VISIT STATE HEALTH COMPARE
Blog & News
2024 NHIS Data Early Release: Q2 (April – June) Estimates Show Uninsurance Remained Stable While Many Shifted from Public to Private Coverage
November 14, 2024:On November 8, 2024, The National Center for Health Statistics (NCHS) released quarterly estimates of health insurance coverage from the National Health Interview Survey (NHIS) covering the second quarter (April – June) of 2024.
This blog post covers this newly released Q2 NHIS data, including relevant changes in health insurance coverage compared to the same period the year prior, April – June 2023. We also delve into coverage changes by various breakdowns, including by age, race and ethnicity, and poverty level.
NHIS Data Begin to Show Medicaid Unwinding Impact on Coverage
These newest data from the NHIS are some of the first from this survey to show significant changes in coverage coincident with the Medicaid unwinding (the state-level resumption of normal Medicaid eligibility redetermination procedures in April 2022 that had been put on hold during the COVID-19 public health emergency). We will continue to monitor quarterly NHIS early release data to track changes in coverage during the unwinding.
Changes by Age
Between Q2 2023 and Q2 2024, rates of uninsurance remained stable across all measured age groups, at:
-
7.6% among all ages
-
9.1% among the nonelderly (age 0–64)
-
4.6% among children (age 0–17), and
-
10.8% among nonelderly adults (age 18–64)
There were concurrent and offsetting changes in public and private coverage over the same period. Among the nonelderly population, public coverage fell 3.6 percentage points (PP) to 26.6%, private coverage rose 2.8 PP to 66.3, and Exchange-based private coverage rose 1.7 PP to 6.0%.
Among nonelderly adults, public coverage fell 3.7 PP to 21.1%, private coverage rose 3.2 PP to 70.3%, and Exchange-based private coverage rose 2.1 PP to 7.1%.
Among persons of all ages, only public coverage had a statistically significant change, falling 2.8 PP to 39.0%.
There were no statistically significant changes in coverage among children, and coverage remained statistically unchanged at 42.0%, 55.2% and 2.9% for public, private, and Exchange-based private coverage, respectively.
Changes by Race and Ethnicity (nonelderly adults)
Rates of health insurance coverage and uninsurance were statistically unchanged among all measured groups by race and ethnicity except for nonelderly, non-Hispanic White adults. Among that group, the share with public coverage fell 5.0 PP to 17.2%, the share with private coverage rose 3.8 PP to 77.6%, and the share uninsured was statistically stable at 7.5%.
Changes by Poverty Level (nonelderly population)
There were fewer statistically significant changes by poverty level among the nonelderly population compared to changes by age group.
Among those with incomes in the range of 100%–200% of the federal poverty level (FPL), the share who were uninsured increased 4.1 PP to 15.4%.
Public coverage fell among those with incomes above 400% FPL, decreasing 2.0 PP to 7.0%.
Rates of uninsurance were statistically unchanged across measured poverty level groups, and coverage rates also held steady among the 0–100% FPL, 100–200% FPL, and 200–400% FPL groups.
Notes
All changes and differences described were statistically significant based on two-sided t-tests at the 95% level of confidence, indicating that these changes were likely to reflect true changes in the population given the available data. Lack of statistically significant changes does not indicate certainty that there was no true population change, but rather that any true population change was not detectable with the available data.
The presented estimates represent the U.S. civilian noninstitutionalized population.
Blog & News
Walsh, Elliot
Hest, Robert
Lukanen, Elizabeth
What Do the New Census Data Say About Insurance Coverage for Children and Adults? A Look at Both the National and State Level (SHVS Cross-Post)
November 01, 2024:
The following Expert Perspective (EP) is cross-posted from State Health & Value Strategies.
Authors: Elizabeth Lukanen, Elliot Walsh, Robert Hest, SHADAC
Original posting date October 30, 2024. Find the original post here on the SHVS website.
Background on Census Data
Every fall, the U.S. Census Bureau releases detailed data on the population, including data on health insurance coverage. The American Community Survey (ACS) is the premier source for detailed state and substate data on income, poverty, disability, marital status, education, occupation, travel to work, disability, and health insurance coverage, among other topics. An important feature of the ACS is that it includes a large enough sample for estimates for all 50 states and the District of Columbia and, in most states, there is sample to explore data disaggregated by insurance coverage type, age, race/ethnicity, and more.
2023 Data Do Not Capture the Full Impact of Coverage Changes Related to Medicaid Unwinding
The new, full-year 2023 insurance estimates from the ACS reflect data collected from January 1, 2023 to December 31, 2023. This health insurance coverage data provide new national- and state-level insurance coverage estimates, but do not fully reflect the Medicaid unwinding.
According to administrative data from the Centers for Medicare & Medicaid Services, Medicaid and Children’s Health Insurance Program (CHIP) enrollment declined by 13.9 million between March 2023 and June 2024. Some of those who disenrolled likely transitioned to other coverage, and others may have become uninsured. However, coverage transitions that happened in 2024 are not captured in the 2023 estimates from the Census Bureau. Because of the large changes in Medicaid and CHIP coverage during the unwinding, compared to the current, on-the-ground reality in 2024, these 2023 coverage estimates likely overestimate rates of public coverage and potentially underestimate rates of uninsurance.
Despite this limitation, the data are still instructive about changes to coverage during the early months of the unwinding period and generally for the year 2023. This expert perspective looks at health insurance coverage estimates at the national and state levels, and examines children’s health insurance coverage, looking at children’s uninsurance rates by state and by income level. As more data are released SHADAC will conduct additional analyses, presenting coverage estimates across key demographic categories, including by race/ethnicity. Disaggregating data is critical to identifying inequities and gaps in coverage, informing policies to improve equity and to prevent new disparities. It is also vital for identifying state policies and practices effective in maintaining coverage for specific populations so that they might be adopted in other states.
Overall Uninsurance Rates Were Fairly Stable
The uninsurance rate in the U.S. remained unchanged from the previous year, sitting at 7.9% in 2023. This was mirrored by stability in uninsurance in the states. From 2022 to 2023, the uninsured rate fell in 11 states and increased in three states – Iowa, New Jersey, and New Mexico (these changes were statistically significant). Table 1 below highlights the states with the highest and lowest rates of uninsurance in 2023.
Table 1. States with the Highest and Lowest Rates of Uninsurance, 2023
|
Highest Rates of Uninsurance |
Lowest Rates of Uninsurance |
||
|---|---|---|---|
|
Texas |
16.4% |
Massachusetts |
2.6% |
|
Georgia and Oklahoma |
11.4% |
District of Columbia |
2.7% |
|
Nevada |
10.8% |
Hawaii |
3.2% |
|
Wyoming and Florida |
10.7% |
Vermont |
3.4% |
|
Alaska |
10.4% |
Minnesota |
4.2% |
Source: SHADAC analysis of U.S. Census Bureau 2022 and 2023 American Community Surveys. Click here for data from all states.
Children’s Uninsurance Rates Increased
Notably, while the overall uninsurance rate remained stable between 2022 and 2023, the rate for children went up slightly (rising from 5.1% in 2022 to 5.4% in 2023). This comes after two years of falling rates of uninsurance for kids.
Five states saw an increase in their uninsured rate for children (Alabama, Louisiana, New Mexico, South Carolina, and Texas). This wasn’t clearly driven by changes in private or public coverage, though, as both remained stable nationally and went up and down in a variety of states.
Texas is the only state where the data tell a clear story — there was a decline in public coverage for children (1.9 percentage point (PP) decrease to 36.8% in 2023) and an increase in uninsurance for children (1.0 PP increase to 11.9%).
Insurance Coverage Changes for Children (Birth Through Age 18), 2022 to 2023
Source: SHADAC analysis of U.S. Census Bureau 2022 and 2023 American Community Surveys.
Low-Income Children Saw Declines in Public Coverage
For U.S. children below 200% of the Census poverty threshold, uninsured rates rose by 0.4 PP to 7.3% in 2023 (see Figure 1 below). This significant increase was likely driven by a 0.6PP decrease in public coverage (bringing that national rate down to 72.6% in 2023) and a statistically unchanged rate of private coverage (27.0%).
Note: Low income children are defined as those below 200% of the Census poverty threshold. Source: SHADAC analysis of U.S. Census Bureau 2022 and 2023 American Community Surveys.
Among the states, Louisiana (+1.5PP), Michigan (+1.2PP), South Carolina (+1.6PP), and Texas (+1.5PP) all saw significant increases in uninsurance for low-income children, rising to 5.5%, 4.3%, 8.0%, and 15.4%, respectively. No states saw decreases in uninsurance rates for low-income children.
These increases in children without coverage are likely tied to declines in public coverage for low-income children. For example, Michigan saw a 3.1PP decrease in public coverage, bringing it down to 73.2%, and Texas saw a 2.5PP decrease in public coverage, bringing it down to 65.0%.
Health Equity Implications
Rising uninsurance rates for children, particularly for low-income children, has a number of implications for health equity. First, it is important to address the likely reason that uninsurance rates for low-income children rose. While the ACS data doesn’t collect information on the reasons for coverage transitions, the data suggests this was driven by declines in public coverage that correspond with the end of the Medicaid continuous coverage requirement (this is supported by administrative data showing that more than 4.5 million children lost Medicaid or CHIP between March 2023 and June 2024, a reduction of almost 11%).
Second, the essential role Medicaid plays in providing health insurance to low-income children, the majority of whom are racial and ethnic minorities, must be acknowledged. Over 60% of children enrolled in Medicaid and CHIP identify as African American or Black, Hispanic, Asian American, Native Hawaiian and Other Pacific Islander, American Indian or Alaska Native, or multi-racial (State Health Compare, SHADAC, University of Minnesota, Accessed 10/10/2024). Declines in public coverage therefore disproportionately impact children of color. This is supported by early evidence that enrollees who identified as Hispanic or Black were twice as likely to report losing coverage because they could not complete the renewal process. SHVS will explore differences in coverage losses by race and ethnicity as more data are released.
Finally, Medicaid plays a critical role in children’s ability to access care – children with Medicaid or CHIP coverage report high rates of having a usual source of care and access to routine care. Further, evidence shows that they were as likely in the past 12 months to have seen a doctor, had a well child visit, and have had a dental exam as privately insured children. While having Medicaid does not erase the health inequity propagated by systemic racism it does improve access to important healthcare services and losing that coverage risks widening gaps in equity. As stated earlier, the full impact of the unwinding isn’t reflected in the latest data as it only includes the beginning months of the unwinding period. It will be important to revisit this once data from the entire unwinding period is released in order to get the full picture of coverage changes for this and other groups.
Blog & News
Walsh, Elliot
Hest, Robert
Stewart, Andrea
Children’s Health Insurance in 2023: Exploring Rising Uninsured Rates for Low-Income Children
October 21, 2024:
This post is a part of our Survey Data Season series where we examine data from various surveys that are released annually from the summer through early fall. Find all of the Survey Data Season series posts on our Survey Data Season 2024 page here.
With the recent release of survey data from both the American Community Survey (ACS) and the Current Population Survey (CPS), SHADAC researchers have begun delving into what this data can tell us about health insurance coverage in 2023 for:
- The total U.S. population
- Nonelderly adults (age 19-64), and
- Children (age 0-18)
As seen in our full blog post on the 2023 ACS data release and our blog & infographic on the 2023 CPS data release, we found that overall rates of public coverage and private coverage remained unchanged in 2023. However, it is important to note that alongside that indicator of coverage stability at a national level, we also found that:
- Changes in uninsured rates for nonelderly adults' (age 19-64) varied depending on Medicaid expansion status and poverty level
- Rates of uninsured children (age 0-18) rose significantly
These findings sparked questions: After two years of falling rates, what could be contributing to rising uninsurance among children? Changes in nonelderly adults’ uninsured rates between 2022 and 2023 varied by poverty level and the status of Medicaid expansion in their state – could either of these factors also be impacting children’s uninsured rates in the newly released data?
While more research into causes behind these changes is needed, SHADAC began by looking at the ACS HI-11 tables, which include data specific to health insurance coverage rates for children below 200% of the Census poverty threshold.
Keep reading to see some of our findings on how the insurance coverage of low-income children (those with family incomes below 200% of the Census poverty threshold) changed between 2022 and 2023 both nationally and at the state level.
Nationally, Children’s Uninsured Rates Increased while Public Coverage Rates Decreased
Looking at 2023 ACS data for children below 200% of the Census poverty threshold, we found that uninsured rates for this group mirrored overall trends at a national level, rising by 0.4 percentage points (PP) to 7.3%. This significant increase was likely driven by a 0.6PP decrease in public coverage (bringing that national rate down to 72.6%) and a statistically unchanged rate of private coverage (27.0%).
Further, low-income children’s uninsured rate was 1.9PP higher than the 5.4% rate of uninsured children overall, a statistic which saw its own significant rise from 5.1% in 2022.
State-Level Coverage Changes for Low-Income Children
When we delve into state-level data for low-income children, we see that Louisiana (+1.5PP), Michigan (+1.2PP), South Carolina (+1.6PP), and Texas (+1.5PP) all saw significant increases in uninsurance, rising to 5.5%, 4.3%, 8.0%, and 15.4%, respectively.
As with the national uninsured rate, our analysis found that a couple of these states mirror a simultaneous decrease in public coverage that likely influenced the increase in uninsurance. For example, Michigan saw a 3.1PP decrease in public coverage, bringing it down to 73.2%, and Texas saw a 2.5PP decrease in public coverage, bringing it down to 65.0%.
Again, similar to trends at the national level, none of the states that saw increased uninsurance for low-income children saw any significant changes in private coverage among that group.
No states saw decreases in uninsurance.
Looking Closer at Public & Private Coverage Rates for Low-Income Children
Looking at public coverage, states saw a wide range of changes:
- Four states, Arkansas (-4.8PP ), Michigan (-3.1PP), Nebraska (-5.4PP), and Texas (2.5PP), saw significant decreases in public coverage.
- Kansas (+4.5PP), Tennessee (+3.2PP), and Wyoming (+15.8PP) saw significant increases in public coverage
Looking at private coverage, states also saw a wide range of changes:
- Alaska (-8.1PP), Kansas (-5.3PP), Tennessee (-3.8PP), and Wisconsin (-4.9PP) all saw decreases in private coverage
- Kentucky (+3.4PP), Nebraska (+6.5PP), and New York (+2.5PP) all saw increases in private coverage
One thing to note here is that Nebraska, the state with the largest significant decrease in public coverage for low-income children, did not appear on the list of states with significant increases in uninsurance for the same group. But it did also see the largest increase in private coverage for this group, which could have mitigated any change in uninsurance.
Conclusion & Discussion
By looking deeper into low-income children’s health insurance coverage in 2023, we hoped to find more information on why uninsured rates have increased both overall and specifically for this group.
At the national level and in a small number of states, we observed increases in uninsurance that coincided with decreases in public coverage. This could be a result of the unwinding of the Medicaid continuous coverage requirement that began during 2023. According to an issue brief on children’s poverty and health insurance coverage published by KFF in January 2024, Medicaid covers 8 in 10 children living in poverty. This brief goes on to report that based on reported unwinding data from 23 states, almost 4 in 10 of those disenrolled from Medicaid during the unwinding are children, likely impacting the many children living in poverty with this public coverage.
However, this story of falling public coverage and rising uninsurance was not consistent across the states. We did not observe significant changes in uninsurance in most states, either because decreases in one type of coverage were offset by increases in another type of coverage, or because there was little movement in coverage overall.
Coverage estimates for 2024 (to be released next fall) will give a more complete picture of coverage during the unwinding and may clarify how coverage evolved during this dynamic period.
Blog & News
Hest, Robert
Stewart, Andrea
2023 ACS: After Two Years of Decline, Uninsured Rates Increased for Children; Public and Private Coverage Rates See Variations Across the States
September 30, 2024:
This post is a part of our Survey Data Season series where we examine data from various surveys that are released annually from the summer through early fall. Find all of the Survey Data Season series posts on our Survey Data Season 2024 page here.
The U.S. Census Bureau released 2023 health insurance coverage estimates from the American Community Survey (ACS) yesterday, September 12, 2024. These estimates include both national- and state-level information about health insurance coverage by type, as well by certain demographic categories.
Overall, 2023 ACS data and findings at the national level echoed those from the Current Population Survey (CPS ASEC), which was released this past Tuesday, September 10, 2024. According to new ACS data, among the total U.S. population, the 7.9% uninsured rate in 2023 remained statistically unchanged from the previous year (8.0%).
Also like the 2023 CPS data, the newly released ACS data show a significant increase in the uninsured rate among children (age 0-18) in 2023, rising to 5.4% from 5.1% in 2022.
The rest of the blog will walk through state-level findings regarding different types of health insurance coverage (public, private, and uninsurance) in 2023. We will also discuss changes by age category for nonelderly adults (age 19-64) and children (age 0-18).
Key Findings from the 2023 ACS by Health Insurance Coverage Types
Uninsurance
The stability of the national uninsurance rate from 2022 to 2023 was supported by little change among the states between these two years as well.
The uninsured rate fell in 11 states, and increased in Iowa, New Jersey, and New Mexico. North Dakota saw the largest decrease in uninsurance at 1.9 percentage points (PP), moving from 6.4% in 2022 to 4.5% in 2023. New Mexico saw the largest percentage point increase in uninsurance at 0.9 PP, rising from 8.2% in 2022 to 9.1% in 2023. Across the states, Texas and Massachusetts continued their long-running trend as the states with the highest and lowest rates of uninsurance, at 16.4% and 2.6%, respectively.
Private Coverage
2023 ACS data show that rates of private coverage fell slightly to 67.0% in 2023 from 67.2% in 2022. Rates of employer-sponsored insurance coverage (ESI) and direct purchase coverage were unchanged at 54.7% and 13.9%, respectively.
Private insurance coverage rates decreased in nine states in 2023, and increased in four - Florida, North Dakota, Texas, and West Virginia. Delaware saw the largest decrease in private coverage with a 2.7PP decrease from 71.8% in 2022 to 69.1% in 2023. North Dakota saw the largest increase in private coverage, rising 2.4PP from 78.4% in 2022 to 80.8% in 2023. Rates of private coverage across the states ranged from a high of 80.8% in North Dakota to a low of 54.1% in New Mexico.
Public Coverage
Nationally, the rate of public insurance coverage rose significantly in 2023, increasing to 37.4% from 37.2% the previous year. Surprisingly, the rate of Medicaid coverage was unchanged at 21.3% (21.2% in 2022), while the rate of Medicare coverage rose to 18.8% in 2023 from 18.5% the year prior.
Public coverage saw the most change of all insurance types across the states in 2023, increasing in 13 and decreasing only in Arkansas, Idaho, Texas, and West Virginia. Arkansas saw the largest decrease in public coverage, falling by exactly 2.0PP from 45.0% in 2022 to 43.0% in 2023. Wyoming experienced the largest increase in public coverage, rising also by exactly 2.0PP from 31.2% in 2022 to 33.2% in 2023. Across the states, rates of public coverage ranged from a high of 52.2% in New Mexico to a low of 22.6% in Idaho in 2023.
Key State-Level Findings from the 2023 ACS by Age: Nonelderly Adults (19-64)
Uninsurance
The uninsured rate among nonelderly adults decreased 0.3PP from 11.3% in 2022 to 11.0% in 2023, representing the third year of falling uninsured rates for this group. Twelve states saw decreases in their uninsured rates while only Connecticut, Iowa, New Jersey, and Ohio saw increases in their uninsured rates. As with the overall population, North Dakota saw the largest decrease in uninsured rates among nonelderly adults, decreasing 2.2PP to 6.1% in 2023. Iowa saw the largest increase in uninsured rates, rising 1.0PP to 7.1% in 2023.
Private Coverage
The rate of private coverage among nonelderly adults was unchanged at 73.5% in 2023 (73.4% in 2022). Across the states, nearly the same number experienced increases (eight) in private coverage rates for nonelderly adults as experienced decreases (six). North Dakota had the largest increase at 3.3PP, with private coverage rates rising to 85.1% in 2023 from 81.8% in 2022. Delaware saw the largest decrease at 2.3PP, with private coverage rates falling to 74.0% in 2023 from 76.3% in 2022.
Public Coverage
The rate of public coverage among nonelderly adults was also unchanged in 2023, holding steady at 19.5% (19.4% in 2022). Looking at the states, this rate stability was supported by a nearly equal number of states that experienced increases (six) as did those that experienced decreases (five). Delaware had the largest increase in public coverage, rising 2.1PP to 21.4% in 2023 from 19.3% in 2022. Arkansas had the largest decrease in public coverage, falling by 2.1PP to 24.1% in 2023 from 26.2% in 2022.
Key State-Level Findings from the 2023 ACS by Age: Children (0-18)
Uninsurance
The uninsured rate among children rose 0.3PP to 5.4% in 2023 from 5.1% in 2022. This change represents the first year of increased uninsurance among children after two years of falling rates. Five states saw an increase in their uninsured rate while three states — Colorado, Kentucky, and North Dakota — saw a decrease in their uninsured rate. As with nonelderly adults, North Dakota had the largest decrease in uninsured rates for children, falling 1.9PP from 5.5% in 2022 to 3.6% in 2023. New Mexico saw the largest increase in uninsurance, rising 2.1PP from 3.8% in 2022 to 5.9% in 2023. Rates of uninsurance among children ranged from a low of just 1.3% in the District of Columbia to a high of 11.9% in Texas.
Private Coverage
The rate of private coverage among children in 2023 was 60.6%, unchanged from the same recorded rate in 2022. Nearly as many states — Florida, Illinois, Maryland, and West Virginia — saw increases in rates of private coverage as those that saw decreases — New Mexico, Ohio, Pennsylvania, Tennessee, and Wyoming — from 2022 to 2023. West Virginia has the largest increase in private coverage, rising 4.8PP to 57.3% while Wyoming had the largest decrease in private coverage, falling 6.4PP to 65.2%.
Public Coverage
The rate of public coverage among children in 2023 was 39.4%, statistically unchanged from the previous year at 39.6%. Five states — Iowa, Missouri, New Mexico, Tennessee, and Wyoming — saw an increase in public coverage while seven saw a decrease in public coverage. Wyoming had the largest increase in public coverage, rising 9.5PP to 33.6% while West Virginia had the largest decrease in public coverage, falling 5.0PP to 46.0% in 2023.
Future Data Releases and Products
Supplemental tables for the 2023 ACS 1-Year Estimates will be released from the U.S. Census Bureau on October 17, 2024, and 2019-2023 ACS 5-Year Estimates will be available on December 12, 2024. Stay up to date with the latest Survey Data Season releases and resources on the archive page here.
We will also soon be releasing more granular details about insurance coverage changes in the states from 2022 to 2023 via customized SHADAC tables examining coverage at the state and county level, along with an announcement of updated health insurance coverage measures available on State Health Compare.
Concluding the Continuous Coverage Requirement and the Medicaid Unwinding
The continuous coverage requirement that prevented states from terminating individuals’ Medicaid coverage during the COVID-19 pandemic ended on March 31, 2023. The resumption of Medicaid eligibility redeterminations and renewals (and potential disenrollments), a process commonly referred to as the “unwinding,” began on April 1, 2023 and has since ended on June 30, 2024.
Each state was given a 14-month period to navigate returning to normal operations while also meeting reporting requirements set by the Centers for Medicare & Medicaid Services (CMS), such as submitting monthly “Unwinding Data Reports,” in order to publicly share coverage transitions and outcomes data during this time. Though the unwinding period has come to a close, a May 30, 2024, State Health Official (SHO) letter announced that CMS will extend these requirements for the foreseeable future. Beginning on July 1, 2024, all states are expected to continue to submit certain metrics contained in the Unwinding Data Report, now referred to as an “Eligibility Processing Report,” on an ongoing basis.
For more information on the post-unwinding period and reporting process, see a recent blog written by SHADAC researchers for State Health & Value Strategies:
Unwinding Ends, but States’ Reporting of Medicaid Renewal Data Continues (SHVS Cross-Post)
It is important to note that full-year 2023 estimates from all surveys, including the ACS and CPS, will not be fully reflective of a Medicaid unwinding process that began mid-year. However, provisional data from sources like the Census Bureau’s Household Pulse Survey, can give us an indicator of coverage trends during this time.
If you are interested in learning more, SHADAC researchers have compiled a clear, concise, and informative data resource that can be found here:
Related Releases and Materials
Recent Data Release: Current Population Survey ASEC: 2023 National Health Insurance Coverage Estimates Remain Steady for Adults but Rise for Children
We just released a new blog and accompanying infographic from SHADAC researchers covering the release of 2023 health insurance coverage data across the United States. Drawing from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), the blog looks at uninsured rates at the national level, as well as by select demographic categories.
Upcoming Webinar: U.S. Census Bureau Data Explained: Breaking Down 2023 Health Insurance Coverage Estimates from the ACS & CPS - featuring a Q&A with a Census Bureau Expert
On Thursday, September 26th at 1:00 PM CST, SHADAC will host a webinar covering the release of new Census data on health insurance coverage estimates for 2023. The estimates come from two key federal surveys conducted by the U.S. Census Bureau: The American Community Survey (ACS) and the Current Population Survey (CPS).
SHADAC researchers and presenters Robert Hest and Andrea Stewart will discuss the 2023 health insurance data at national and state levels, as well as by coverage type, and a range of other demographic categories (age, geography, poverty level, and more).
In addition, SHADAC will walk through how to access the data and examples of how to use it to answer research questions. We are also pleased to once again welcome a special guest from the Census Bureau, Sharon Stern, who will join us to answer questions from attendees after the presentation.
Notes
All changes described in this document are significant at the 90% level. Private coverage includes individually purchased, employer-sponsored coverage, and TRICARE military health coverage. Public coverage includes Medicare, Medicaid/CHIP, and VA health care. Public and private coverage types are not exclusive and include individuals with those types of coverage alone or in combination with other coverage. Estimates represent the civilian noninstitutionalized population.
Overarching estimates of uninsurance and public and private coverage are for all ages, except where noted for children (age 0-18) and nonelderly adults (19-64).
Blog & News
Hest, Robert
Stewart, Andrea
CPS ASEC: 2023 National Health Insurance Coverage Estimates Remain Steady for Adults but Rise for Children
September 25, 2024:
This post is a part of our Survey Data Season series where we examine data from various surveys that are released annually from the summer through early fall. Find all of the Survey Data Season series posts on our Survey Data Season 2024 page here.
Today, September 10, 2024, the U.S. Census Bureau released an initial report containing data on health insurance coverage across the United States in 2023, drawn from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC). This latest issue in the long-running line of Current Population Reports did not include any state-level estimates, as the Census Bureau plans to release those data from the American Community Survey (ACS) on Thursday, September 12, 2024.
The following blog post explores changes in national-level coverage rates by demographic characteristics such as age, employment, race and ethnicity, immigration status, poverty status, and Medicaid expansion status.
Uninsured Rates Across the Nation in 2023
Overall, data from the “Health Insurance Coverage in the United States” report highlights good news for 2023: the share of the total population without health insurance coverage remained statistically unchanged from 2022 at 8.0%, representing 26.4 million people. Nonelderly adults (age 19-64) similarly did not see any statistically significant change in their uninsurance rate from 2022 (10.8%) to 2023 (10.9%).
However, the report does note that the rate of uninsurance among children (age 0-18) rose significantly to 5.8% in 2023 from 5.4% in 2022.
The overarching stability of uninsured rates in 2023 for the total U.S. population held mostly true when looking across demographic groups, as well. The data show no significant changes for uninsurance among nonelderly adults and children for all measured racial and ethnic groups and by immigration status.
There were some slight changes in uninsurance by region, with both nonelderly adults and children in the Midwest seeing rate increases from 7.2% to 8.1% for the former and from 3.3% to 4.6% for the latter. Children in the West also experienced increasing uninsured rates from 4.2% in 2022 to 5.1% in 2023.
Changes in Uninsurance by Medicaid Expansion Status and Poverty Level
The one subcategory to experience any larger changes in 2023 was uninsurance for individuals in states that have or have not expanded Medicaid.
The rate of uninsurance among nonelderly adults in Medicaid expansion states rose to 8.9% in 2023 from 8.4% in 2022. The rate among those in nonexpansion states remained statistically unchanged at 15.5%. Among children, the rate of uninsurance rose to 4.6% in expansion states (from 4.1%) and was unchanged in nonexpansion states at 8.3%.
Rate of Uninsurance for Nonelderly Adults in Expansion States by Income Level
The rate of uninsurance among nonelderly adults in expansion states with incomes between 100% and 399% of the poverty level rose to 13.3% in 2023 from 12.4% in 2022. The rate of uninsurance among nonelderly adults in expansion states was unchanged among those with incomes below 100% of the poverty level (18.7%) and among those at or above 400% of the poverty level (3.5%).
Rate of Uninsurance for Nonelderly Adults in Nonexpansion States By Income Level
The rate of uninsurance among nonelderly adults in nonexpansion states with incomes below 100% of the poverty level fell to 32.5% in 2023 from 37.9% in 2022. The rate of uninsurance among nonelderly adults in nonexpansion states was unchanged among those with incomes between 100% and 399% of the poverty level (21.4%) and at or above 400% of the poverty level (5.4%).
Public and Private Coverage Across the Nation in 2023
Among all persons, overall rates of public coverage and private coverage in 2023 remained unchanged at 36.4% and 65.4%, respectively. Much like uninsured rates, rates of public and private coverage remained steady across demographic groups by race and ethnicity, immigration status, and even mostly across Medicaid expansion status.
The only exception of note was in expansion states, which saw a decrease in rates of private coverage, falling 0.7 percentage points to 65.9% in 2023. (The rate of public coverage remained unchanged at 37.8%.)
Changes in Employment-Based, Medicaid, and Medicare Coverage
However, there was more change in coverage when looking at specific types of private and public coverage.
Within private coverage types, the rate of employment-based coverage fell 0.7 percentage points to 53.7% in 2023 while the rate of direct purchase and Marketplace coverage each increased to 10.2% (0.3 percentage point increase) and 4.0% (0.4 percentage point increase), respectively.
Within public coverage types, the rate of Medicare coverage increased 0.2 percentage points to 18.9% while the rate of Medicaid coverage was unchanged at 18.9%.
Image Text: Health Insurance Coverage by Employment Status for Nonelderly Adults in 2023: Among nonelderly adults who worked full-time, year-round, the rate of uninsurance increased to 8.9% in 2023 from 8.4% in 2022. However, the rate of uninsurance actually decreased to 12.9% from 13.8% among those who worked less than full-time, year-round. Rates were unchanged among those who did not work (14.7%) and among all workers (10.0%). There was no change in rates of either private or public coverage among all workers; those who worked full-time, year-round; those who worked less than full-time, year-round; and those who did not work.
COVID-19 Public Health Emergency, Medicaid Unwinding, and Related Impacts
Concluding the Continuous Coverage Requirement and the Medicaid Unwinding
The continuous coverage requirement that prevented states from terminating individuals’ Medicaid coverage during the COVID-19 pandemic ended on March 31, 2023. The resumption of Medicaid eligibility redeterminations and renewals (and potential disenrollments), a process commonly referred to as the “unwinding,” began on April 1, 2023 and has since ended on June 30, 2024.
Each state was given a 14-month period to navigate returning to normal operations while also meeting reporting requirements set by the Centers for Medicare & Medicaid Services (CMS), such as submitting monthly “Unwinding Data Reports,” in order to publicly share coverage transitions and outcomes data during this time. Though the unwinding period has come to a close, a May 30, 2024, State Health Official (SHO) letter announced that CMS will extend these requirements for the foreseeable future. Beginning on July 1, 2024, all states are expected to continue to submit certain metrics contained in the Unwinding Data Report, now referred to as an “Eligibility Processing Report,” on an ongoing basis.
For more information on the post-unwinding period and reporting process, see a recent blog written by SHADAC researchers for State Health & Value Strategies:
Unwinding Ends, but States’ Reporting of Medicaid Renewal Data Continues (SHVS Cross-Post)
It is important to note that full-year 2023 estimates from all surveys, including the CPS and ACS, will not be fully reflective of a Medicaid unwinding process that began mid-year. However, provisional data from sources like the Census Bureau’s Household Pulse Survey, can give us an indicator of coverage trends during this time.
If you are interested in learning more, SHADAC researchers have compiled a clear, concise, and informative data resource that can be found here:
CPS ASEC Data Collection - Response Rates and Nonresponse Bias
Continuing a trend that began in 2020 during the COVID-19 pandemic, Census Bureau researchers once again noted an issue of lower response rates for the CPS ASEC this year (67.2% in March 2024 compared to 81.5% in March 2019). While a newly published CPS companion blog from Census points out that low response rates in and of themselves are not inherently problematic, issues can arise when certain types of respondents are overrepresented in the data as compared to nonrespondents.
For example, starting in 2020, the CPS ASEC began to see more respondents with reported higher earnings than in years prior, and Census researchers have found that differences in median earnings between respondents and nonrespondents were statistically significant in each year since 2019 (2020-2024). This difference has the potential to, in turn, affect overall income and poverty estimates.
The Census Bureau has continued to monitor these issues since they first arose during the COVID-19 pandemic, and has begun to develop a number of methods to address them, including combining data from different sources to produce improved estimates of the income distribution as well as creating and employing an alternative weighting scheme.
Related Releases and Materials
ACS 2023: After Two Years of Decline, Uninsured Rates Increased for Children; Public and Private Coverage Rates See Variations Across the States
As previously mentioned, the Census Bureau released 2023 estimates from the American Community Survey (ACS) - including coverage rates at the state level - on Thursday, September 12, 2024. SHADAC has now created and released a blog post analyzing the new ACS data.
You can check for other updates on our Survey Data Season 2024 Resource Page.
Upcoming Webinar: U.S. Census Bureau Data Explained: Breaking Down 2023 Health Insurance Coverage Estimates from the ACS & CPS - featuring a Q&A with a Census Bureau Expert
On Thursday, September 26th at 1:00 PM CST, SHADAC will host a webinar covering the release of new Census data on health insurance coverage estimates for 2023. The estimates come from two key federal surveys conducted by the U.S. Census Bureau: The American Community Survey (ACS) and the Current Population Survey (CPS).
SHADAC researchers and presenters Robert Hest and Andrea Stewart will discuss the 2023 health insurance data at national and state levels, as well as by coverage type, and a range of other demographic categories (age, geography, poverty level, and more).
In addition, SHADAC will walk through how to access the data and examples of how to use it to answer research questions. We are also pleased to once again welcome a special guest from the Census Bureau, Sharon Stern, who will join us to answer questions from attendees after the presentation.
Notes
- All changes are tested at the 90% confidence level.
- All estimates come from the 2023 and 2024 Current Population Survey Annual Social and Economic Supplements, which provide data for years 2022 and 2023, respectively.
- Uninsured estimates represent individuals with no health insurance coverage for the entire calendar year.
- Estimates of health insurance coverage type represent individuals with that type of coverage at any point during the calendar year. Types of health insurance coverage are not mutually exclusive.
