the climate related disasters that we’ve seen happening more. And more recently, I’m also concerned about the count of people experiencing homelessness.
50:47
The Census Bureau does have some strategies for accounting this group because places like shelters, and food pantries, these are sort of the primary locations that the census targets to try to get an estimate of how many people experiencing homelessness there are. These waivers were impacted by Coburn 19.
51:12
And so, we don’t know for sure where the folks who would have been getting services at these places, know, may have been, or may have gone and what impact that may have had on our ability to accurately count them.
51:26
Um, and, yeah, I’m glad you mentioned our, our recent report on census evaluation, for folks who are really interested in sort of the nitty gritty, about how we evaluate the census and figure out how accurate, the Censuses. We do have a report out on our website that we did with a demographer named fellow Hare who’s really excellent. And if you’re interested in that, you know, keep a lookout for demographic analysis, that’s going to be one of the earliest indicators of quality that we’ll be able to see. I believe that should be out in December. And those are independent national estimates that you can compare with the published census data, starting with procurement data in theory. And that’ll give us some of the first indication, so keep it, keep an eye out for that.
52:19
I will also add that another indicator that will be useful is that the percentage of account in any community that are imputed imputations nationwide in 2010, 2% of the population was imputed weight.
52:32
So that means the household was on the master address file, and they couldn’t get any information from the households, so they had they use algorithms to impute.
52:42
If no, it may be communities where 10 or 15% of the population is computed that high. That’s a problem.
52:50
Because imputation is just a guess including you’re guessing the number of people inside the house so it’ll be interesting to see what the level of imputations or Nationwide is still to presenter, 5% and then how do communities vary?
53:07
Alumni?
53:08
Right, And like you said, Andrew, one of the ways that we impute data is using administrative records and with administrative records. The thing is that they’re not as reliable and accurate for some groups, as they are for others. And again, it’s the people of color. And people with low incomes, where that data is going to be much less accurate and reliable. So if we’re seeing lots of imputation for those groups, that’s going to be lower quality data that we get about those groups.
53:35
All right.
53:36
And I say, like, specific communities that have actually have the lowest self response rates are particularly communities that were really concerned about. I’d say, American Indian and tribal communities have very low response rates. Obviously, we’re incredibly hard by phone at 19. And so that’s an area of real concern in urban areas are, Black and Latino communities have had lower response rates on average, and we’re also seeing some impacts. And in some rural areas, and so what, we’ll see kind of, what, what happens. But those are some of the major areas of concern that we’re looking at.
54:13
Thanks, Beth. I want to add one positive note that one of my co panelists mentioned the, This is the first time this option to respond to that, and, you know, half of the country responded on the Internet.
54:28
The quality of the data collected through the Internet is much better than inequality collected through the mail, because in the mail, you can check off two boxes when you’re only supposed to check off one. But the computer will let you do that.
54:40
So, it will be interesting to see the extent to which there was a quality improvement because of the Internet.
54:46
Yeah.
54:47
I think, for all of our concern about whether the Internet was going to fail, I was traveling with a colleague within the Census Bureau who say, like, you know, remember we were so worried about that, and, look, you know, the contingency plans we didn’t didn’t think about did, did take before. So yeah, that’s a good point, Andrew.
55:07
And to that end, I just want to recognize that the Census Bureau exceeded the self response rate in 2010, I believe, during the pandemic, which, you know, for all the problems we’re talking about, it is quite an achievement.
55:27
Well, I filled out my Census response by the Internet, so I enjoyed doing that.
55:34
one question. Should the government revisit how often it conducts the census, for instance? Should it be every five years?
55:45
So that is a good question. And it’s a good question.
55:51
So um, actually in statute there is a provision for maybe a mid decade census. It does not It could not be used for the purposes of apportionment. But, Andrew, and I think it could be used for re-allocation of Federal funding OneNote is that the census, as an addition to be very complicated, is very expensive.
56:13
So, the census, the 2010 census, cost about $16 billion, so there would, obviously, be consequences to adding another census.
56:23
But, thanks, Beth.
56:26
I want to add to one historical footnote, is that the mid decade Census was first proposed by President Ulysses S Grant, 18 69 because the country was growing so quickly, he went to Congress, he said, Look, no difference between 18, 16, 18, 70, is enormous, and we should do this every five years.
56:46
That finally got passed, as Beth said, over 100 years later, in 19 76, but it was never funded.
56:54
And the of the American Community Survey is sort of seen as the replacement for the mid decade census.
57:01
Because up until 2005, there was nothing between the years ending in zeros.
57:08
It was a long for, the last long form was in 2000, and now we collect a sample of data from a sample of households every month, throughout throughout the decade. And so there, in terms, the ACS is not about the county.
57:25
It’s about that distribution of characteristics, what percentage of the people are in poverty?
57:33
So it is not account.
57:36
But it is a partial response to the need for a mid decade since.
57:47
OK, well, I want to thank everyone for your their insight on this important topic. Unfortunately, that’s all the time that we have for today.
57:56
So I definitely want to thank our panelists for joining us this afternoon, and to the audience, please take time to complete the brief evaluation survey that you’ll receive immediately after the broadcast, as well as via e-mail today.
58:12
Later today, a recording of this webinar and additional materials will be available on the Alliance’s website.
58:18
So Beth, Andrew, Cara, thank you very much for joining us.
58:23
Thank you.
58:24
Thank you.