The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2019 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. These are both the first available full-year coverage estimates for 2019 from a federal survey as well as the first full-year estimates released since the NHIS questionnaire was redesigned and launched in January 2019—further details on which can be found at the end of this post.
National-level estimates are available by breakdowns including age group, sex, poverty status, race and ethnicity, and by state Medicaid expansion status. This is the first time that the NHIS full-year estimates have not included either full or partial state-level data.
More Americans without Health Insurance Coverage in 2019; Public Coverage Remained Steady and Private Coverage Fell among Certain Subgroups
The uninsured rate for all ages increased by 0.9 percentage points to 10.3% in 2019, up from 9.4% in 2018. This represents 33.2 million uninsured persons of all ages and is the first significant rise in the uninsured rate in several years as shown by the NHIS. Uninsured rates also increased from 2018 among all nonelderly persons (0-64) and nonelderly adults (19-64)—with the nonelderly rate rising 1.0 percentage points from 11.1% to 12.1% in 2019, and nonelderly adult rate increasing 1.4 percentage points from 13.3% to 14.7% in 2019.
Rates of public coverage were statistically unchanged across all age groups, while among nonelderly adults, rates of private coverage fell 2.1 percentage points in 2019 to 66.8% from 68.9% in 2018. Rates of uninsurance, private coverage, and public coverage were stable in 2019 for children (age 0-17).
More Black Americans had public coverage, fewer had private coverage; Uninsured rate increased among Whites*
Among the nonelderly population, the only racial/ethnic group that saw an increase in the uninsured rate were non-Hispanic Whites, whose rate increased to 9.0% in 2019 from 7.8%, a rise of 1.2 percentage points. Uninsured rates remained statistically unchanged for other racial/ethnic groups between 2018 and 2019.
One of the most significant findings in this category was a relatively large decrease in rates of private coverage of 3.7 percentage points among non-Hispanic Blacks, whose rate fell to 48.5% from 52.2% in 2018. Rates of private coverage were again statistically unchanged among other racial/ethnic groups.
Conversely, non-Hispanic Blacks experienced a large increase in rates of public coverage, which rose by 5.0 percentage points to 42.8% in 2019 from 37.8%. Rates of public coverage were statistically unchanged for other racial/ethnic groups.
More Women were Uninsured in 2019
The uninsured rate among nonelderly women increased to 11.0% in 2019, up from 10.0% in 2018, representing a 1.0 percentage-point increase. The uninsured rate among nonelderly men remained steady at 13.2%.
Uninsurance, Public and Private Coverage Rates See Similar Trends by State Medicaid Expansion Status
Across both those states that opted to expand Medicaid and those states that have yet to adopt Medicaid expansion, the nonelderly uninsured rate significantly increased in 2019 from 2018, rising to 9.1% from 8.3% (a 0.8 percentage-point increase) in expansion states and rising to 17.1% from 15.4% (a 1.7 percentage-point increase) in non-expansion states.
Though the year-over-year changes did not reach the specified threshold for statistical significance, both expansion and non-expansion states experienced possible erosions in rates of private coverage, with rates falling 1.4 percentage points to 65.0% in the former and falling 1.6 percentage points to 61.4% in the latter. Rates of public coverage experienced smaller, statistically insignificant changes in both categories of states.
Notes about the Estimates
*All subsequent category breakdowns (Race/Ethnicity, Sex, and Medicaid Expansion Status) encompass the nonelderly population, age 0-64.
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.
All changes described compare full-year 2018 to full-year 2019 and are statistically significant at the 95% confidence level unless otherwise specified.
2019 NHIS Redesign
The NHIS recently underwent a substantial redesign of its content and structure, the goals of which were to “improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.”[1]
One of the largest changes made under the redesign is the elimination of the family questionnaire, which previously asked questions about the family as a whole as well as separately of each member of the family. Most of the family questionnaire content was moved to revised sample adult and sample child questionnaires, which are asked of one adult and one selected at random from members of the household and has the effect of substantially reducing the available sample size. For example, the 2019 full-year early release report has a total sample of 32,391 persons, whereas the same report in 2018 was based on a sample size of 72,762 persons. However, NCHS anticipates that the redesign’s reduction in respondent burden will result in more sample adult and sample child interviews due to higher response rates.
[1] National Center for Health Statistics (NCHS). (2019, November 27). 2019 Questionnaire Redesign. Available from https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm