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Blog & News
Now Available on State Health Compare: New 2022 Estimates from the ACS and CPS
March 04, 2024:
2022 estimates from the American Community Survey (ACS) and Current Population Survey (CPS) are now available for eight measures on SHADAC’s State Health Compare.
Updated measures using new ACS data include:
Coverage Type
Health insurance coverage by type of coverage (private, public, employer-sponsored, Medicare, Medicaid/CHIP, individual, and uninsured) available by a variety of breakdowns, including by income, disability status, race/ethnicity, and more.
Broadband Internet Access
This measure allows the user to view state-level percentages of people who have access to high-speed internet, which is an increasingly important tool for individuals to access health care (via telehealth), find employment, and connect with a range of other services. The measure has multiple layers of breakdowns by income, disability status, and metropolitan status, among others.
Child Poverty
Children who experience poverty can be more prone to many different negative health outcomes, often lacking in access to health care, education, shelter, sanitation, and more compared to children not considered to be in poverty. This is a vulnerable population that needs to be monitored continuously. This measure provides state-level data on children <100% Federal Poverty Guideline for both the total population and by race and ethnicity.
Income Inequality
Lower incomes are correlated to effects like housing instability, food insecurity, and more that can lead to negative health outcomes. This measure presents state-level data on income inequality as measured by the Gini coefficient.
Unaffordable Rents
Stable housing is a key component of health and wellbeing. Unaffordable Rents on State Health Compare measures the share of renters who may be struggling to afford their rents, thus contributing to unstable housing. This measure is available by a number of policy-relevant breakdowns, including race/ethnicity, Medicaid enrollment, and household income.
Updated measures using new CPS data include:
Percent of People with High Medical Cost Burden
Out-of-pocket spending on health care can make up a large share of income, creating burdens for those with large health care expenses. This measure can help us understand trends and disparities in healthcare affordability. These data are available both by insurance coverage type and by race/ethnicity.
Median Medical Out-of-Pocket (OOP) Spending
This measure shows the amount that the typical individual spends using their own money on health care costs, including health insurance coverage premiums, forms of insurance cost sharing (e.g., co-pays, deductibles), and services not covered by health insurance and/or paid by uninsured individuals. The 2022 estimates are available to be viewed by total and specifically by those with employer-sponsored insurance.
Health Status
Stable housing is a key component of health and wellbeing. Unaffordable Rents on State Health Compare measures the share of renters who may be struggling to afford their rents, thus contributing to unstable housing. This measure is available by a number of policy-relevant breakdowns, including race/ethnicity, Medicaid enrollment, and household income.
Be sure to check out a recent analysis of new data where we add context to the Health Insurance Coverage by Race/Ethnicity measure.
Other Related Reading:
Blog & News
New Data on Health Insurance Coverage by Race/Ethnicity Added to State Health Compare
June 28, 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. |
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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.
Blog & News
Revised Childhood Vaccinations Measure on State Health Compare Shows Vaccination Rates Vary by State, Race/Ethnicity, and Insurance Coverage
January 30, 2024:Introduction
Childhood Vaccinations are an effective way to protect infants and young children from harmful diseases that can cause serious illness or death. Children are commonly vaccinated against a number of diseases, including chickenpox (Varicella), polio, hepatitis A and B, and measles, mumps, and rubella (MMR).
Despite the well-documented safety and efficacy of the vaccines, along with the endorsement of child vaccinations by the Centers for Disease Control and Prevention (CDC) and other public health authorities, rates of child vaccination lag in some portions of the United States. Monitoring trends in child vaccination rates can help explain why such gaps exist and inform efforts to improve child vaccination rates in the U.S.
A revised child vaccination measure on SHADAC’s State Health Compare (SHC) now presents annual, state-level vaccination rates for children aged 35 months, specifically the percent of those children who received the full series of recommended vaccines using data from the National Immunization Survey (NIS-Child) by survey year. This measure also presents these state-level rates by race and ethnicity, health insurance coverage type, and poverty level. In this blog post, SHADAC researchers highlight key findings from this new child vaccinations measure by race and ethnicity and type of health insurance coverage.
The Share of Children Receiving Recommended Vaccinations Has Been Relatively Stable, Though Large Variation Exists Across States
Nationally between 2017 and 2021, the share of children aged 35 months who had received the full schedule of recommended vaccinations remained relatively stable, remaining between 70% and 73% nationwide.
National Child Vaccination Rates, 2017–2021
However, while stable nationally, there was substantial state variation in the share of children who had received recommended vaccinations. For example, in 2021, the national child vaccination rate sat at 72.1%, but state-level rates ranged from as low as 56.6% in West Virginia to as high as 87.9% in Iowa. Also in 2021, six states (CT, IA, MD, MA, ND, and VT) had child vaccination rates of 80% or greater while West Virginia was the only state with a vaccination rate below 60%.
Top Five and Bottom Five State Child Vaccination Rates, 2021
| Top Five States | Iowa | 87.9% |
|---|---|---|
| Massachusetts | 85.4% | |
| Connecticut | 84.0% | |
| Vermont | 82.1% | |
| North Dakota | 81.3% | |
| United States | 72.1% | |
| Bottom Five States | West Virginia | 56.6% |
| Alaska | 61.3% | |
| Louisiana | 62.0% | |
| Arizona | 62.2% | |
| Georgia | 63.3% | |
Black Children, Hispanic/Latino Children, and Children of Other or Multiple Races Were Less Likely to Have Received Recommended Vaccinations Compared to White Children
Nationally, there were significant gaps in the share of children who had received the recommended vaccines by age 35 months by race and ethnicity.1
Non-Hispanic White children had the highest rate of vaccination at 75.5%, followed by children of multiple races or some other race (non-Hispanic) at 72.8%, Hispanic/Latino children (any race) at 69.9%, and, finally, African-American/Black children at 66.5%.
National Child Vaccination Rates by Race and Ethnicity, 2019–2021
There were also large gaps in rates of child vaccinations by race and ethnicity at the state level in 2019–2021, as shown in the table below. For example, in Michigan, African-American/Black children were nearly 30 percentage points less likely to have received the full schedule of recommended vaccinations compared to White children (49.8% vs. 79.3%). In the District of Columbia, Hispanic/Latino children were more than 20 percentage points less likely to have received the recommended vaccinations compared to White children (62.1% vs. 82.5%). And in North Dakota, children of some other race or multiple races were 20 percentage points less likely to have received the recommended vaccinations compared to White children (60.1% vs. 80.1%).
States with statistically significant gaps in child vaccination rates by race and ethnicity, 2019–2021
| State | White | African-American / Black | Hispanic / Latino | Other / Multiple Races |
|---|---|---|---|---|
| United States | 75.5% | 66.5%* | 69.9%* | 72.8%* |
| Dist. of Columbia | 82.5% | 68.1%* | 62.1%* | 70.8% |
| Georgia | 75.2% | 57.8%* | 69.8% | 70.8% |
| Illinois | 79.3% | 61.3%* | 66.9%* | 75.9% |
| Indiana | 73.1% | 66.0% | 59.1%* | 70.4% |
| Louisiana | 70.1% | 58.5%* | 69.3% | 71.9% |
| Maryland | 84.5% | 75.7%* | 71.4%* | 77.7% |
| Michigan | 79.3% | 49.8%* | 76.7% | 72.8% |
| Nevada | 76.4% | 55.8%* | 73.2% | 72.7% |
| New Jersey | 76.1% | N/A | 59.6%* | 72.2% |
| New Mexico | 76.6% | N/A | 67.7%* | 72.6% |
| New York | 69.8% | 69.0% | 67.0% | 79.5%* |
| North Dakota | 80.1% | N/A | N/A | 60.1%* |
| Oklahoma | 75.2% | N/A | 71.1% | 59.5%* |
| Rhode Island | 81.7% | N/A | 70.6%* | 83.1% |
| Tennessee | 75.9% | 49.4%* | 59.9%* | 76.6% |
| Texas | 71.0% | 61.7%* | 72.2% | 70.1% |
|
* Statistically significant difference (95% confidence level) in state estimate compared to Whites Source: SHADAC analysis of 2019–2021 NIS-Child microdata N/A indicates that data were not available or were suppressed due to statistical unreliability or small sample size |
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Health Insurance Coverage Matters for Rates of Child Vaccinations
Nationally, during the years 2020 through 2021, there were substantial gaps in the share of children who had received the recommended vaccinations by source of health insurance coverage. Children with private coverage alone (e.g., employer-sponsored or direct-purchase coverage) had the highest rate of vaccination coverage at 80.3%. Children with some other insurance (Children's Health Insurance Plan [CHIP] coverage, Indian Health Service [IHS] coverage, military, or some other form of insurance alone or in combination with private insurance) had a vaccination rate of 70.7%. Children with any Medicaid coverage (alone or in combination with other coverage) had a vaccination rate of 66.2%, 14 percentage points lower than private coverage. Children with no health insurance coverage (i.e., uninsured) had by far the lowest vaccination rate at 50.0%, which is more than 30 percentage points lower than children with private coverage alone.
National Child Vaccination Rates by Coverage Type, 2020–2021
That national pattern holds across the states, though due to small sample sizes, there are few available state-level estimates for children with other insurance and uninsured children. The chart below compares rates of vaccinations for children with private coverage alone and children with any Medicaid coverage. Rates of vaccinations among children with Medicaid were lowest in Alaska at 53.1% and highest in Connecticut at 81.1%. Child vaccination rates among children with Medicaid were at or below 60%in five states—AK, CO, KS, LA, and NJ—and were at or above 80% in just two states—Connecticut and Iowa. Rates of vaccinations among children with private coverage alone ranged from the lowest at 74.2% in Minnesota to the highest at 90.3% in Iowa.
In 35 states, children with any Medicaid coverage were less likely to have received recommended vaccinations compared to children with private coverage alone. Colorado had the largest percentage point gap between children with private coverage alone and any Medicaid coverage at 23.4 (82.4% vs. 59.0%), while Nebraska had the smallest gap at 1.5 percentage points (not statistically significant, 79.8% vs. 78.3%).
Data and Methods
Estimates of child vaccination rates represent the share of children aged 35 months who have received all recommended vaccinations, including the full series of DtaP, poliovirus, measles-containing, Hib, HepB, varicella, and PCV vaccines, which together provide protection against diphtheria, pertussis, tetanus, poliovirus, measles, mumps, rubella, hepatitis b, haemophilus influenza b, chicken pox, and pneumococcal infections.
Data in this post come from SHADAC’s revised Child Vaccinations measure on State Health Compare, which are based on our analysis of National Immunization Survey-Child (NIS-Child) microdata produced by the Centers for Disease Control and Prevention.
Three years of data were pooled to produce estimates by race and ethnicity; two years of data were pooled to produce estimates by coverage type. In both cases, this was done to increase sample sizes at the state level for smaller populations and to increase the number of statistically reliable state estimates. Estimates represent an average for these periods.
Note that the data source used in this analysis (NIS-Child) does not make data by more detailed race and ethnicity categories available. It is likely that these available categories conceal important differences within the aggregate groups, particularly the “some other race / multiple races” category. This group is likely to be primarily composed of children of different racial and ethnic groups in different states. Further, estimates were not available for all states for all racial and ethnic groups due to small sample sizes, even when pooling multiple data years.
Unless otherwise specified, all differences described in this analysis are statistically significant at the 95% level of significance.
1 Race lacks a genetic basis—it is socially constructed based on skin color and “apparent” physical differences. While race is socially created, it does have real social meaning and implications for health and well-being, including access to important health care services, such as vaccinations.
Publication
ACS 5-year Estimates: State and County Uninsured
Following the release of 2022 single-year estimates of health insurance coverage, household income, and poverty levels, the U.S. Census Bureau has now made available 5-year American Community Survey data files. These ACS 5 Year estimates are generated by pooling together five years of American Community Survey (ACS) data to produce estimates for areas and subgroups with smaller populations.
The interactive map provided below offers users the opportunity to explore health insurance coverage estimates, specifically the percentage of uninsured individuals for each state and all counties for the pooled years 2018-2022.* These data can be accessed via the Census Bureau’s data.census.gov tool. Click on a county in the map below to view state/county data tables. Counties are easily searchable through bookmarks in each state file.
2018-2022 American Community Survey (ACS) 5-Year Estimates: Percent Uninsured, Total Civilian Noninstitutionalized Population by County
Click here to view estimates for Puerto Rico by municipio.
Click here to view a 50-state table of estimates.
About the American Community Survey and ACS Data
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million US households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates. The Census Bureau provides ACS 1 year estimates and ACS 5 year estimates.
The Census Bureau publishes 1-year estimates for areas with populations of 65,000 or more and 5-year estimates (covering 60 months) for all statistical, legal, and administrative entities.
The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.
*The U.S. Census Bureau has extensively cautioned against the use of single-year 2020 ACS estimates due to disruptions caused by the COVID-19 pandemic (e.g., limited means of data collection, such as shutdowns of mail operations, switches to telephone-first methodologies, etc., leading to low response rates and nonresponse bias). However, the Census Bureau believes that course corrections to address nonresponse bias, and the larger sample resulting from pooled data mean that the “data are fit for public release, government and business uses, and understanding the social and economic characteristics of the U.S. population and economy.”[1]
How Are These Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for State Health Compare. The definitional differences are as follows:
Family
The Census Bureau defines a family as “all related people in a household.”
SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
To learn more about the 2020 update of SHADAC's Health Insurance Unit (HIU) see our HIU resource page, which houses two issue briefs: The first describes the SHADAC HIU, its purpose, the most recent update, and improvements to HIU data inputs; and the second outlines the impacts of using the SHADAC HIU in analysis so that researchers can assess whether the SHADAC HIU is suitable for their research and what the potential impacts of its use might be. The page also provides a link to STATA and SAS codes to aid in the use of the HIU variable.
Family Income
The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guideline (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and CHIP, as well as the Supplemental Nutrition Assistance Program (SNAP).
Check out our blog post from April 2023 to learn more about the difference between FPL and FPG.
Related ACS Materials:
Blog: 2022 ACS Tables: State and County Uninsured Rates, with Comparison Year 2021
[1] U.S. Census Bureau. (2022, February 7). Census Bureau Update on 2016–2020 American Community Survey (ACS) 5-Year Estimates [Press Release CB22-RTQ.01]. https://www.census.gov/newsroom/press-releases/2022/acs-5-year-estimates-update.html
