How the U.S. Census Affects a Decade of Healthcare Funding

The decennial United States census is a short form each citizen is required by law to fill out every 10 years. The U.S. Census Bureau provides the collected data to lawmakers and federal agencies to determine how hundreds of billions of dollars in federal funding will be spent annually in communities for healthcare and assistance programs over the next decade.

Experts say that’s why counting everyone is so crucial—but that doesn’t always happen. The 2020 census has had unique challenges.

“The amount of money that every state gets for these programs is directly tied to their census counts,” Janna Johnson, PhD, assistant professor at the University of Minnesota's Hubert H. Humphrey School of Public Affairs, tells Verywell. “So if an area has a severe undercount of population, they might get less money from the federal government than what they need.”

The U.S. Census and Federal Funding

The decennial U.S. census asks questions about the sex, age, and race of each person living in a home or institution. According to the U.S. Census Bureau, the data helps determine where more than $675 billion per year in federal funds will be spent for the decade.

Funds also go to programs that impact health and well-being, such as the National School Lunch Program, the Supplemental Nutrition Assistance Program (SNAP)—formerly known as food stamps—and the related Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Additional impacted programs include the Maternal and Child Health Grant (MCH) for the health of low-income pregnant women, mothers, and children, and programs funded under the Violence Against Women Act and the Family Violence Prevention and Services Act.

“Most of these [programs] are targeted to underserved populations, people in poverty, low-income communities,” Johnson says. “And unfortunately, a lot of those same communities are the ones that tend to suffer the highest undercount rates as well.”

Johnson, who studies undercounts, says that the communities that would most benefit from accurate data (which ensures they will receive an adequate amount of federal funding) are the communities most likely to be missed. 

The Ramifications of Undercounts

“The census is critical for low-income communities and communities of color to receive the resources and representation that they deserve,” Lemuria Alawode-El, a vice president at United Way of New York City (UWNYC), tells Verywell.

The U.S. Census Bureau is responsible for defining hard-to-count populations. “It’s mostly based on socioeconomic status, which unfortunately in this country is strongly associated with race and ethnicity,” says Johnson.

The exact reasons why people might be missed are unknown, but Johnson says one factor could be housing instability. 

The most-missed age group is children under 5. Johnson says that this could be because a person filling out the form doesn’t account for the youngest members of the household. Additionally, if a child splits their time between two caregivers, both adults might assume the other person included the child in their household count.

The dollars lost when children are left off the census could have directly benefited them. “The undercount of children would reduce the city’s Title I funding,” says Alawode-El, who is leading the UWNYC census effort, “meaning fewer federal dollars for programs to improve schools in high-poverty districts and for children with disabilities.”

Local Census Data

Decennial census counts not only impact how federal resources are allocated, but in some ways, how municipalities distribute funds. “County governments, city governments—they all rely on census counts and Census Bureau estimates in order to plan for what sort of budget they’re going to need for programs for folks,” Johnson says.

According to the U.S. Census Bureau, local governments use the data for public safety and emergency preparedness initiatives, as well as for deciding where to direct funds for hospitals, clinics, schools, and infrastructure.

“The census is also important for how nonprofits strategize to assist communities and help fill in the gaps of resources and support,” Alawode-El says.

Decennial vs. American Community Survey Census 

A decennial census is a short form that’s sent out every 10 years, specifically in years that end in a zero, like 2020, to count every person in the U.S. population. The short form includes questions about age, sex, race, and Hispanic origin. About one in six households also used to receive a longer form as part of the decennial census. 

“It contained all sorts of questions, including health insurance coverage, disability status, income, commuting time—pretty detailed information,” Johnson says. “And what happened after 2000 is that the Census Bureau decided that they wanted to collect that type of information more often than just every 10 years, so they started a new survey called the American Community Survey.”

According to the Census Bureau, the American Community Survey is meant to provide communities with a regular picture of economic, housing, social, and demographic data.

The U.S. Census and Congress

Although decennial census data is used to allocate federal funding, the U.S. Census Bureau says the count’s main function is to determine the apportionment of the 435 seats in the U.S. House of Representatives.

Accuracy matters: Since congress proposes and passes legislation, a change in seats across states could impact federal healthcare policy and health-related federal funding.

Johnson, who lives in Minnesota, uses her state as an example. “We’re considered one of the states that’s potentially at risk for losing a seat in the House," she says. "So we would go from eight down to seven. And, of course, that reduces the amount of sway that our state would have in the House of Representatives.” 

“If New York doesn’t have a complete count, we could lose up to two seats following this year’s census," Alawode-El says.

However, Johnson adds that reapportionment doesn’t change too much with each decennial census. She estimates that about five out of the total 435 seats change states from decade to decade. “It’s not huge, but for the states that are affected it’s not insignificant.”

States also use decennial census data for redistricting every 10 years, Johnson adds. Redistricting is when a state redraws the lines of individual legislative districts, something that is separate from House seat reapportionment.

Challenges of the 2020 Census

The 2020 decennial U.S. census has faced some unique challenges. For one, households received their census forms in the mail per the U.S. Census Bureau’s timeline in the middle of March. Around the same time, much of the nation was sheltering in place for the COVID-19 pandemic.

Johnson says the rollout was unfortunate timing. “All the follow-up work that Census Bureau workers do in terms of going out into the neighborhoods and trying to catch people who haven't submitted their census form already,” says Johnson. “That all got delayed as well as affected by the COVID pandemic.”

The U.S. Census Bureau is now under a preliminary injunction order issued by a federal judge to continue counting through the end of October after the Bureau’s announcement on Twitter late last month that it would wrap up early on October 5.

Johnson brings up another concern with the 2020 census. “There were actions taken by the Trump administration to add a citizenship question to the census. It was struck down by the Supreme Court, but it was viewed as an attempt to discourage particular groups from answering the census.” 

When asked if the U.S. Census Bureau has concerns regarding undercount this year, the Bureau declined to comment for this article and directed Verywell to a recent press release. The release states: “As of Oct. 5, 2020, 99.7% of housing units have been accounted for so far in the 2020 Census through either self-response or Nonresponse Followup.”

Johnson isn’t confident about the count. “For multiple reasons, no one who has this particular knowledge that I have is expecting the 2020 census to be particularly accurate.”