Encourage Patients, Again, to Answer the U.S. Census
By Sean Price


So far this year, not enough Texans have stood up to be counted.

The Lone Star State’s response rate for the 2020 U.S. Census is 58.7%, below the national response rate of 63.6% and below Texas’ 2010 response rate of 64.4%, according to the Census 2020 website.

Texas ranks 39th out of the 50 states in responding. On top of this, the U.S. Census Bureau recently moved up the deadline for responding to the census from Oct. 31 to Sept. 30, giving people a narrower window for submitting their information. 

A George Washington University study examined how a Texas undercount would affect funding for five programs: Medicaid, the Children’s Health Insurance Program (CHIP), adoption assistance, childcare, and foster care. It found that if Texas’ undercount is just 1% more than the undercount seen in the 2010 census, Texas would lose about $300 billion in those five programs alone. This is a conservative estimate, the study says. 

“I don’t think a lot of physicians realize what a huge impact this has and how an undercount of the census can be potentially devastating for our patients,” Lauren Gambill, MD, an Austin pediatrician told Texas Medicine when it first reported on the census in March. Dr. Gambill is promoting education about the census through the Texas Pediatric Society and the Texas Educators in Advocacy and Community Health (TEACH) Network, a collaborative of pediatric residency programs.

Undercounting has remained a concern in Texas, but other problems have emerged this year. Texas has been hard hit by the COVID-19 pandemic, which has forced census workers to change how they gather information. Also, unlike 47 other states, Texas has no coordinated state-run effort to encourage people to respond to the census, though Texas Counts, a coalition of several state organizations, has stepped into that role.

The census directly affects physicians and patients, Dr. Gambill says. For instance, it determines the distribution of more than $675 billion each year nationally in federal funding for several programs, including Supplemental Nutrition Assistance Program (SNAP) and Title I. Population figures from the census also guide how many seats Texas will have in the U.S. House of Representatives and how the boundaries for those and other elective districts are drawn. And the census guides local planners about where to build hospitals and medical clinics.

People can fill out census forms online or by phone by calling (844) 330-2020. Physicians can take several steps to encourage patients to fill out the census:

  • Reassure families that the census is safe. This is especially important in immigrant communities, where many people are concerned about contact with government officials. Census workers take an oath swearing to protect the data they collect for life. Violating that oath can lead to five years in jail and a $250,000 fine, according to the Census Bureau. Also, valid census workers wear a photo identification tag that can be easily checked.
  • Stress the importance of the census. Let patients know that funding for schools, health care, and other vital services hinge on getting an accurate count.
  • Guide patients to materials that can help them overcome language obstacles. Census documents come in English and 12 other languages, according to the Census Bureau. Also, there are language guides and glossaries in 59 non-English languages.
  • Put materials that promote the census in waiting and exam rooms. Texans Care for Children, an Austin-based nonprofit has developed several Texas-themed posters, flyers, and other media.
  • Provide a dedicated computer for patients to fill out census forms before they leave the clinic. This is especially important for patients with no internet access. Patients also can call the Census Bureau and give their answers or fill out paper forms and mail them in.

The census is conducted once every 10 years as required by the U.S. Constitution. Undercounting remains a common flaw across the country in each census, and this year’s version has the potential for more severe problems than usual, Dr. Gambill says.

The two biggest reasons for undercounting are confusion among respondents over who should be counted and fear that the government will use the data for law enforcement purposes, including immigration control, she says.

Undercounting is most severe among hard-to-count populations like those in remote rural areas, people who are homeless, low-income communities, immigrants, and people of color, Dr. Gambill says. Children also are more likely to be undercounted.

Last Updated On

August 18, 2020

Originally Published On

August 18, 2020

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Sean Price


(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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