The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2018 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. These are the first available full-year coverage estimates for 2018 from a federal survey, with estimates available for the U.S. and 17 states.
Key Findings
Uninsurance
Approximately 30.4 million persons of all ages, or 9.4%, were uninsured nationwide in 2018. This uninsured rate was statistically unchanged from 2017, as were the rates in the 17 states for which the NHIS provided 2018 estimates.[1] Uninsurance also held steady among most populations by age, sex, race/ethnicity, Marketplace type, state, state Medicaid expansion status, and region. There were, however, significant increases in uninsurance among adults age 45-64 (from 9.3% to 10.3%) who, the report noted, were the most likely group to be uninsured, and among nonelderly adults (age 18-64) with household incomes above 400% of the Federal Poverty Level (FPL).
Public and Private Coverage
Like uninsurance, public coverage and private coverage held steady nationwide in 2018 at 36.7% and 62.3%, respectively. Public and private coverage were also largely stable in the 17 select NHIS states, with the exception of New York, where public coverage increased in 2018 from 38.9% to 43.6%, and Virginia, where public coverage increased from 31.8% to 38.4%. Public coverage also increased from 67.9% to 72.7% among children (age 0-17) with household incomes from 100% to 200% FPL. Private coverage decreased from 26.5% to 21.4% among non-elderly adults with incomes below 100% FPL.
Behind the Numbers
From 2017 to 2018, premiums for silver Marketplace plans increased an average of 32%, with bronze premiums rising 17% and gold premiums rising 18%.[2] Since 45-64 year-olds are subject to age rating both on and off the Marketplace, they face even higher premiums than average, while individuals above 400% FPL are ineligible for Marketplace subsidies and therefore face the entire cost of premium increases. With this in mind, increasing uninsurance among these two groups suggests that some were dropping coverage in response to rising premium costs in 2018. An increase in the rate of high-deductible health plan (HDHP) enrollment, which grew from 43.7% in 2017 to 45.8% in 2018 among the nonelderly (age 0-65) nationwide, provides additional evidence that premium increases played a role in 2018 coverage changes, as individuals may be responding to rising premium costs by shifting to coverage with higher deductibles.
About the Numbers
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview. The 2018 estimates based on a sample of 72,762 persons from the civilian noninstitutionalized population, a decrease from the 2017 sample of 78,074 persons.
For more information about the early 2018 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
[1] Significant differences between 2017 and 2018 are at the 95% confidence level or greater.
[2] Semanskee, A., Claxton, G., & Levitt, L. (November 29, 2017). How Premiums Are Changing in 2018. Kaiser Family Foundation. Retrieved from https://www.kff.org/health-costs/issue-brief/how-premiums-are-changing-in-2018/
Citation
Cohen, R.A., Terlizzi, E.P., & Martinez, M.E. (May 2019). Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, 2018 [PDF file]. National Center for Health Statistics: National Health Interview Survey Early Release Program. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf