Recent Gallup polls have shown adult (18+) uninsurance rates increasing in 2017, leading many to wonder whether federal survey data would show a similar jump in uninsurance. However, new coverage estimates from the National Health Interview Survey (NHIS) indicate that uninsurance rates for nonelderly adults (18 to 64) held steady in the first half of 2017.
| Why the Differing Stories about Uninsurance? | |
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The Gallup poll measuring uninsurance and the National Health Interview Survey employ different methods, instruments, and definitions in generating their respective estimates. As a result, their findings are not directly comparable. |
According to the new numbers, 12.5% of nonelderly adults nationwide were uninsured during the first half of 2017, which is statistically unchanged from 12.4% during the first half of 2016.
This stability in NHIS estimates of uninsurance from 2016 to 2017 mirrors the stability seen from 2015 to 2016, which was preceded by historic declines from 2013 to 2014 and from 2014 to 2015.
The new NHIS estimates also show that uninsurance rates were mostly stable across age, race/ethnicity, and income groups when comparing the first half of 2016 to the first half of 2017. There was, however, an exception to this stability: Among nonelderly adults (18 to 64) with incomes between 250% and 400% of the federal poverty level (FPL), the uninsurance rate increased significantly from 10.2% to 12.2%. This is an important subgroup from a policy perspective, because people in this income range are among the population (100% to 400% FPL) for whom the ACA's individual market provisions specifically aim to expand coverage. During the 2017 open enrollment period, individuals between 250% and 400% FPL made up nearly 20% of consumers enrolling in marketplace plans on HealthCare.gov.
| Uninsurance: Disparities among Subgroups in 2017 | |
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Disparities in uninsurance levels continued to be seen among certain subpopulations in the first half of 2017:
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Increased Enrollment in High-Deductible Health Plans
When comparing data from the first half of 2016 with the first half of 2017, some shifts in public and private coverage emerge.
The percentage of nonelderly Americans enrolled in high-deductible health plans (HDHPs) was one of the few broad points of change in the NHIS estimates, increasing significantly between the first half of 2016 and the first half of 2017, from 38.8% to 42.9% (4.1pp). This increase was even more pronounced among individuals with employer-sponsored insurance, among whom the percentage enrolled in HDHPs jumped from 38.7% in the first half of 2016 to 43.5% in the first half of 2017 (4.8pp).
Private and Public Coverage Rates Changed in Some Cases
| More about Those High-Deductible Health Plans... | |
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The trend of increasing enrollment in HDHP plans through an employer echoes the findings from SHADAC’s recent in-depth analysis of employer-sponsored insurance coverage from 2015 to 2016. Learn more. |
- Private coverage rates increased significantly from 21.6% to 25.8% for nonelderly adults (18 to 64) below the federal poverty level and from 16.1% to 19.4% for all nonelderly individuals (0 to 64) below the poverty level.
- Private coverage rates decreased significantly from 82.7% to 80.3% among children (0 to 17) with incomes at or above 200% of the poverty level and from 84.4% to 83.2% among all nonelderly individuals (0 to 64) with incomes at or above 200% of poverty.
- Public coverage for children at or above 200% of the poverty level increased significantly from 15.1% to 17.3%.
Uninsurance Gap between Medicaid Expansion States and Non-Expansion States Persists
At 8.8%, uninsurance in the first half of 2017 continued to be significantly lower among nonelderly adults (ages 18-64) in states that expanded Medicaid than in states that did not expand Medicaid, where the uninsurance rate for this group was 19.0%.
The gap between uninsurance levels in expansion and non-expansion states for the first half of 2017 was wider than the gap seen in the first half of 2016 (see figure above), as was the case when comparing the first quarters of 2017 and 2016. We will continue to track the size of this gap as additional NHIS data are released.
A Note about the Numbers
The above estimates provide a point-in-time measure of uninsurance, indicating the percent of persons without coverage at the time of the interview. First half of the year refers to January through June.
For more information about the early 2017 NHIS health insurance coverage estimates, read the NCHS brief. Estimates for the first half of 2016 are available here.
Citation
Zammitti, E.P., Cohen, R.A., & Martinez, M.E. November 16, 2017. “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-June 2017.” National Center for Health Statistics: National Health Interview Survey Early Release Program. Available at https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201711.pdf