High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

August 9, 2018

Questions for Robin Cohen, Ph.D. and Lead Author of “High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

Q: What made you decide to put together a report about high and low deductible health plans for adults with employment-based coverage?

RC: We decided to produce an analysis focusing on high-deductible health plans (HDHPs) after observing how enrollment in HDHPs has increased over the past decade. In addition, HDHP enrollment growth has been faster among those with employment-based coverage than among those with directly-purchased coverage, so it also made sense to highlight employment-based insurance plans in this study. This report examines differences in the demographic characteristics for those with employment-based coverage by plan type.    


Q: Was there a finding in your new report that really surprised you?

RC: It was the dramatic increase in high-deductible health plan (HDHP) enrollment in recent years that really surprised us. We hadn’t expected to see such a large jump, which was most notable among those with a health savings account (HSA). The percentage of adults aged 18 to 64 enrolled in an HDHP with an HSA more than quadrupled in the past decade from 4.2% to 18.9%.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

RC: Both the differences among age groups and the lack of variance by sex in this study’s findings are notable. Among adults aged 18 to 64 with employment-based coverage, there were no differences in the type of health insurance plan by sex. Enrollment in a high-deductible health plan with a health savings account was higher among adults aged 30 to 44 than those aged 18 to 29 and 45 to 64.


Q: What is the significance of having a health savings account and not having one when you have a high-deductible health insurance plan?

RC: A health savings account (HSA) allows pretax income to be saved to help pay for the higher costs associated with a high-deductible health plan (HDHP). However, this report did not examine the association of having an HDHP — coupled with an HSA — on service use and financial burden for medical care.

 

Q: Is it a choice for Americans to have a health savings account? Can anyone have one?

 

RC: A health savings account (HSA) must be coupled with a high-deductible health plan (HDHP), but not everyone enrolled in an HDHP has an HSA. High-deductible health plans with HSAs are offered to individuals both by employers and in the direct-purchase health insurance market.

Q: What would you say is the take-home message of this report?

 

RC: I think the real take-home message in this Data Brief is the role that education and income play in health insurance coverage with these types of high-deductible health plans (HDHPs). More highly educated and affluent adults were more likely to enroll in an HDHP with a health savings account (HSA) and less likely to enroll in a traditional plan or an HDHP without an HSA — than their less educated and less affluent counterparts. The National Health Interview Survey will continue to monitor different types of private health insurance, and the survey can be used to examine further differences according to plan type.

Q: Do you have trend data on high-deductible health plans going back further than 2007?

RC: No, we don’t have earlier than 2007 trend data on high-deductible health plans (HDHPs). The National Health Interview Survey began to collect data on enrollment in HDHPs starting in 2007.

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State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

June 28, 2018

Questions for Lead Authors Debra L. Blackwell, Ph.D., Demographic Statistician, and Tainya C. Clarke, Ph.D., M.P.H., Health Statistician, of “State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

Q:  Was there a result in your study that you hadn’t expected and that really surprised you?

DB/TC:  The result that we found most surprising – and it really is quite striking – is the state-level variation in  the percentages of adults who were meeting the federal physical activity guidelines through their leisure-time physical activity. We were also surprised that many of the states with the highest percentages of meeting the guidelines through leisure-time physical activity were “cold weather” states that get more snow during winter months. How are people in these states meeting these guidelines during the colder winter months? Are they participating in outdoor winter sports, do they exercise at indoor facilities, or some combination of outdoor and indoor activities? Unfortunately we can’t answer these questions with our data, but it would be interesting to know. In addition, previous research has generally shown higher rates of leisure-time physical activity for men than for women. This also includes studies that look at meeting the 2008 federal guidelines for aerobic and muscle-strengthening activities through leisure-time physical activity. While our current study also found that men were more likely than women to meet the guidelines through leisure-time physical activity, some states were exceptions – especially Colorado, but also in Massachusetts, Washington, New Hampshire, Utah, and Wyoming, where men and women had statistically comparable percentages.


Q:  What would you say is the take-home message of this report?

DB/TC:  This is a “good news” data report – for the most part. We think the real take-home message of this report is that, overall, American adults aged 18-64 are exceeding guideline targets for physical activity through their leisure-time physical activity. The Healthy People 2020 objective regarding physical activity specifies that 20.1% of all adults meet both aerobic and muscle-strengthening federal guidelines by 2020. We found that in 2010-2015, nearly 23% of adults aged 18-64 were accomplishing this through their leisure-time physical activity– a truly positive finding. But when we looked at differences by gender and work status, we found that among all women aged 18–64, 18.7% met the guidelines through their leisure-time physical activity, which is nearly two percentage points lower than the Healthy People target. While the average for working women (20.9%) was above the target, the average among all nonworking women was only 14.6%, almost six percentage points lower than the Healthy People 2020 target. Nonworking women in just five states—Colorado, Idaho, New Hampshire, Utah, and Washington—met the objective through their leisure-time physical activity. We should keep in mind though, that the National Health Interview Survey (NHIS) only collects information on leisure-time physical activity, so our study was not able to look at occupational physical activity.


Q:  What made you decide to conduct this study on physical activity among Americans?

DB/TC:  One motivation for conducting this study was that we wanted to look at state-by-state percentages.  This new report is a continuation of a previous report (https://www.cdc.gov/nchs/data/nhsr/nhsr094.pdf) that looked at occupational differences among employed adults who met federal physical activity guidelines during their leisure-time physical activity. That report focused on individuals, not states, and excluded adults who were not working. While doing that analysis, we saw that there was considerable regional variation in the outcome.  We wanted to expand that earlier research to include all adults in this same age group (working as well as nonworking), and to consider differences in meeting the guidelines by state because we had already seen this regional variation.


Q:  What differences or similarities did you see between or among various demographic groups in this analysis?

DB/TC:  We did observe some differences between men and women, as well as by work status, but we didn’t distinguish between many demographic groups since this was a state-level analysis. Men had higher percentages of meeting the guidelines through leisure-time physical activity than women overall — and within most, but not all, states. This was also true when we compared working and nonworking men and women overall and within most states.


Q:  Why do you think there is such a vast difference among the states in the percentage of adults who meet the guidelines for physical activity through their leisure-time physical activity?

DB/TC:  There are likely many factors that play a role in these state differences, as researchers are likely to suggest. We looked at just two: occupational distributions among working adults (and among working men and women), and at percentages of illness and disability among nonworking adults (and among nonworking men and women). States with higher percentages of professionals and managers — relative to production workers –generally had higher percentages of working adults meeting the federal guidelines for physical activity during their leisure time than states with more production workers and fewer professionals and managers. Similarly, states with higher percentages of nonworking adults in fair or poor health or with a disability had lower percentages of meeting the guidelines during their leisure time than states with fewer nonworking adults in fair or poor health or with a disability. Indeed, many factors are likely involved. And we only considered leisure-time physical activity in our study. Our survey doesn’t collect information on physical activity performed while at work or when commuting.


Q:  What sort of trend data do you have on this topic that will help us see how physical activity for Americans has evolved over time?

DB/TC:  There is some trend data available through various sources. The Centers for Disease Control and Prevention (CDC) has published several reports on this topic; the 2014 report is available at https://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf, and a 2010 report is available at https://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf. CDC also has mini-reports available for each state that take into account state-specific data; these are available at  https://www.cdc.gov/physicalactivity/resources/state-action-guides.html.

Also, the National Center for Health Statistics (NCHS) reports Key Health Indicators based on the National Health Interview Survey (NHIS), including person-level estimates of adults aged 18 and over who meet the 2008 federal physical activity guidelines for both aerobic and muscle-strengthening activities during leisure-time physical activity. Please see tables 7.5 through 7.8 in https://www.cdc.gov/nchs/nhis/releases/released201806.htm#7A.


Q:  Is this the most recent data you have on this topic?

DB/TC:  While we do have newer data files, those data were not available when we were carrying out our analysis. So our current report is based on 2010-2015 National Health Interview Survey (NHIS) data. However, the most recent Key Health Indicators report at the website immediately above includes results from the 2016 and 2017 National Health Interview Survey.


Q: How many people were surveyed for this report?

DB/TC:  The National Health Interview Survey, or NHIS, is a national, in-person survey conducted annually. Roughly 35,000 U.S. adults respond to the “Sample Adult” interview in any given survey year, and all of them are asked a series of questions about how often, how long, and how vigorously they spend leisure time doing exercise. This report looks at state-level variation in meeting the 2008 federal guidelines for physical activity through leisure-time physical activity among adults aged 18-64 using the 2010-2015 NHIS. The 2008 physical activity guidelines recommend muscle-strengthening activities at least twice weekly, with either moderate-intensity aerobic physical activity for at least 150 minutes per week, vigorous-intensity aerobic physical activity for at least 75 minutes per week, or an equivalent combination. For those of our readers interested in the specific sample sizes used in this analysis, here are the numbers:

Sample adults aged 18-64 years who met the guidelines for both muscle-strengthening and aerobic activities through leisure physical activity (n = 32,942) are the focus of the study. Sample adults meeting only one guideline (n = 48,810) or neither guideline (n = 70,402) are not shown separately, but are included in the denominators. Percentage estimates are based on pooled data from the 2010–2015 NHIS for all 50 states and the District of Columbia.

 


QuickStats: Percentage of Adults Aged 18 Years or Older With or Without Psychological Distress† Who Were Current Smokers, by Age Group and Level of Distress — National Health Interview Survey, 2014–2016

June 18, 2018

During 2014–2016, 37.2% of adults aged 18 years or older with serious psychological distress were current smokers, followed by 27.6% of those with mild to moderate psychological distress and 14% of those with no psychological distress.

Among adults aged 18–44 and 45–64 years, the percentage of adults who were current smokers increased with the level of psychological distress.

Among adults aged 65 years or older, the percentage who were current smokers was less among adults with no psychological distress than among adults with mild to moderate or serious psychological distress.

Source: National Health Interview Survey, 2014–2016. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6723a6.htm


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

May 22, 2018

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

Q: What were some of the major findings in your full-year 2017 health insurance estimates?

RC: In 2017, 29.3 million persons were uninsured at the time of interview. This is 19.3 million fewer persons than in 2010. In 2017, 9.1% were uninsured, 36.2% had public coverage, and 62.6% had private coverage at the time of interview.


Q: What are the trends among race and ethnicity groups who were uninsured in 2017 and compared over time?

RC: In 2017, 27.2% of Hispanic, 14.1% of non-Hispanic black, 8.5% of non-Hispanic white, and 7.6% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview.

Significant decreases in the percentage of uninsured adults were observed from 2013 through 2017 for Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults.

Hispanic adults had the greatest percentage point decrease in the uninsured rate from 2013 (40.6%) through 2016 (25.0%). The observed increase among Hispanic adults between 2016 and 2017 (27.2%) was not significant.


Q: What does your data show this year for Americans who have high-deductible health insurance plans compared to previous years?

RC: In 2017, 43.7% of persons under age 65 with private coverage were enrolled in a high-deductible health plan (HDHP). Enrollment in HDHPs has increased 18.4 percentage points from 25.3% in 2010 to 43.7% in 2017. More recently, the percentage enrolled in an HDHP increased from 39.4% in 2016 to 43.7% in 2017.


Q: What do you see in state-level estimates of health insurance coverage this year?

RC: Among the 18 states presented in this report, there were no significant changes in the percentages of uninsured among persons aged 18–64 between 2016 and 2017.


Q: What is the take home message in this report?

RC: The take-home message from this report is found in the number of Americans who no longer lack health insurance. In 2017, 29.3 million (9.1%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from 2016, but there are 19.3 million fewer uninsured persons than in 2010.

 


QuickStats: Age-Adjusted Percentages of Adults Aged 18 Years or Older Who Are Current Regular Drinkers of Alcohol, by Sex, Race, and Hispanic Origin — National Health Interview Survey, 2016

March 19, 2018

In 2016, men aged 18 years or older were more likely than women to be current regular drinkers of alcohol (62.1% versus 47.2%).

Non-Hispanic white men (65.5%) were more likely to be current regular drinkers than Hispanic men (57.8%) and non-Hispanic black men (52.9%).

Non-Hispanic white women (55.6%) were more likely to be current regular drinkers than non-Hispanic black women (35.9%) and Hispanic women (31.5%).

Source: Tables of summary health statistics for US adults, National Health Interview Survey, 2016.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a8.htm


Early Release of Selected Estimates Based on Data From the January-September 2017 National Health Interview Survey

March 15, 2018

Questions for Jeannine Schiller M.P.H., Health Statistician and Lead Author of “Early Release of Selected Estimates Based on Data From the January-September 2017 National Health Interview Survey

Q: What is new in this quarterly update that looks at 15 key health indicators for Americans?

JS: There is always something new in our quarterly estimates of 15 key health indicators for Americans. While results in this release were similar to those from last quarter, consistency of results is also an important finding. These new estimates, when analyzed with those from previous years, allow us to see where we are moving in public health measures and critical public health concerns today. This update provides the latest estimates (through January–September 2017) for this collection of key health indicators. The estimates for the first nine months of 2017 are provided by sex, age group, and race/ethnicity. Estimates represent the noninstitutionalized civilian population of the United States and allow monitoring of these indicators from 1997 to the most recent data available.


Q: What are the goals and benefits of producing a new update on all of these health behaviors every three months?

JS: The goals and benefits of producing these quarterly updates is to provide the most recent data available for timely monitoring of 15 key health indicators important to Americans’ health. Researchers and policy makers can then use this information to make critical decisions and take action sooner rather than later—to improve or maintain the health of our nation. The Early Release Program of the National Health Interview Survey (NHIS) provides analytic reports and preliminary microdata files on an expedited schedule. Estimates are available just six months after the end of data collection. The public can have access to these timely reports and Early Release files without having to wait for the final, annual NHIS microdata files to be released in late June following the end of each data collection year. These early reports and data files are produced prior to final processing in order to provide early access to the most recent information from NHIS.


Q: Was there a result in your latest release of estimates that you hadn’t expected and that really surprised you?

JS: Most of the results for these indicators tend to be fairly consistent over time, so there was nothing unexpected in this latest analysis of 15 key health indicators. Of note, we did see continued increases in pneumococcal and influenza vaccination, obesity, physical activity (based on leisure-time activity), HIV testing, and diabetes—and decreases in current cigarette smoking. When examined over the course of the past couple of decades, some of these results are quite striking.


Q: What differences or similarities did you see among race and ethnic groups and various demographics in this analysis?

JS: We observed a number of variations among race and ethnic groups—and among women—in this quarter’s analysis of 15 health behaviors. Rates of pneumococcal vaccination, physical activity (based on leisure-time activity), and having at least 1 heavy drinking day in the past year, were all higher among non-Hispanic white persons compared to non-Hispanic black persons and Hispanic persons. Current cigarette smoking was lower among Hispanic persons compared to non-Hispanic black persons and non-Hispanic white persons. Among women, the prevalence of obesity was higher among non-Hispanic black persons compared to non-Hispanic white persons and Hispanic persons, while there was no significant difference in the prevalence of obesity by race and ethnicity groups among men.   


Q: What is the take-home message from this report?

JS: In some ways, this is a good news report, though it is also important to keep an eye on some negative trends. I think its take-home message is that there is overall good health of Americans now and in recent years, despite some health behaviors that could affect overall wellness of our population. About two-thirds of persons had excellent or very good health during the first nine months of 2017, and this rate has been stable in recent years.  While some health outcomes are going in the preferred direction (smoking, selected vaccinations, physical activity during leisure time, HIV testing), others, such as obesity and diabetes, continue to move in an undesirable direction.


QuickStats: Percentage of Children Aged 1–5 Years Who Had Never Been to a Dentist, by Age and Year — National Health Interview Survey, United States, 2006–2016

March 5, 2018

During 2006–2016, the percentage of children aged 1–5 years who had never seen a dentist decreased as age increased.

In 2016, 80.2% of children aged 1 year, 49.7% of children aged 2 years, 28.6% of children aged 3 years, 18.3% of children aged 4 years, and 6.8% of children aged 5 years had never seen a dentist.

For all ages, the percentage of children who had never seen a dentist declined from 2006 to 2016.

Source: National Health Interview Survey, 2006–2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6708a8.htm