NHIS: Early Release Estimates for January-June 2021 Show Continued Significant Changes in Public and Private Coverage across All Groups

A report of health insurance coverage estimates for the first half of 2021 (January to June) from the National Health Interview Survey (NHIS) has just been released by the National Center for Health Statistics (NCHS) as part of the NHIS Early Release Program.

Comparing the 2021 estimates to the same time period in 2020 showed broadly similar overall trends by coverage type:

• The rate of individuals without health insurance coverage was statistically unchanged for those of all ages (9.6 percent) as well as for children age 0-17 (4.4 percent).
• The rate of individuals with public coverage increased for those of all ages to 39.5 percent from 37.9 percent, and to 44.7 percent from 41.1 percent for children age 0-17.
• The rate of individuals with private coverage decreased to 60.1 percent from 62.2 percent for those of all ages and dropped to 53.1% from 53.5% for children (age 0-17)—though this change was only statistically significant at the 90% confidence level.

Analysis of coverage trends for specific subpopulations, however, revealed larger differences among nonelderly respondents (age 0-64).

Findings by race/ethnicity

Large disparities in rates of uninsurance persisted from 2020 to 2021, with Hispanic/Latino individuals being more than twice as likely to be uninsured compared with all nonelderly individuals (23.6 percent versus 11.4 percent). Additionally, the share of nonelderly Hispanic/Latino people who were uninsured increased to 23.6 percent from 19.7 percent.

Examining uninsured rates for individuals of other races/ethnicities showed that uninsurance decreased to 5.1 percent from 8.4 percent for nonelderly Asian individuals, but was stable among White individuals, Black individuals, and persons who reported as Multiple/Other race at 7.5 percent, 11.8 percent, and 11.7 percent, respectively.

Looking at public coverage in the first half of 2021, the share of nonelderly White persons who had public coverage increased to 22.0 percent from 19.8 percent in the first half of 2020 while remaining stable among: Hispanic/Latino people (35.9 percent), Black people (40.2 percent), Asian people (21.0 percent), and those of Multiple/Other race (35.4 percent).

Conversely, the share of Hispanic/Latino nonelderly individuals with private coverage fell to 42.0percent in the first half of 2021 from 47.9 percent in the same time period of 2020. Rates of private coverage, however, were stable among White individuals (72.7 percent), Black individuals (50.2 percent), Asian individuals (74.7 percent), and individuals of Multiple/Other race (50.8 percent).

Findings by Medicaid Expansion status

For January-June 2021, nonelderly individuals (age 0-64) living in non-expansion states were more than twice as likely to be uninsured than those living in expansion states at 17.1 percent vs. 8.5 percent—though these rates were both stable when compared with rates from January-June 2020.

In expansion states, rates of public coverage increased to 29.2 percent (from 26.9 percent) while rates of private coverage conversely decreased to 64.4 percent (from 67.0 percent). Rates of both public and private coverage remained stable in non-expansion states at 25.2 percent and 59.6 percent, respectively.

Impact of COVID-19 on NHIS 2020 and 2021 data

Though NCHS notes that data collection efforts for the 2020 NHIS were disrupted by the COVID-19 pandemic and, subsequently, estimates for April-December 2020 may have been impacted by nonresponse bias, normal survey collection and follow-up operations resumed in full by September 2020. All subsequent estimates presented in this early release report for January-June 2021 meet NCHS standards of reliability as specified in “National Center for Health Statistics data presentation standards for proportions.”¹

Notes

All differences described in this analysis are statistically significant at the 95% confidence level, unless otherwise indicated.

Estimates are representative of the civilian noninstitutionalized U.S. population, and comparisons presented here are between NHIS data for January-June 2021 and January-June 2020.