Comparing Federal Government Surveys That Count the Uninsured: 2016
This brief provides an annual update to comparisons of uninsurance estimates from four federal surveys1:
The American Community Survey (ACS)
The Current Population Survey (CPS)
The Medical Expenditure Panel Survey - Household Component (MEPS-HC)
The National Health Interview Survey (NHIS)
In this brief, we present current and historical national estimates of uininsurance along with the most recent avaialble state-level estimates from these surveys. We also discuss the main reasons for variation in the estimates across the different surveys.
1Another federal survey that provides estimates of the uninsured is the Behavioral Risk Factor Surveillance System (BRFSS), which provides uninsurance estimates for non-elderly adults (ages 18 to 64) nationally and among states. Details about the BRFSS are included in Appendix A of the brief, and estimates from the BRFSS are provided in Appendix B.
SHADAC Researchers Co-Author Article on Changes to the NHIS
September 26, 2016:
The American Journal of Public Health recently published an article authored by Lynn A. Blewett (SHADAC), Heather M. Dahlen (Medica Research Institute), Donna Spencer (SHADAC), Julia A. Rivera Drew (Minnesota Population Center), and Elizabeth Lukanen (SHADAC).
Led by Lynn Blewett, the authors discuss the importance of the NHIS and the continued need for state-level analysis. They also make suggestions for future consideration aimed at further strengthening the survey.
Publication
2015 ACS Tables: State & County Uninsured Rates
The map on this page links to tables containing state and county uninsurance estimates for 2015. These estimates come from the 2015 American Community Survey (ACS) via the U.S. Census Bureau’s American FactFinder (AFF) tool and were released on September 15, 2016. Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
Click on a state to see state and county uninsurance rates by characteristics (for example, age, race/ethnicity, and poverty level) for 2015 and comparison year 2014.
Click here to view uninsurance estimates for the United States.
Click here to view uninsurance estimates for Puerto Rico and its municipios.
Note: These tables present uninsured rates, which indicate the share of the population that is uninsured. For example, a 10 percent uninsured rate for adult women indicates that 10 percent of all adult women are uninsured.
Additional Estimates (50-State Comparisons)
Maps & Tables of Private, Public, & Uninsured Change from 2014 to 2015
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 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.
Why Aren’t Estimates Provided for All Counties?
Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
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 the SHADAC Data Center and the RWJF Data Hub. 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.
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 Guidelines (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
To learn more about the difference between FPL and FPG, click here.
Most States Saw Uninsurance Declines in 2015, As in 2014
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The percentage of the population who were uninsured when they responded to the ACS fell in 47 states and the District of Columbia from 2014 to 2015.
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Uninsurance was stable in three states during this time: North Dakota, South Dakota, and Wyoming.
Variation in Uninsurance between States Continues
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Texas had the highest uninsured rate in 2015, at 17.1%.
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The lowest 2015 uninsured rate was 2.8% in Massachusetts.
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California saw the largest decline in uninsurance from 2014 to 2015, with a 3.9 percentage-point drop, from 12.4% to 8.6%.
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No state saw a statistically significant increase in uninsurance in 2015. (As indicated above, North Dakota, South Dakota, and Wyoming each saw no significant change in uninsurance from 2014 to 2015.)
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The uninsurance rate for expansion states (i.e., states that expanded Medicaid as of January 1, 2015) fell from 9.6% in 2014 to 7.2 % in 2015 (a 2.4 percentage-point decline).
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The uninsurance rate for non-expansion states fell from 14.4% in 2014 to 12.3% in 2015 (a 2.1 percentage-point drop) .
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Among expansion states, 2015 uninsurance rates ranged from a low of 2.8% in Massachusetts to a high of 12.3% in Nevada.
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Among non-expansion states, 2015 uninsurance rates ranged from a low of 5.7% in Wisconsin to a high of 17.1% in Texas.
The ACS Estimates in Context
The findings from the 2015 ACS are consistent with findings from the Current Population Survey (CPS), which were also released today. The CPS, which is the official source for information on poverty, found that the percentage of all people who were uninsured for the entire calendar year fell 1.3 percentage points nationwide, from 10.4% in 2014 to 9.1% in 2015. An early release of 2016 findings from the National Health Interview Survey (NHIS) showed stable uninsurance rates between the first quarter of 2015 and the same period in 2016.
Census Bureau Experts Will Share Insights during September 21st SHADAC Webinar
On Wednesday, September 21st, SHADAC will host a webinar to examine the new 2015 ACS and CPS estimates, with technical insight provided by researchers from SHADAC and the U.S. Census Bureau. Speakers will discuss the new national and state estimates, and attendees will learn when to use which estimates from which survey, how to access the estimates via Census reports and American FactFinder, and how to access state-level estimates from the ACS using SHADAC tables. Attendees will also have the opportunity to hear more about CPS employer offer and take-up estimates, for which three full years of data will be available. Speakers will answer questions from attendees after the presentations.
Publication
SHADAC Newsletter - September 2016
The SHADAC newsletter contains updates on SHADAC activities, news from the states, resource updates, and blog highlights. Subscribe to our newsletter here.