Blog & News
New Data on Health Insurance Coverage by Race/Ethnicity Added to State Health Compare
February 13, 2024:State Health Access Data Assistance Center (SHADAC) has added two new racial/ethnic population groups to our measures of health insurance coverage available on State Health Compare.
Using micro-data from the American Community Survey (ACS), we were able to add health insurance coverage measures for American Indian/Alaska Native (AIAN) and Native Hawaiian Pacific Islander (NHPI) populations. Specifically, SHADAC has added insurance coverage data for AIAN and NHPI populations at both the national and state level (when sample size permits) from the years 2008-2022. Estimates for these groups are also available by age and poverty status.
This update now allows users to download estimates of insurance coverage for all of the minimum race categories for data collection outlined by the Office of Management and Budget (OMB), which are: American Indian or Alaska Native (AIAN), Asian, Black or African American, Native Hawaiian or Other Pacific Islander (NHPI), and White.
Uninsured adults (19-64) in the US, 2021-2022 | ||||||
---|---|---|---|---|---|---|
Race/ethnicity | Age | 2021 | 2022 | Difference | * | |
AIAN | 19-64 | 24.5% | 22.2% | -2.4 | * | |
African-American / Black | 19-64 | 13.4% | 12.1% | -1.3 | * | |
Asian | 19-64 | 7.2% | 6.7% | -0.5 | * | |
Hispanic / Latino | 19-64 | 24.4% | 22.8% | -1.5 | * | |
NHPI | 19-64 | 12.1% | 13.6% | 1.5 | ||
Other / Multiple Races | 19-64 | 11.2% | 10.5% | -0.7 | * | |
White | 19-64 | 8.2% | 7.4% | -0.7 | * | |
All | 19-64 | 12.0% | 11.2% | -0.9 | * | |
* Significant difference between years. Source: SHADAC analysis of the 2021-2022 American Community Survey. |
In this analysis, we used this newly available data from State Health Compare to examine differences in uninsurance from 2021 to 2022 by race/ethnicity for adults ages 19-64. Over this period, the overall uninsured rate for non-elderly adults dropped nearly a percentage point, reaching 11.2%. The largest drop in uninsurance was seen among AIAN adults, lowering by 2.4 percentage points. Hispanic and Black adults also saw improvements in coverage of greater than one percentage point (1.5 and 1.3 percentage points, respectively). More modest gains in coverage were reported by adults who were White, Asian, and Other/Multiple races.
Significant decreases were seen consistently across populations by race/ethnicity except for the NHPI adult population, which did not see this same decrease in uninsurance. While estimates were limited by sample size and changes were not significant, uninsurance rates for this group increased from 12.1% to 13.6%. These concerning rates of uninsured NHPI adults contrasted with the overall trend of decreased uninsurance rates and thus warrant further observation.
While encouraging to see a trend of decreasing uninsurance amongst non-elderly adults, disparities in insurance coverage between racial/ethnic groups are persistent. For example, in 2022, more than one in five adults were uninsured among both the Hispanic/Latino and AIAN populations. Uninsurance was also high for NHPI and Black adults, at 13.6% and 12.1%, respectively. The substantial differences in coverage between racial/ethnic populations illustrate the ongoing priority of improving health equity, including health care access. We plan to continue monitoring insurance coverage in light of ongoing post-pandemic policy changes. Providing more granular estimates by race/ethnicity will support efforts to understand and reduce disparities in health care access.
Publication
SHADAC’s Primary Source of Coverage Hierarchy for American Community Survey (ACS) Estimates on State Health Compare
This updated brief from SHADAC defines a “primary source of coverage hierarchy,” and how and when researchers can use this tool to determine which payer is primary when an individual reports multiple sources of health insurance coverage on the American Community Survey (ACS).
Using a hierarchy provides multiple benefits for researchers, including the ability to ensure that individuals who report having multiple types of coverage are only counted once, reducing the rate of over-reporting for a specific type of coverage, and making coverage estimates more comparable across different surveys. However, SHADAC researchers caution that there is not one specific, singular hierarchy that should always be imposed; rather, there are a multiplicity of possible hierarchies with orders of coverage varying based on the research focus and requirements of each individual analysis (e.g., if a researcher would like to look at a range of coverage over time, or examine coverage for a singular year or specific subpopulations).
When performing national, state, and sub-state analysis of ACS coverage data, SHADAC imposes a particular coverage hierarchy that places respondents into two categories, age 0-18 and age 19 and older, and then ranks possible coverage options—Medicare, Medicaid/CHIP, Employer/Military (TRICARE, VA), Direct purchase, and Uninsured —in descending order for which respondents in each age group will be sorted.
The reason for this separation by age is that for all adults age 19 and older, Medicare is considered the primary source as it is the primary payer for covered medical services. Children age 0-18 are not eligible for Medicare (except in one rare and specific instance) and therefore Employer/Military is considered primary, as many dependents draw this source of coverage from an adult parent or caregiver.
In addition to exploring the different hierarchy possibilities, the brief also walks the user through an example application of SHADAC’s coverage hierarchy on data from the 2022 American Community Survey, and how this affects the rates of reported coverage for each insurance source for the two age groups, both separately and together.
For more on the data produced using SHADAC’s primary source of coverage hierarchy, visit our State Health Compare web tool and explore the “Health Insurance Coverage Type” measure.
Download a PDF of SHADAC’s Coverage Hierarchy for American Community Survey (ACS) Estimates on State Health Compare brief.