How many people have Medicare coverage in YOUR Congressional District?

I recently published an ambitious spreadsheet which attempted to compile a comprehensive & up to date tally of total ACA healthcare coverage (including both exchange-based Qualified Health Plans (QHPs), Basic Health Plans (BHPs) and ACA Medicaid expansion enrollment), broken out by not just state but by Congressional District.

Doing this on a state-by-state level is easy. Doing so by Congressional District (CD) gets a lot trickier.

As I noted in my prior article, for state level ACA enrollment I'm using official data reports from the Centers for Medicare & Medicaid Services (CMS) for the "baseline" numbers, supplemented by more recent state-level data from some of the state-based ACA exchanges & state Health & Human Services departments.

There's only a single CD in Alaska, Delaware, Montana, North Dakota, South Dakota, Vermont and Wyoming, as well as one non-voting House member in the District of Columbia, so no further work is needed for those. For the other 43 states, however, breaking the enrollment data out by CD gets trickier.

My prior post explains my data sources & methodology for all ACA-specific CD-level enrollment estimates, which also include non-ACA Medicaid as well as Children's Health Insurance Program (CHIP) enrollment.

Today I'm adding another major piece of the puzzle to the spreadsheet: MEDICARE.

As a reminder, Medicare enrollment basically falls into two categories: "Traditional" or Fee For Service (FFS) Medicare...and Medicare Advantage, the highly controversial variant which is privately administered and which over the past year has actually surpassed FFS Medicare to become the default choice for enrollees, for good or for bad.

Similar to my prior project, breaking out Medicare enrollment by Congressional District isn't as easy as it sounds. I've only been able to find two reliable sources for this, each of which is problematic for different reasons.

The first is a CD-level Medicare enrollment breakout directly from the U.S. House Ways & Means Committee, compiled from data at the Centers for Medicare & Medicaid Services (CMS) Integrated Data Repository. In other words, it should be about as comprehensive, reliable and accurate as possible.

The only problem is that...it's three years out of date; it was published in February 2022...and the enrollment data comes from July 2021. This wouldn't be too bad...except that this also means that it uses the 2010 Census Congressional Districts...which makes it completely useless for my purposes.

Fortunately, I was able to find a second CD-level Medicare enrollment breakout. This one is much more recent (the data comes from July 2023), and even more importantly, it uses the current Congressional District maps.

In fact, the only thing "troubling" about the second resources is where it comes from: The Better Medicare Alliance.

The Better Medicare Alliance is basically a think tank & lobbying organization devoted to heavily promoting...Medicare Advantage. Given how incredibly problematic Medicare Advantage is for a host of reasons, I'm not exactly thrilled to be utilizing them as a resource, believe me.

HOWEVER...as far as I can tell, their data regarding actual Medicare enrollment by Congressional District seems to be accurate (or at least I can't find any evidence that it isn't or why it wouldn't be). There's no benefit to them to inflate or manipulate these particular numbers, which basically just state how many people had Medicare FFS vs. Medicare Advantage in each CD as of July 2023.

This just left the problem of the data itself being 18 months out of date. As I did with the ACA and Medicaid/CHIP data, the best way I've found to address this is to assume that any statewide changes since July 2023 have been proportional within each state--that is, if statewide Medicare enrollment increased by 5%, I'm assuming that it went up around 5% within each Congressional District.

Again, this isn't ideal, but it's the best I can do for now.

With that in mind, here it is. Note that I've also separated out the ACA/BHP and Medicaid/CHIP spreadsheets into their own worksheets, while adding another worksheet which combines every category together: