In the wake of a high-profile U.S. push to include a citizenship question in the 2020 census, civil rights groups and professionals say it may undercount “hard-to-count” people, skewing the distribution of health care resources in the state.

By Thomas Goldsmith

The 2020 Census could have a distinct effect on the distribution of health services in North Carolina, particularly if the process misses “hard-to-count” populations including Hispanics, older people in long-term care, children and rural residents.

That’s the concern expressed by voices from the Washington, D.C.-based organization The Leadership Conference on Civil and Human Rights, as well as by authors of a recent Triangle-led academic paper, and by Adam Zolotor, a physician and epidemiologist at the University of North Carolina-Chapel Hill and president of the North Carolina Institute of Medicine.

“For sure we use census data to inform a lot of the ways we think about the distribution of resources,” Zolotor said in a phone interview. “If the census is less accurate it will impact our ability how to allocate resources.”

Who are the “hard-to-count”? “Historically, the census has undercounted young children, people of color, rural residents, and low-income households at higher rates than other population groups. Also, groups with low self-response rates in prior censuses or census tests include “linguistically isolated” households; frequent movers; foreign born residents; households below the poverty line; large (i.e. overcrowded) households; low educational attainment households; and single-parent-headed households. “And people who distrust government authorities and/or have been or could be targets of law enforcement or heightened surveillance…” Source: U.S. Census Bureau

Worry about full participation followed a protracted effort by President Donald Trump’s administration to add the citizenship question, beginning with a March 2018 announcement by U.S. Commerce Secretary Wilbur Ross. The U.S. Supreme Court ultimately stopped the effort, rejecting Ross’ claim that the citizenship data was needed to enforce civil rights law.

Bureau: ID data can’t be shared

Zolotor said even the losing effort has led to fears that non-citizens could give themselves away by their answers.

Theautry Green, a North Carolina media partnership specialist for the Census Bureau’s Atlanta region, discounted fears that people’s personal census information would be used against them.

“The Census Bureau cannot release any identifiable information about individuals, households or businesses, even to law enforcement agencies,” Green said in an email. “The law states that information collected can only be used for statistical purposes.”

But Zolotor was skeptical.

“The Supreme Court has made that decision, but there has been a lot of discussion about this in the media, and I’m not sure that individuals keep up with what the Supreme Court is doing,” he said.

Researchers are concerned that a lower response could lead to inadequate data on which to base some state and federal decisions on where to spend health care dollars. Other recent developments could also affect the response rate, including the General Assembly’s passage of a bill that required county sheriffs to turn in non-citizens to ICE.

“If they are uneasy about how welcome they are, that can lead to a reluctance in participating in the census,” Zolotor said.