SHADAC Staff

p 612.624.4802
e shadac@umn.edu

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.

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

State Health Compare Adds New Social Determinants Measure: Percent of Children with Adverse Childhood Experiences

A new State Health Compare measure examines the prevalence and degree of adverse childhood experiences (ACEs) among different demographic groups, with estimates available across the states and over time.

What are ACEs?
The Centers for Disease Control and Prevention (CDC) defines ACEs as “potentially traumatic events that occur in childhood (0-17 years)” including experiencing violence, abuse, or neglect; witnessing violence in the home or community; or having a family member attempt or die by suicide. ACEs also include “aspects of the child’s environment that can undermine their sense
of safety, stability, and bonding,” such growing up in a household with substance misuse, mental health problems, and instability due to parental separation or household members being in jail or prison.ⁱ

Why are ACEs Important?
A landmark study conducted in the 1990s found a significant relationship between the number of ACEs an individual experienced and a variety of negative outcomes in adulthood, including poor physical and mental health, substance abuse, and risky behaviors (e.g., smoking, having a history of sexually transmitted disease/infection, etc.). The more ACEs an individual experienced, the greater the risk of these outcomes.ⁱⁱ Because ACEs are common, with about 61% of adults reporting at least one type of ACE and nearly one in six reporting four or more types of ACEs, preventing ACEs
could reduce a large number of negative physical and behavioral health outcomes.ⁱⁱⁱ

How Can We Prevent ACEs?
Creating and sustaining safe, stable, nurturing relationships and environments for children and families can prevent ACEs.^iv Data on the prevalence and severity of ACEs among different groups can help policymakers and public health professionals target prevention efforts effectively so that resources are efficiently leveraged to support these relationships and environments where they are most needed.

What Can We Learn from the State Health Compare Estimates?
The ACEs estimates presented in State Health Compare indicate the percent of children with no ACEs, the percent of children with one ACE, and the percent of children with multiple ACEs. Breakdowns are available by age, insurance coverage type, education, poverty level, and race/ethnicity. Available time periods are the two-year pooled periods of 2016-2017 and 2017-2018

Children with ACEs: Data Highlights
Nationwide, an estimated 18.6% of all children (age 0-17) had multiple ACEs in 2017-2018, 23.3% had one ACE, and 58.2% had zero ACEs. The following section takes a quick dive into the percentages of children with multiple ACEs to highlight some of the subgroup analyses that are available using State Health Compare.

Percent of Children with Multiple ACEs: By Age Group
Figure 1 shows the national rates of children with multiple ACEs and state high and low rates for different age groups of children, with rates tending to be higher among older children and lower among younger children. Overall, the lowest percentage of children with multiple ACEs by age was 5.1% among 0-5 year-olds in Wisconsin, and the highest percentage was 42.1% among 12-17 year-olds in the District of Columbia (DC).

Percent of Children with Multiple ACEs: By Race/Ethnicity
Figure 2 shows the national rates and state high and low rates for children with multiple ACEs by race/ethnicity in 2017-2018. When examining the national rate of children with multiple ACEs by race/ethnicity, as well as state-level highs and lows for this measure, White children consistently ranked at the bottom, with the lowest percentage being 4.4% among White children living in DC. The highest nation- wide percentage of children with multiple ACEs by race/ethnicity was among African American/Black children, of whom 28% had more than one ACE. The highest state-level percentage was 41.8% among Hispanic/Latino children living in Alaska.

Percent of Children with Multiple ACEs: By Insurance Coverage Type
Figure 3 shows the percentage of children with two or more ACEs according to insurance status in 2017-2018. Nationwide, the highest proportion of children reporting multiple ACEs was among those with public coverage, at 31.6 percent. This is more than 2.5 times the nationwide low of 12.1 percent among children with private coverage. At the state level, a low of 7.9 percent of privately insured children in Massachusetts reported multiple ACEs, versus a high of 50.5 percent of publicly insured children in Wyoming. 

Percent of Children with Multiple ACEs: By Poverty Level
Figure 4 shows the prevalence of multiple ACEs by poverty level in 2017-2018. The national percentage of children who had multiple ACEs by poverty level was highest among children at 0 to 199 FPG at 27.4 percent. This proportion was lowest among children in household with incomes at or above 400 percent of the Federal Poverty Guideline (FPG) at 8.1 percent—a 19.3 percentage-point difference from the rate for high-income children. At the state level, the highest percentages of children with multiple ACES by poverty level were 39.7 percent among children at 200 to 299 percent FPG living in DC and 39.0 percent among children at 0 to 199 percent FPG living in Montana. The state low for multiple
ACEs by poverty level was 5.0 percent among children at
or above 400 percent FPG living in Delaware.

Learn More
To explore State Health Compare’s ACEs estimates further, visit State Health Compare at statehealthcompare.shadac.org and click on “Explore Data.”

Other social and economic factors that can be explored through State Health Compare include:

• Children Considered to be Poor
• Unemployment Rate
• Income Inequality
• Unaffordable Rents

Planalp, Colin
Research Fellow

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

After drop in 2018, newer data indicate a resurgence in drug overdose deaths

While new SHADAC research found small but statistically significant declines in opioid and drug overdose death rates during 2018, newer data indicate those reductions may have been short-lived. Overall, in 2018, drug overdose death rates declined 4.6 percent as compared to the prior year, but our analysis also found variation in amounts and direction of changes in individual types of drugs. For instance, overdose death rates from prescription opioids dropped 14.7 percent and those from heroin dropped 3.8 percent, but overdose death rates from synthetic opioids (e.g., fentanyl) increased 9.6 percent and those from psychostimulants (e.g., methamphetamine) grew 22.1 percent.

Provisional data published by the U.S. Centers for Disease Control and Prevention show evidence of an increase in overall drug overdose deaths in 2019, as well as for certain individual types of drugs. During a rolling 12-month period ending in December 2019, drug overdose deaths reached a record high of 70,980—a 4.6 percent increase over the 12-month period ending in December 2018.¹ And among the states, 36 of 50 saw increases in their reported drug overdose deaths. In that same amount of time, overdose deaths from synthetic opioids increased 15.8 percent and overdose deaths from psychostimulants increased 26.8 percent.

The state of Minnesota also recently published its own preliminary data on drug overdose deaths in 2019, finding similar patterns to the U.S. After experiencing a decline in drug overdose deaths in 2018, Minnesota reported that preliminary data showed a 20 percent increase in overall drug overdoses in 2019—in addition to synthetic opioid overdose deaths that increased by 48 percent, and psychostimulant overdose deaths that grew by 37 percent.²

Some reports also indicate that drug overdose deaths may have spiked in early 2020, coinciding with the beginning of the coronavirus pandemic and various associated stressors. For example, a White House analysis found an 11.4 percent increase in overdose deaths in the first four months of 2020 as compared to the prior year.³ In the midst of the COVID-19 emergency, experts such as those from the National Academy of Medicine have raised concerns that “the nation is experiencing an unprecedented convergence of epidemics, and there is great concern that the opioid crisis…may only worsen in the absence of a concerted response.”⁴

As new data on drug overdoses become available in the coming months and years, it will be vital to monitor the continually shifting dynamics of the opioid crisis, to identify early the emerging patterns—such as the rise of synthetic opioids and psychostimulants—and to continue to guide policy efforts to address the persistent public health emergencies of substance use and drug overdose deaths.

Explore SHADAC's most recent analysis of the Widening Drug Overdose Crisis in the United States or visit our Opioid Epidemic Resources page to access all opioid-related analysis done by SHADAC researchers over the last several years. 

Overdose Crisis in Transition: Changing National and State Trends in a Widening Drug Death Epidemic

August 2020:

For nearly two decades, the United States has experienced a growing and evolving crisis of substance abuse and addiction; a crisis illustrated by statistically significant increases in overdose deaths directly from, or related to, opioids. These increases have occurred throughout the country, as the annual number of drug overdose deaths has nearly quadrupled from 17,500 in 2000 to 67,400 in 2018, and nearly every state has experienced increases in overdose deaths from one or more types of opioids since 2000.^1,2

In the years since the U.S. Centers for Disease Control and Prevention (CDC) declared overdoses from prescription painkillers an “epidemic” in 2011, the opioid overdose crisis has evolved rapidly from a problem tied mostly to prescription opioid painkillers to one driven by illicitly trafficked heroin, to one marked by the rise of synthetic opioids, to most recently one with surging numbers of overdose deaths related to cocaine and psychostimulants—non-opioid illicit substances that have been linked to the opioid crisis via emerging evidence from both the CDC and U.S. Drug Enforcement Administration (DEA).^3,4

Variations in the opioid and opioid-related drug overdose crisis have become especially pronounced in recent years. While data from the CDC has shown that drug overdose deaths overall and opioid overdose deaths in aggregate declined a small but statistically significant amount from 2017 to 2018 (4.6 percent), examining data at a more granular level shows a more nuanced picture. While deaths from prescription opioids and heroin declined in 2018, deaths from synthetic opioids, cocaine, and psychostimulants increased significantly to reach new record highs.

As a result of these more current variations, SHADAC’s annually produced opioid and opioid-related drug overdose briefs have shifted slightly in order to particularly focus on changes in overdose deaths across the nation and among the states in more recent years, especially in 2018. The briefs provide high-level information about opioids and opioid addiction, present the historical context for the epidemic of opioid and related addiction and mortality in the United States, and examine trends in opioid-related mortality across the country and among population subgroups between 2017 and 2018.

    

Related Resources
The Opioid Epidemic in the United States
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (Infographics)
After drop in 2018, newer data indicate a resurgence in drug overdose deaths (Blog)
The Evolving Opioid Epidemic: Observing the Changes in the Opioid Crisis through State-level Data (Webinar)
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths from 2000 to 2017 (Briefs)

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1 Hedegaard, H., Miniño, A.M., & Warner, M. (2020). Drug overdose deaths in the United States, 1999-2018 [Data brief No. 356]. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db356-h.pdf  

2 State Health Access Data Assistance Center (SHADAC). (2019). The opioid epidemic: State trends in opioid-related overdose deaths from 2000 to 2017 [PDF file]. Available from http://www.shadac.org/2017OpioidBriefs  

3 Kariisa, M., Scholl, L., Wilson, N., Seth, P., & Hoots, B. (2019, May 3). Drug overdose deaths involving cocaine and psychostimulants with abuse potential—United States, 2003-2017. MMWR, 68(17), 388-395. DOI: http://dx.doi.org/10.15585/mmwr.mm6817a3

4 Drug Enforcement Administration (DEA) Strategic Intelligence Section. (2020). 2019 National Drug Threat Assessment [DEA-DCT-DIR-007-20]. Retrieved from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf  

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

Now Available on State Health Compare: 12 Updated and New Measures on Health Insurance Coverage, Cost of Care, Public Health, Health Behaviors and Outcomes, and Quality of Care

SHADAC has published one brand new measure and updated eleven existing data measures with the latest available estimates on our State Health Compare site. 

The new measure we’ve added is:

Adverse Childhood Experiences (ACEs)
This measure defines the percent of children (age 0-17) who report having experienced none, one, or multiple traumatic events, or adverse experiences, among categories of possibilities that include: (1) difficulty covering basic needs on family's income; (2) parent or guardian divorced or separated; (3) parent or guardian died; (4) parent or guardian served time in jail; (5) saw or heard parents or adults slap, hit, kick, punch one another in the home; (6) was a victim of violence or witnessed violence in their neighborhood; (7) lived with anyone who was mentally ill, suicidal, or severely depressed; (8) lived with anyone who had a problem with alcohol or drugs; and (9) treated or judged unfairly due to race/ethnicity. Percentages are available for years 2016-2017 and 2017-2018, and breakdowns include age, health insurance coverage type, education, poverty level, race/ethnicity, and number of ACEs reported.

The updated measures include:

Unemployment Rate
Available for all states from 2000 to 2019, this measure reports the seasonally adjusted rate of unemployment for all states.

Workers in Establishments that Offer Coverage*
Estimates for this measure calculate the percent of workers whose employer offers health insurance coverage to employees, and can be broken down by firm size. Full data is available from 2003 to 2019, and partial data is also available for 2002.

Average Annual ESI Premium*
This measure reports the average annual premium for private-sector workers who get health insurance through their employer. The measure is available for all states from 2003 to 2019, with partial data also available for 2002, and can be broken down by plan type (family or single).

Average Annual ESI Deductible*
This measure reports the average annual deductible for private-sector workers who receive a health insurance plan through their employer that has a deductible. The measure is available for all states from 2003 to 2019, with partial data also available for 2002, and can be broken down by plan type (family or single).

Employee Contribution to Premiums*
This measure reports the percent of annual premiums contributed by private-sector workers who get health insurance through their employer. The measure is available for all states from 2003 to 2019, with partial data also available for 2002, and can be broken down by plan type (family or single).

High Deductible Health Plans*
This measure reports percentage estimates for private-sector employees who are enrolled in high-deductible health insurance plans. High-deductible health plans are defined as plans that meet the minimum deductible amount required for Health Savings Account (HSA) eligibility ($1,350 for an individual and $2,700 for a family in 2019). The measure is available for all states from 2012 to 2019 and can be broken down by firm size.

Costs of Potentially Preventable Hospitalizations^
Estimates for this measure show the per-person costs of potentially preventable hospitalizations, which are hospital visits that research suggests could have been avoided by better access to high-quality patient care, such as care provided in doctor’s offices, clinics, or other settings outside the hospital. Data are available for all 50 states from 2009-2015, and 2016.

Adult Potentially Preventable Hospitalizations^
Estimates for this measure show the rate of potentially preventable hospitalizations per 100,000 adults. Potentially preventable hospitalizations are hospital visits that research suggests could have been avoided by better access to high-quality patient care, such as care provided in doctor’s offices, clinics, or other settings outside the hospital. Data are available for all 50 states from 2009-2015, and 2016, and can be broken down by acute and chronic care.

Child Potentially Preventable Hospitalizations^
Estimates for this measure show the rate of potentially preventable hospitalizations per 100,000 adults. Potentially preventable hospitalizations are hospital visits that research suggests could have been avoided by better access to high-quality patient care, such as care provided in doctor’s offices, clinics, or other settings outside the hospital. Data are available for all 50 states from 2009-2015, and 2016.

Cancer Incidence
This measure provides the age-adjusted rate of breast, cervical, lung, and colorectal cancer incidence per 100,000 people. Estimates are available for all 50 states for years 2000-2016 and can be viewed by race/ethnicity breakdowns.

Sales of Opioid Painkillers
This measure captures the rate of legal prescription opioid painkiller sales in kilograms per 100,000 people per year for both hydrocodone and oxycodone—the most common types of prescription opioids. Data is now available for all states from 2000 through 2019.

Explore these updated estimates on State Health Compare!

Data Sources
The State Health Compare measure of unemployment rates comes from the Bureau of Labor Statistics (BLS). Estimates for workers in establishments that offer coverage, average annual ESI premium, average ESI deductible, employee contribution to premiums, and high-deductible health plans come from the Medical Expenditure Panel Survey – Insurance Component (MEPS-IC). Measures regarding costs of potentially preventable hospitalizations, adult potentially preventable hospitalizations, and child potentially preventable hospitalizations are from the Health Care Cost and Utilization Project (HCUP). Data for the cancer incidence measure is drawn from the National Cancer Institute via the CDC Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. The estimates for the sales of opioid painkillers measure come from the U.S. DEA’s Automated Reports Consolidated Ordering System Retail Drug Summary Reports (ARCOS).

Notes
All measures marked with an “*”: No estimates are available for these measures for the year 2007, as the MEPS-IC did not collect data that year, but this does not indicate a break in series.
All measures marked with a “^”: There is a break in series for these measures in 2016 due to the switch from ICD-9 to ICD-10 codes.