SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Employer-Sponsored Insurance (2019-2021): A National-Level Look at Cost and Coverage Rates (Infographic)

Throughout the United States, a majority of Americans and their families receive health insurance coverage through their employer. In 2021, the number of individuals enrolled in this type of coverage–known as employer-sponsored insurance or ESI–exceeded 62.2 million. In this blog, infographic, and companion documents, SHADAC researchers use data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to analyze the private-sector ESI landscape in 2021 on a national level and within the states. As discussed in SHADAC’s 2020 ESI coverage blog, the COVID-19 pandemic complicated the collection and analysis of data throughout recent years, leading our researchers to compare 2021 ESI access data against pre-pandemic (2019) estimates and 2021 ESI cost data against 2020 estimates.

Key Findings

Employee Access to Coverage (2019 vs. 2021)

Establishment
Not all private sector establishments offer their employees health insurance coverage. In fact, slightly less than half of establishments in the U.S. offered coverage in 2021 (49.2%). This was a significant increase from 47.4% in 2019.

Offer
The offer of employer-sponsored insurance coverage was extended to the majority of private-sector employees. In 2021, 85.7% of employees in the U.S. worked in establishments that offered health insurance coverage, a rate that remained statistically unchanged from 2019 (85.3%).

Eligibility
Among employees working at establishments that offered coverage, the percent eligible for coverage was 80.3% in 2021; an increase from 77.7% in 2019.

Take-Up
The take-up rate of ESI-eligible employees has varied over the years, and in 2021, 69.8% of eligible employees enrolled in coverage. This represented a 2.1 percentage-point decrease from 2019 (71.9%).

Employee Coverage Costs (2020 vs. 2021)

Premiums and contributions

• The average annual premium for single coverage rose to $7,380 in 2021, a $231 or 3.2% increase from 2020.
   
• For those enrolled in family coverage, average annual premiums also rose. In this case, premiums climbed to $21,381 in 2021, a $623 or 3.0% increase from 2020.

Deductibles

• For single coverage, the 2021 average individual deductible was $2,004. This represented a significant increase of 3.0% from 2020 ($1,945).
   
• Among those enrolled in family coverage, the average deductible per employee enrolled was $3,868 in 2021. This was also a significant increase of 3.9% from 2020 ($3,722).

High-Deductible Health Plans

• In 2021, the share of employees enrolled in high-deductible health plans (HDHPs) increased substantially in 2021 to 55.7% – an increase of 5.3 percentage points from 2020.

Key Takeaways

With so many Americans relying on their employers for health insurance coverage, ESI findings remain an important indicator of the financial and health burdens many individuals and families face. In 2021, the U.S. experienced several continuing ESI trends, including rising costs across employee premiums, premium contributions, and deductibles. Additionally, the share of private sector employees enrolled in high-deductible plans increased substantially. In regards to coverage, more employers offered ESI to their employees in 2021 when compared to pre-pandemic levels. Meanwhile, the rate of ESI-eligible employees enrolling in offered coverage was down overall from pre-pandemic, though unchanged from 2020.

For more detailed information on ESI findings from SHADAC, see the following products:

Report Narrative
The report narrative provides an in-depth look at 2019-2021 ESI estimates including state-level changes and trends.

50-State Comparison Tables
The 50-state tables include 2017-2021 ESI estimates and allow for easy cross-state and state vs. national analysis.

Other related resources
   • 2021 ESI Blog (2019-2020 data) 
   • 2020 ESI Report, Blog, and Infographic (2015-2019 data) 
   • 2019 ESI Report, Blog, and Infographic (2014-2018 data)

Comparing Federal Government Surveys That Count the Uninsured: 2021

January 2022:

With the release of new insurance coverage estimates from surveys conducted by the U.S. Census Bureau, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC), SHADAC has updated our annual “Comparing Federal Government Surveys that Count the Uninsured” brief.

The brief provides an annual update to comparisons of uninsurance estimates from four federal surveys:

• The American Community Survey (ACS)
• The Current Population Survey (CPS)
• The Medical Expenditure Panel Survey - Household Component (MEPS-HC)
• The National Health Interview Survey (NHIS)

In this brief, SHADAC presents current and historical national estimates of uninsurance along with the most recent available state-level estimates from these surveys (where possible). We also discuss the main reasons for variation in the estimates across the different surveys as well as possible reasons for incomparability of estimates across and within the surveys.

Due to the substantial impacts of the COVID-19 pandemic on federal survey data collection and production, this year the brief also includes a brief overview of the unique challenges faced by each agency conducting the four surveys due to pandemic-related disruptions, how the agencies addressed and compensated for these challenges, and what these impacts mean in terms of utilizing survey data on health insurance coverage for 2020.

Download a PDF of the Comparing Federal Government Surveys Brief.

Last year’s brief with data from the 2020 collection year, and certain 2019 collection-year data, can be accessed here.

Hest, Robert
Senior Research Fellow

p 612-624-5507
e hestx005@umn.edu

U.S. Census Bureau Analytic Report Shows Significant Non-Response Bias in the 2020 American Community Survey

The U.S. Census Bureau recently released an analytical report that details and evaluates the impact of the COVID-19 pandemic on data collection and data quality in the 2020 American Community Survey (ACS) and provides evidence supporting its decision to release the 2020 ACS 1-Year estimates and public use microdata on an “experimental,” rather than official basis. This blog post highlights evidence from the report that the pandemic-related disruptions to data collection resulted in measurable non-response bias in the 2020 ACS, causing the survey to over-represent economically advantaged populations.

The analytical report examines trends in a number of measures that are thought to be reasonably stable from year to year or which can be validated against external data sources. The measures evaluated include:

• Building structure type,
• Medicaid coverage,
• educational attainment,
• non-citizen population, and
• median household income.

This post will highlight trends from a selection of these measures: Medicaid coverage, non-citizen population, and educational attainment.

Medicaid Coverage

Figure 1 below compares Medicaid coverage (millions of persons covered) information from the ACS to enrollment data from the Centers for Medicare and Medicaid Services (CMS). Though ACS data have consistently under-estimated the number of individuals covered by Medicaid relative to administrative data, the figure shows how trends in enrollment have been parallel in the past. However, in 2020, these trends diverged, with CMS enrollment data showing an increase in Medicaid coverage (consistent with previous experience that Medicaid coverage increases during economic downturns) and ACS data showing a decrease in Medicaid coverage. This divergence is evidence that households that responded to the ACS were more socioeconomically advantaged than in previous years, and therefore were less likely to report having Medicaid coverage.

Non-Citizen Population

Results in figure 2 show that the number of non-citizens has been largely stable year to year from 2016 through 2019, but the number of non-citizens decreased substantially in 2020, falling by 1.6 million persons. The report’s authors propose that this decrease, though potentially due in part to changes in international migration, is likely due to non-response bias since “foreign born—and non-citizens in particular—disproportionately respond to the ACS via in-person response follow-up methods,” which were substantially cut back in 2020 due to the COVID pandemic.

Educational Attainment

The share of the population age 25 years and over with a bachelor’s degree or higher was relatively stable year-over-year from 2016 through 2019, changing by less than one percentage point. However, from 2019 to 2020, the percent of the population with a bachelor’s degree increased by 2.3 percentage points, which, if accurate, would translate to an increase of about 6 million people with a bachelor’s degree or higher between 2019 and 2020. In previous years, the ACS has shown a year-over-year increase of approximately 2 million in the number of bachelor’s degrees (figure 3).

Conclusion

The measures presented here and in the Census Bureau’s analytic report on the 2020 ACS provide fairly clear evidence that the data collected in the 2020 ACS over-represent a more socioeconomically and educationally advantaged population, an issue that is the product of pandemic-related disruptions to data collection as well as resulting non-response bias. Because of these demonstrable data quality issues, the Census Bureau has chosen to release a limited set of 2020 ACS 1-Year estimates and the public-use microdata sample (PUMS) as “experimental” data products, which will be available later this month.

We commend Census for its transparency in providing this level of detailed evidence of the complications with the 2020 ACS and for making the 2020 ACS data available in an experimental format at least, rather than withholding them entirely from public release. Though the lack of reliable 2020 ACS data creates a critical information gap for a range of data users, given this evidence and the "gold standard" nature of ACS data, it is clear that the Census Bureau acted prudently in not releasing the 2020 ACS as usual.

Related Resources

Census Bureau Announces Major Changes to 2020 American Community Survey (ACS) Data Release (SHADAC Blog)
Changes in Federal Surveys Due to and During COVID-19 (SHADAC Brief)
Current Population Survey (CPS) will Serve as Primary Source of 2020 State-level Data on Health Insurance (SHADAC Blog)

Hest, Robert
Senior Research Fellow

p 612-624-5507
e hestx005@umn.edu

Current Population Survey Shows 2020 National Uninsured Rate Stable, Rising in Three States

On September 14, the U.S. Census Bureau released 2020 national health insurance estimates from the Current Population Survey along with public use microdata. These data will serve as one of very few sources of information on 2020 state-level health insurance as the U.S. Census Bureau will not release its normal set of 1-year estimates from the 2020 American Community Survey (ACS), due to impacts of the pandemic that resulted in nonresponse bias and substantially lower response rates.

Given its large sample size, SHADAC typically relies on the ACS to study state and sub-state (e.g., county-level or state-level coverage by race) health insurance trends and posts detailed state estimates on State Health Compare. However, because the ACS data are not being released as usual this year, we recommend that analysts use the CPS, and have posted 2020 estimates from this survey on State Health Compare for analysts and policymakers that need 2020 state-level information on coverage. Differences between the ACS and CPS and considerations for their use are summarized here.

This post presents highlights from the 2020 state-level coverage estimates on State Health Compare and compares 2020 estimates to 2018, a pre-COVID baseline unaffected by pandemic-related data collection challenges.

Uninsurance was stable nationally and in most states
In 2020, 8.6 percent of Americans (nearly 28 million people) were uninsured all year, statistically unchanged from a pre-pandemic baseline of 8.5 percent in 2018. Rates of uninsurance were unchanged in most states, though three states (Arizona, Missouri, and Tennessee) saw increases and five states (Florida, Maryland, Oregon, Vermont, and Virginia) experienced decreases. Tennessee had the largest increase at 4.1 percentage points (PP) (11.4 percent vs. 7.3 percent), and Virginia had the largest decrease at 3.3 PP (5.5 percent vs. 8.8 percent).

More Americans had public coverage and fewer had private coverage
The percent of Americans with public coverage at some point during 2020 increased to 32.8 percent from 32.3 percent in 2018. This equates to 2.4 million more people with public coverage at some point in 2020 as compared to 2018. At the state level, seven states had increases in rates of private coverage (Maryland, Massachusetts, Michigan, New Hampshire, Ohio, Oklahoma, and Wyoming), and only Virginia had a decrease in rates of private coverage. Of these states, Maryland had the largest increase in public coverage at 6.2 PP (31.2 percent vs. 25.0 percent) and Virginia had the largest and only decrease in public coverage at 3.4 PP (25.1 percent vs. 28.5 percent).

The percent of Americans with private coverage at some point during 2020 fell to 58.6 percent from 59.2 percent in 2018, which represents 934,000 fewer people with private coverage. In most states, however, the percent with private coverage remained stable. Just two states (Virginia and West Virginia) saw increases in private coverage, and five states (Colorado, Delaware, Massachusetts, Ohio and Tennessee) saw decreases. Of these states, Virginia had the largest increase at 6.7 PP (69.5 percent vs. 62.7 percent), and Tennessee had the largest decrease at 7.1 PP (54.7 percent vs. 61.7 percent).

2020 coverage estimates available on State Health Compare
In addition to state-level estimates by both broad coverage types (Insured, Private, Public, and Uninsured) and more detailed (Employer, Individual, Medicaid/CHIP, Medicare, and Uninsured), state-level coverage estimates are available by age group (0-18, 0-64, 19-64, and 65+) and health status (Good/Very Good/Excellent and Fair/Poor). Estimates by poverty level will likely be forthcoming. However, coverage estimates by race/ethnicity for most states do not meet our standards for statistical reliability and precision due to the relatively small sample size of the CPS.

Data users should also note that the 2020 State Health Compare coverage estimates from the CPS are not comparable to estimates from the ACS, since the two surveys use different concepts of health insurance coverage and uninsurance. The CPS asks respondents if they had a particular type of coverage at any point during the previous year or if they were uninsured for the entire year. The ACS asks respondents about their health insurance coverage at the time of the interview. More information on this topic will be available in a forthcoming related brief.

Stewart, Andrea
Research Fellow

p 612-624-4850
e astewart@umn.edu

2021 CPS ASEC Release: Fewer Americans Had Health Insurance Coverage in 2020 — Private Coverage Fell while Public Coverage Rose

National Story
The U.S. Census Bureau has released 1-year health insurance coverage estimates for 2020 from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC). The Census report, “Health Insurance Coverage in the United States: 2020,” showed that the national uninsured rate was 8.6 percent in 2020, which represented a significant increase from 8.0 percent in 2019.¹

No state-level estimates were published in the report, which in the past has drawn on data from the Census Bureau’s American Community Survey (ACS) for information on health insurance coverage by state. Estimates from the 2020 1-Year ACS will not be released as usual this year due to substantial COVID-19-pandemic-related disruptions to data collection operations and resulting issues with data quality. However, the CPS ASEC does provide important breakdowns of available health insurance coverage estimates at the national level, which are explored in this blog, and SHADAC plans to soon release state-level 2020 health insurance coverage estimates from the CPS ASEC.

Public/Private
In 2020, 66.5 percent of the United States population had private coverage, which represented a 1.6 percentage-point (PP) decrease from 68.0 percent in 2019. Conversely, the portion of the U.S. population with a public plan increased by 0.7PP to 34.8 percent in 2020 from 34.1 percent in 2019.

Among categories of private-based insurance coverage…

… employer-sponsored insurance (ESI) continued to be the most common form of coverage at 54.4 percent, followed by direct-purchase coverage (including marketplace coverage) at 10.5 percent, individual marketplace coverage at 3.3 percent, and TRICARE at 2.8 percent.

Among categories of public-based insurance coverage…

… Medicare and Medicaid were split nearly evenly at 18.4 percent and 17.8 percent, respectively. Individuals who had the Department of Veterans Affairs (VA) or Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) made up 0.9 percent of public coverage.

Medicaid Expansion Status
Differences in uninsured rates were also apparent when examined by state Medicaid expansion status. In 2020, the rate of uninsured for states that expanded Medicaid was 6.4 percent, and in non-expansion states the uninsured rate for 2020 measured at 12.6 percent.

Age
Looking at rates of uninsured individuals by age, children age 19 and younger measured at 5.6 percent in 2020. Adults under age 65 had an uninsured rate of 10.2 percent in 2020, while uninsured rates for adults over the age of 65 measured at just 1.0 percent in 2020.

Race/Ethnicity
Estimates of uninsurance by race/ethnicity were also included within the CPS ASEC report. For 2020, the portion of the population who identified as White had an uninsured rate of 8.3 percent, those who identified as Black had an uninsured rate of 10.4 percent, the uninsured rate for those who identified as Asian was 5.9 percent, and those who identified as Hispanic regardless of their race had a rate of 18.3 percent who were uninsured.

Income
The report also provided health insurance coverage data by poverty levels. The rate of uninsured for 2020 for those below 100 percent of poverty measured at 17.2 percent and individuals below 138 percent of poverty saw a similar rate of 16.1 percent in 2020. Conversely, individuals at or above 400 percent of poverty had an uninsured rate of 3.4 percent.

Access the full report on “Health Insurance Coverage in the United States: 2020.”

Current and Future Data Releases and Products
In addition to their health insurance coverage report, the Census Bureau also published two new companion blogs to the CPS ASEC release.

The first post discusses the way in which the CPS has changed its measure of health insurance coverage within a particular year as a result of the 2014 questionnaire redesign, as well as providing an overview of subannual coverage in the CPS from 2018 to 2020, and whether and how these measures may be compared with estimates from other surveys such as the Medical Expenditure Panel Survey (MEPS) and the Survey of Income and Program Participation (SIPP).

The second blog takes a deeper dive into the effects of the COVID pandemic on response rates for the 2021 CPS ASEC and the extent that nonresponse bias played a factor in the outcome of the 2020 estimates for income, poverty, and health insurance coverage.

Experimental data from the 2020 ACS 1-Year Estimates are expected to be published by the Census Bureau in November 2021, and 2016-2020 ACS 5-Year Estimates are planned for release in December 2021 (though Census is still evaluating whether the 5-Year ACS estimates meet their standards for data quality).

SHADAC will monitor these planned ACS releases and will assess whether and how any of these products could be used to produce state-level health insurance coverage and related estimates. We will also assess if and which other data sources may be useful for producing the coverage estimates we typically get from the ACS.