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2019 ACS: Insurance Coverage Overall Fell Nationwide and among the States, with Private and Public Coverage Declines Seen at the State Level

The U.S. Census Bureau has released 1-year estimates from the 2019 American Community Survey (ACS), including state-level information about health insurance coverage by type. This post focuses on private and public coverage.

The State Story
Nationally, the health insurance coverage rate was 90.8% in 2019, down from 91.1% in 2018. This overall drop in coverage was reflected by significant decreases in coverage rates across 19 states in 2019. Health insurance coverage increased in just one state, Virginia, in 2019. There was variation in the extent to which states saw changes in public and private coverage in particular, and in whether these changes represented increases or decreases.

Private Coverage Changes by State, 2018-2019: Significant Decreases in 10 States, Increases in Just Two States
Nationally, private coverage was statistically unchanged from 2018, coming in at 67.4% in 2019. Rates of private coverage varied substantially by state in 2019, ranging from a low of 53.7% in New Mexico to a high of 79.1% in North Dakota.

• From 2018 to 2019, ten states (Arkansas, Connecticut, Iowa, Louisiana, Mississippi, New Jersey, North Carolina, Pennsylvania, Virginia, and Wyoming) saw decreases in rates of private coverage in 2019—a substantial change from 2018, when just four states experienced decreases in private coverage (2017-2018). Wyoming saw the largest decrease in private coverage in 2019, dropping 3.3 percentage points to 71.6% from 74.9% in 2018.
• Only Rhode Island and the District of Columbia (D.C.) saw increases in rates of private coverage in 2019—half the number of states (four) that experienced increases in 2018 (looking at 2017-2018 data). Rhode Island experienced the largest increase in private coverage at 3.3 percentage points, increasing from 70.0% to 73.3% in 2019.
• 39 states experienced no significant changes in their rates of private health insurance coverage.

Public Coverage Changes by State, 2018-2019: Significant Decreases Seen by 11 States while Six States Saw Increases
Rates of public coverage fell 0.2 percentage points nationwide from 2018 to 2019, decreasing to 35.4% from 35.6% in 2018. As with private coverage, more states experienced decreases in public coverage than increases in public coverage. Rates of public coverage also continued to vary widely across states in 2019, ranging from a low of 20.7% in Utah to a high of 50.1% in New Mexico.

• From 2018 to 2019, 11 states (Arizona, California, Colorado, Florida, Illinois, Nevada, Rhode Island, South Carolina, Tennessee, Texas, and Washington) experienced significant decreases in rates of public coverage. This represents a considerable increase from the previous year when just two states experienced decreases in public coverage (2017-2018). Rhode Island, which experienced the largest increase in private coverage in 2019, conversely saw the largest decrease in public coverage—falling 2.5 percentage points to 36.2% in 2019 from 38.7% in 2018.
• Six states (Connecticut, Hawaii, Maine, New Jersey, Virginia, and Wyoming) experienced significant increases in public coverage, a drop from the previous year when 11 states saw increases in public coverage (2017-2018). Virginia’s public coverage rose to 30.7% in 2019 from 28.6% in 2018—the largest increase seen by any state, at 2.1 percentage points.
• 33 states and the District of Columbia (D.C.) saw no significant changes in rates of public coverage between 2018 and 2019.

Access the 2019 ACS 1-year tables here.

Future Data Releases and Products
Stay tuned for more granular details about insurance coverage changes in the states from 2018 to 2019 via customized SHADAC tables examining coverage at the state and county level.

Supplemental tables for the 2019 ACS 1-Year Estimates will be released from the U.S. Census Bureau on October 15, 2020, and 2015-2019 ACS 5-Year Estimates will be available on December 10, 2020.

Related Materials
2019 ACS: Rising National Uninsured Rate Echoed Across 19 States; Virginia Only State to See Decrease (Infographics)
2019 ACS Tables: State and County Uninsured Rates, with Comparison Year 2018
New Subsidized Marketplace Data and Other Data Tables Now Available from the 2019 American Community Survey (ACS)

More Coverage Insights to Come at September 23^rd Webinar with SHADAC and Census Bureau Experts
On Wednesday, September 23^rd at 12:00 PM Central Time (1:00 PM Eastern), SHADAC will host a webinar to examine the new 2019 coverage estimates from the ACS as well as from the Current Population Survey (CPS), with technical insight provided by researchers from SHADAC and from the U.S. Census Bureau, which administers both surveys.

Speakers will discuss the new national and state-level estimates, and attendees will learn:

• When to use which estimates from which survey
• How to access the estimates via Census reports and the new data.census.gov site
• How to access state-level estimates from the ACS using SHADAC tables
• Attendees will have an opportunity to ask questions after the speaker presentations.

Register for this event.