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Blog & News
September 23rd Webinar - An Annual Conversation with the U.S. Census Bureau: 2019 Health Insurance Coverage Data from the American Community Survey (ACS) & Current Population Survey (CPS)
September 4, 2020:On Wednesday, September 23, 2020, SHADAC researchers and U.S. Census Bureau experts held a webinar that examined the new 2019 health insurance coverage data at both the national and the state level, as well as by coverage type, from both the American Community Survey (ACS) and the Current Population Survey Annual Social and Economic Supplement (CPS ASEC).
In addition to further details on important health insurance coverage data and trends,
webinar attendees learned about:
- When to use which estimates from which survey
- How to access the estimates via Census reports and Census data site: data.census.gov
- How to access state-level estimates from the ACS using SHADAC tables
Panelists on this webinar included:
Lynn Blewett, PhD - the founding Director of SHADAC, as well as a Professor in the Division of Health Policy and Management at the University of Minnesota, School of Public Health, where she teaches graduate courses on the U.S. health care system and international health systems. Dr. Blewett has a committed history in working and researching health policy, access to care, Medicaid coverage, and payment policy with experience at both the state and national levels. She has expertise in leading applied policy research, directing research with diverse funding, analyzing state and federal data resources and translating research to inform health policy. Her health policy experience includes legislative work for the U.S. Senate and state policy work as Director of the Health Economics Program for the Minnesota Department of Health. Dr. Blewett holds a Ph.D. and a master's in Public Affairs from the University of Minnesota, and a B.A. from the University of Wisconsin at Madison.
Laryssa Mykyta, PhD - the chief of the Health and Disability Statistics Branch in the Social, Economic and Housing Statistics Division at the U.S. Census Bureau. The Health and Disability Statistics Branch is primarily responsible for analyzing and publishing data collected on health insurance coverage, health status and health care utilization, and disability. These data are collected in the Current Population Survey Annual Social and Economic Supplement, the American Community Survey, and the Survey of Income and Program Participation. Her research interests focus on how changing economic conditions influence health and well-being. Ms. Mykyta was previously an assistant professor in sociology and director of the Center for Survey Research and Policy Analysis at the University of Texas Rio Grande Valley. Ms. Mykyta received her doctorate in sociology and demography from the University of Pennsylvania.
Katherine Keisler-Starkey, PhD - an Economist and Survey Statistician at the U.S. Census Bureau. Ms. Keisler-Starkey's research interests focus on Applied Microeconomics, including Health Economics, Public Finance, and Labor Statistics. Ms. Keisler-Starkey received a Ph.D in Economics, a Bachelor of Science degree in Statistics, and a Bachelor of Arts degree in Economics from the University of Texas at Austin.
Robert Hest, MPP - manages SHADAC’s State Health Compare website, coordinating data processing, quality assurance, dissemination and documentation of data used on the cite. Robert also works on SHADAC’s Minnesota Long-term Care Projection Model (MN-LPM), which projects future long-term care utilization and spending among older adults in Minnesota. In addition, Mr. Hest leads a project tracking and analyzing 1332 State Innovation Waivers for State-Based Reinsurance programs. Before joining the SHADAC staff as a Research Fellow in October 2017, Robert worked at SHADAC as a Graduate Research Assistant. He earned his Master of Public Policy from the Humphrey School of Public Affairs with an emphasis in Policy Analysis, and he received his Bachelor of Arts from Carleton College in Political Science.
A recording of the webinar is available to view and download at the top of this page, and slides and a transcript are also available for download.
Related Resources
2019 ACS Tables: State and County Uninsured Rates, with Comparison Year 2018
Blog & News
2019 NHIS Full-Year Insurance Coverage Estimates Early Release: Uninsurance Increases, Variation among Public and Private Coverage
September 11, 2020:The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2019 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. These are both the first available full-year coverage estimates for 2019 from a federal survey as well as the first full-year estimates released since the NHIS questionnaire was redesigned and launched in January 2019—further details on which can be found at the end of this post.
National-level estimates are available by breakdowns including age group, sex, poverty status, race and ethnicity, and by state Medicaid expansion status. This is the first time that the NHIS full-year estimates have not included either full or partial state-level data.
More Americans without Health Insurance Coverage in 2019; Public Coverage Remained Steady and Private Coverage Fell among Certain Subgroups
The uninsured rate for all ages increased by 0.9 percentage points to 10.3% in 2019, up from 9.4% in 2018. This represents 33.2 million uninsured persons of all ages and is the first significant rise in the uninsured rate in several years as shown by the NHIS. Uninsured rates also increased from 2018 among all nonelderly persons (0-64) and nonelderly adults (19-64)—with the nonelderly rate rising 1.0 percentage points from 11.1% to 12.1% in 2019, and nonelderly adult rate increasing 1.4 percentage points from 13.3% to 14.7% in 2019.
Rates of public coverage were statistically unchanged across all age groups, while among nonelderly adults, rates of private coverage fell 2.1 percentage points in 2019 to 66.8% from 68.9% in 2018. Rates of uninsurance, private coverage, and public coverage were stable in 2019 for children (age 0-17).
More Black Americans had public coverage, fewer had private coverage; Uninsured rate increased among Whites*
Among the nonelderly population, the only racial/ethnic group that saw an increase in the uninsured rate were non-Hispanic Whites, whose rate increased to 9.0% in 2019 from 7.8%, a rise of 1.2 percentage points. Uninsured rates remained statistically unchanged for other racial/ethnic groups between 2018 and 2019.
One of the most significant findings in this category was a relatively large decrease in rates of private coverage of 3.7 percentage points among non-Hispanic Blacks, whose rate fell to 48.5% from 52.2% in 2018. Rates of private coverage were again statistically unchanged among other racial/ethnic groups.
Conversely, non-Hispanic Blacks experienced a large increase in rates of public coverage, which rose by 5.0 percentage points to 42.8% in 2019 from 37.8%. Rates of public coverage were statistically unchanged for other racial/ethnic groups.
More Women were Uninsured in 2019
The uninsured rate among nonelderly women increased to 11.0% in 2019, up from 10.0% in 2018, representing a 1.0 percentage-point increase. The uninsured rate among nonelderly men remained steady at 13.2%.
Uninsurance, Public and Private Coverage Rates See Similar Trends by State Medicaid Expansion Status
Across both those states that opted to expand Medicaid and those states that have yet to adopt Medicaid expansion, the nonelderly uninsured rate significantly increased in 2019 from 2018, rising to 9.1% from 8.3% (a 0.8 percentage-point increase) in expansion states and rising to 17.1% from 15.4% (a 1.7 percentage-point increase) in non-expansion states.
Though the year-over-year changes did not reach the specified threshold for statistical significance, both expansion and non-expansion states experienced possible erosions in rates of private coverage, with rates falling 1.4 percentage points to 65.0% in the former and falling 1.6 percentage points to 61.4% in the latter. Rates of public coverage experienced smaller, statistically insignificant changes in both categories of states.
Notes about the Estimates
*All subsequent category breakdowns (Race/Ethnicity, Sex, and Medicaid Expansion Status) encompass the nonelderly population, age 0-64.
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview.
All changes described compare full-year 2018 to full-year 2019 and are statistically significant at the 95% confidence level unless otherwise specified.
2019 NHIS Redesign
The NHIS recently underwent a substantial redesign of its content and structure, the goals of which were to “improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.”[1]
One of the largest changes made under the redesign is the elimination of the family questionnaire, which previously asked questions about the family as a whole as well as separately of each member of the family. Most of the family questionnaire content was moved to revised sample adult and sample child questionnaires, which are asked of one adult and one selected at random from members of the household and has the effect of substantially reducing the available sample size. For example, the 2019 full-year early release report has a total sample of 32,391 persons, whereas the same report in 2018 was based on a sample size of 72,762 persons. However, NCHS anticipates that the redesign’s reduction in respondent burden will result in more sample adult and sample child interviews due to higher response rates.
[1] National Center for Health Statistics (NCHS). (2019, November 27). 2019 Questionnaire Redesign. Available from https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm
Blog & News
SHADAC COVID-19 Survey Chartbooks Provide Visualizations of Coronavirus Impacts on Health Insurance Coverage, Access and Affordability of Care, and Pandemic Stress Levels of U.S. Adults
August 24, 2020:Earlier this year, SHADAC published initial results from a two-part survey designed by our researchers to measure the impacts of the novel coronavirus on health care access and insurance coverage, as well as COVID-related worries and coping responses, for adults in the United States. The “SHADAC COVID-19 Survey” was fielded in late April 2020 as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago.*
Survey Topics
The first portion of the survey results focused on recording changes in health insurance coverage, delays in seeking medical care, and issues of access to and affordability of care due to the pandemic as reported by adult respondents.
The second half of the survey results focused on understanding rising stress levels of U.S. adults in response to the COVID-19 pandemic, and how these same individuals did or did not employ a variety of coping responses, such as increased eating, alcohol use, and smoking or vaping and changes in exercise habits, social media use, and communication with family and friends, among others.
Chartbooks and Data Visualizations
In addition to the previously published blogs and issue briefs, SHADAC has created two new chartbooks that provide clear, informative visualizations of responses to a variety of individual survey questions from both sections of the survey.
The chartbooks are again divided by overall category—health insurance coverage and access to/utilization of care in the first and stress and coping responses second—and include breakdowns by age, gender, race/ethnicity, chronic condition, health status, educational attainment, income level, and metropolitan area.
Survey Impacts
Monitoring data on COVID-related worries regarding access, affordability, and utilization of health care, as well as the effects of the pandemic on stress and coping responses for U.S. adults, is important to understanding impacts for both individual and community health. In the first case, worries about affordability or access may cause individuals to delay needed care, which then has the potential to result in health consequences for individuals and increased community spread of the virus. For the second, recognizing the effects of the pandemic on stress levels and the responses chosen to cope with increased stress is important to understanding individual and community mental health status in order to encourage great self- and community care and access to needed support systems.
Acknowledgment: We appreciate contributions to the survey by Sarah Gollust of the University of Minnesota School of Public Health and Brendan Saloner of the Johns Hopkins University Bloomberg School of Public Health.
*The survey was conducted using a mix of phone and online modes from April 24 and 26, 2020, among a nationally representative sample of 1,007 respondents age 18 and older.
Publication
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (Infographics)
This set of two-page infographics uses estimates from SHADAC’s State Health Compare online data tool to explore the evolving opioid overdose epidemic across all 50 states and the District of Columbia, examining state variation in both the prevalence of opioid deaths and the types of opioids associated with these deaths. Additionally, due to growing concern and evidence that the opioid crisis may be expanding to other non-opioid illicit drugs, we have included data on drug overdose deaths from two types of drugs that are commonly involved in opioid overdoses: cocaine and psychostimulants, such as methamphetamine.
The infographics highlight key findings for trends in drug overdose deaths from 2000-2018, show how each state's overdose rates compare to the national average, and provide a high-level comparison of all 50 states' overdose death rates broken down by each of the five drug types.
Click on a state below to see its two-page infographic or download all state's infographics here.
Explore the drug overdose death data further on State Health Compare.
Further Reading and Resources
The Opioid Epidemic in the United States
SHADAC Resource, March 2020 (Updated)
The Evolving Opioid Epidemic: Observing the Changes in the Opioid Crisis through State-level Data
SHADAC Webinar, September 2019
The Opioid Epidemic: National and State Trends in Opioid-Related Overdose Deaths from 2000 to 2017
SHADAC Briefs, June 2019
Archive: 2000-2017 Evolving Opioid Crisis Infographics
SHADAC Infographics, February 2019
Blog & News
NHIS: 2.4 million more uninsured working-aged adults in first six months of 2019
May 28, 2020:The number of nonelderly adults (age 18-64) without health insurance coverage increased to 27.2 million in the first six months of 2019 (January-June), up from 24.8 million in the same period in 2018. This put the uninsured rate for the first half of 2019 at 13.7%, an increase from 12.5% in the same period in 2018.
This finding comes from new health insurance coverage estimates for Q1-Q2 2019 from the National Health Interview Survey (NHIS). These estimates were released by the National Center for Health Statistics (NCHS) as part of the NHIS Early Release Program and are the first available coverage estimates for 2019 from a federal survey and the first estimates since the NHIS was redesigned for 2019. Though this post compares the 2019 estimates from the redesigned NHIS to 2018 NHIS estimates from the prior version of the survey, readers should take caution in making this comparison, as the survey redesign and co-occurrent changes to survey weighting may have affected estimates of health insurance coverage. A short summary of the NHIS redesign is provided at the end of this post.
Though current rates of health insurance coverage have been substantially altered by the ongoing coronavirus pandemic and resulting economic upheaval, estimates of health insurance coverage in 2019 are an important baseline and provide information about changes to the coverage landscape that were ongoing before COVID-19.
Uninsurance Increased, Public and Private Coverage Remained Stable in First Half of 2019
The new NHIS estimates show that overall rates of uninsurance among the nonelderly adult population increased to 13.7%. Rates of private and public health insurance coverage among this same population remained statistically unchanged from 2018, a trend echoed among all other age groups, none of which experienced statistically significant changes in rates of uninsurance or public or private coverage.
Uninsurance Increased among Other Subpopulations (Income and Race/Ethnicity)
Among nonelderly adults above 200% of the Federal Poverty Level (FPL), the uninsured rate increased to 8.5% in January-June 2019 from 7.6% in the same period in 2018. Rates of public and private coverage were stable for this income group, and no other income group saw significant changes in either rates of uninsurance or public or private coverage over the same period.
The uninsured rate for non-Hispanic, White nonelderly adults rose to 9.8% in the first half of 2019, up from 8.6% in the same period of 2018. This increase in uninsurance among White adults was accompanied by a decrease in private coverage, falling to 74.8% in the first six months of 2019 from 76.9% in the first half of 2018. The rate of public coverage among Whites was stable, as was uninsurance and private coverage for all other reported racial/ethnic groups in the report.
Changes in Coverage Type among Children by Income
Uninsurance Fell among Children in Poverty
Among children (age 0-17) below 100% FPL, the percent without health insurance coverage decreased to 3.4% during January-June 2019 from 6.4% in the same period in 2018. Rates of public and private coverage for this group were statistically unchanged during the same period.
Public Coverage Decreased among Children 100-200% FPL
Among children with family incomes of 100-200% FPL, rates of public coverage decreased to 69.8% in the first half of 2019 from 75.7% during the same period in 2018. The percent uninsured and with private coverage were statistically stable for this group at 6.1% and 27.1%, respectively, during the first six months of 2019.
Shift from Public to Private Coverage among Children above 200% FPL
For children in families with incomes above 200% FPL, rates of private coverage rose by 2.8 percentage points from 78.7% to 81.5% in the first halves of 2018 and 2019, respectively—an increase which mostly offset the 2.5 percentage-point drop in public coverage from 18.6% to 16.1% over the same period. The percent of uninsured children in this income category remained stable, however, at 3.7%.
2019 NHIS Redesign
The NHIS recently underwent a substantial redesign of its content and structure, culminating in the launch of the redesigned survey instrument in January 2019. Per the survey overview page from NCHS, the goals of the redesign were to “improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.”1
One of the largest changes made under the redesign is the elimination of the family questionnaire, which previously asked questions about the family as a whole as well as separately of each member of the family. Most of the family questionnaire content was moved to revised sample adult and sample child questionnaires, which are asked of one adult and one selected at random from members of the household and has the effect of substantially reducing the available sample size. For example, the January-June 2019 early release report had a total sample of 21,902 persons, whereas the same report in 2018 was based on a sample size of 39,112 persons. This also appears to have resulted in a substantial decrease in the number of available estimates of health insurance coverage by subpopulation and geography published in the January-June Early Release report. However, NCHS anticipates that the redesign’s reduction in respondent burden will result in more sample adult and sample child interviews due to higher response rates.
About the Numbers
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview. The 2019 estimates are for the months of January to June 2019 (Q1 and Q2) and are based on a sample of 21,902 persons from the civilian noninstitutionalized population.
Differences described in this post are statistically significant at the 95% confidence level unless otherwise specified.
For more information about the early 2019 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
Citation
Cohen, R.A., Terlizzi, E.P., Martinez, M.E., & Cha, A.E. (2020). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–June 2019. Available from https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm
1 National Center for Health Statistics (NCHS). (2019, November 27). 2019 Questionnaire Redesign. Available from https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm
