Each year, SHADAC covers the releases of health insurance coverage data from major federal surveys such as the American Community Survey (ACS) and Current Population Survey (CPS), both of which are overseen by the U.S. Census Bureau.1 Not only do these data provide an understanding of trends for the millions of individuals in the United States who lack any type of coverage, but they also give indications of changes in other major forms of health insurance, like public coverage, private coverage, and employer-sponsored coverage.
SHADAC researchers work to provide insights into these data in a variety of formats (including reports, blog posts, and webinars) and analyze a multitude of important demographic groups (children, families living below poverty levels, and for communities of color). We also know that to truly understand the trends and vagaries of health insurance coverage, it’s important to look beyond national-level statistics, to see what’s happening at the state level.
That’s why we recently updated one of the longest-running measures on SHADAC’s data tool, State Health Compare, “Health Insurance Coverage Type” with the latest data for 2021. Users can take a look at estimates of health insurance coverage across all 50 states by type (uninsured, employer-sponsored, Medicaid/CHIP, etc.), by categories (age, education level, race/ethnicity, marital status, poverty level, etc.),2 over time (from 2008-2021),3 and can even examine estimates using color-coded maps, trend and bar charts, or by ranking states in terms highest and lowest rates for any coverage type.
2021 Key Findings
After multiple disruptions to data collection efforts resulted in data quality issues for 2020 ACS estimates, SHADAC is excited that data for 2021 are able to be used with confidence once again—though users are cautioned not to compare data to the prior year. Nationally, the U.S. saw a near-record low rate of uninsurance in 2021, at 8.6%, second only to a rate of 8.5% in 2016.
Looking at the state level, however, shows much wider variation in uninsured rates, from a low of 2.4% in Massachusetts to a high of 17.9% in Texas. By larger demographic groups:
- Among children (age 0-18), 5.4% were uninsured in 2021; however, by state, this ranged from 1.1% in Massachusetts to 11.8% in Texas.
- Among those below the poverty level, 15.6% were uninsured in 2021; however, by state, this ranged from 4.4% in Vermont to 30.5% in Texas.
- Among individuals with less than a high school degree, 22.2% were uninsured in 2021; however, by state, this ranged from 5.9% in Massachusetts to 41.4% in Texas.
- Among people reporting “Fair” or “Poor” health status, 25.9% were uninsured in 2021; however, by state, this ranged from 17.9% in Louisiana to 44.7% in Utah.
SHADAC Publications
For a full range of available products from SHADAC’s coverage of the 2022 health insurance data release (2021 estimates) please see below.
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2021 CPS ASEC: National-level |
An Annual Conversation with |
Comparing Federal Government |
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2021 ACS: State-level Analysis |
2019 vs 2021 ACS: State and |
2017-2021 ACS: 5-year State and |
- CPS ASEC: 2021 National Health Insurance Coverage Estimates Show Falling Uninsured and Private Coverage Rates Across Population Demographics (Blog & Infographic)
- 2021 ACS: Estimates Show Declining Uninsurance Rates Across 28 States, Driven by Rise in Public Coverage and Fall in Private Coverage (Blog & Interactive Maps)
- An Annual Conversation with the U.S. Census Bureau: Coverage Estimates from the 2021 ACS and CPS (Webinar Recording)
- 2021 ACS Data: State and County Uninsured Rates, with Comparison Year 2019 (Blog, Interactive Map, & Data Tables)
- Comparing Federal Government Surveys That Count the Uninsured: 2022 (Issue Brief)
- 2017-2021 ACS: 5-year Combined State and County Uninsured Rates (Blog, Interactive Map, & Data Tables)
For more detailed estimates on health insurance coverage in 2021, please visit State Health Compare. Be sure to also check out our helpful guide to Navigating Data on State Health Compare for more on what users can do with this unique data tool!
1 SHADAC also covers health insurance coverage data releases from both the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS). For more on the NHIS, see a recent blog post discussing the early release estimates from the first half of 2022, and for more on the MEPS, see the latest edition of our of Employer-Sponsored Health Insurance report.
2 Because of changes made in 2020 to how the ACS measures race and ethnicity, caution should be used when comparing data by race and ethnicity from 2021 and later to data from 2019 and earlier.
3 As previously documented by SHADAC, 2020 ACS data were unfortunately severely disrupted by the COVID-19 pandemic, resulting in the choice by the U.S. Census Bureau to release the estimates in an “experimental-only” capacity. For that reason, SHADAC created a special “Health Insurance Coverage Type (2020)” measure using data from the CPS. For more on the reasoning behind using the CPS instead of the ACS and the differences between the two surveys, please see our explanatory blog post.