Reasons for Being Uninsured Among Adults Aged 18–64 in the United States, 2019

September 30, 2020

Questions for Amy Cha, Health Statistician and Lead Author of “Reasons for Being Uninsured Among Adults Aged 18–64 in the United States, 2019.”

Q: Why did you decide to do a report on this topic?

AC: In 2019, 14.5% of adults aged 18–64 were uninsured in the United States. Individuals without health insurance experience barriers to health care such as not having a usual source of care and postponing or forgoing care due to cost, which may lead to negative health outcomes. Therefore, in this report we evaluated the characteristics of uninsured adults aged 18–64 in 2019 and the percentage among uninsured adults who identified with six reasons for being currently uninsured.


Q: Was there a specific funding in the data that surprised you from this report?

AC: We were surprised that the percentage of adults who were uninsured due to cost was higher among women and adults in fair or poor health. The percentage who were uninsured due to cost increased with age from 66.8% among those aged 18–29 to 80.9% among those 50─64.


Q: How did you obtain this data for this report?

AC: The data for this report came from the 2019 National Health Interview Survey (NHIS) Sample Adult component. NHIS is a nationally representative, household survey of the civilian noninstitutionalized U.S. population. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. The data is publicly available on the NHIS website (https://www.cdc.gov/nchs/nhis) with detailed data documentation.


Q: Is there any trend data for this report? If so, where can I find this data?

AC: We do not have any trend data for this report. With the NHIS redesign, questions concerning the reasons for being uninsured were asked in a different manner than in previous surveys and therefore are not comparable.


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

AC: Among uninsured adults aged 18–64, the most common reason for being currently uninsured was because they perceived that they could not afford the cost of coverage, followed by not being eligible, not wanting coverage, the process of signing up was too difficult or confusing, could not find a plan that meets their needs, and they signed up for coverage, but the plan has not started yet.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2019

May 28, 2020

Questions for Robin Cohen, Health Statistician and Lead Author of “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2019.”

Has the percentage of people without health insurance changed much in recent years?

RC: This most recent release from the National Health Interview Survey (NHIS) includes estimates for January through June 2019. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. Due to changes in weighting and design methodology, direct comparisons between estimates for 2019 and earlier years should be made with caution, as the impact of these changes has not been fully evaluated at this time. A working paper entitled, “Preliminary Evaluation of the Impact of the 2019 National Health Interview Survey Questionnaire Redesign and Weighting Adjustments on Early Release Program Estimates” discusses both these issues in greater detail.


Q: Why did NCHS redesign the NHIS?

RC: In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. The redesign aimed to improve measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal surveys, establish a long-term structure of ongoing and periodic topics and incorporate advances in survey methodology and measurement.


Q: Has the NHIS ever been redesigned before?

RC: The NHIS has undergone several questionnaire redesigns since its inception in 1957. The last major questionnaire redesign occurred in 1997.


Q: How was the health insurance data strengthened by this redesign?

RC: The flow and content of the health insurance questions in the redesign are similar to those from 1997-2018. The main difference is that instead of a family respondent providing health insurance information for all family members as a proxy, health insurance is now asked directly of the sample adult and the parent or guardian of the sample child.


Q: Do we have a sense of how COVID-19 has impacted health insurance coverage in the U.S.?

RC: The estimates from this report are based on data collected from January through June 2019. This is prior to the COVID-19 pandemic. There are some estimates of health insurance coverage during the COVID-19 pandemic available from the Household Pulse Survey (https://www.cdc.gov/nchs/covid19/pulse/health-insurance-coverage.htm). The Household Pulse Survey is a 20-minute survey on how the COVID-19 pandemic may impact households across the country. However, these estimates of health insurance coverage may not be comparable with those using NHIS data. 


Q: When will NHIS have data on the impact of COVID-19 on health insurance coverage?

RC: Data collection from the 2020 NHIS is ongoing, and the early release of estimates from the 2020 NHIS has not been determined.


Q: Is the uninsured # for kids higher than previously reported?

RC: This most recent release from the National Health Interview Survey (NHIS) includes estimates for January through June 2019. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. Due to changes in weighting and design methodology, direct comparisons between estimates for 2019 and earlier years should be made with caution, as the impact of these changes has not been fully evaluated at this time.


Q: Anything else of note in your report that you’d like to mention?

RC: In January 2019, the National Health Interview Survey launched a redesigned questionnaire. The new design collects health insurance information from one randomly selected adult and child from each household in the survey. Estimates in this report are based on the first two quarters of 2019.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018

May 9, 2019

Questions for Emily P. Terlizzi, M.P.H., Associate Service Fellow and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2018

Q; How did the uninsured vary by age groups and compare to last year in this report?

ET: In 2018, 9.4% of persons of all ages, 11.1% of persons under age 65, 5.2% of children, and 13.3% of adults aged 18-64 lacked health insurance at the time of interview. In 2017, 9.1% of persons of all ages, 10.7% of persons under age 65, 5.0% of children, and 12.8% of adults aged 18-64 lacked health insurance at the time of interview. However, between 2017 and 2018, none of these differences by age group were significantly different.


Q: How did the uninsured vary by regions in the United States?

ET: In 2018, 7.7% of adults aged 18-64 living in the Northeast, 11.1% of those living in the Midwest, 18.4% of those living in the South, and 11.6% of those living in the West lacked health insurance coverage at the time of interview.


Q: Has there been an increase in the percentage of persons with private coverage enrolled in high deductible health plans?

ET: In 2018, almost 45.8% of persons under age 65 with private coverage were enrolled in a high-deductible health plan (HDHP). The percentage of persons enrolled in a HDHP has increased 20.5 percentage point since 2010.


Q: What is new in this report?

ET: This report provides health insurance estimates for the United States and 17 selected states using a full year of 2018 National Health Interview Survey data. Among adults aged 18–64 the percentage who were uninsured ranged from 4.9% in Massachusetts to 25.0% in Texas.


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

ET: The take-home message from this report is found in the number of Americans who no longer lack health insurance. In 2018, 30.4 million (9.4%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from the 29.3 million (9.1%) in 2017, but there are 18.2 million fewer uninsured persons than in 2010.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2018

February 27, 2019

Questions for Emily P. Terlizzi, M.P.H., Health Statistician and Lead Author on “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2018

Q: How did the uninsured vary by age groups in this report?

ET: In the first 9 months of 2018, 9.2% of persons of all ages, 10.8% of persons under age 65, 4.9% of children, and 13% of adults aged 18-64 lacked health insurance at the time of interview.


Q: How did the uninsured vary by race in this report?

ET: In the first 9 months of 2018, 26.3% of Hispanic, 14.7% of non-Hispanic black, 8.8% of non-Hispanic white, and 8.2% of non-Hispanic Asian adults aged 18–64 lacked health insurance coverage at the time of interview.


Q: How did the uninsured vary by regions in the United States?

ET: In the first 9 months of 2018, 7.3% of adults aged 18-64 living in the Northeast, 11% of those living in the Midwest, 18.1% of those living in the South, and 11.2% of those living in the West lacked health insurance coverage at the time of interview.


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

ET: I think the take-home message from this report is found in the number of Americans who no longer lack health insurance. In the first 9 months of 2018, 29.7 million (9.2%) persons of all ages were uninsured at the time of interview. This estimate is not significantly different from 2017, but there are 18.9 million fewer uninsured persons than in 2010.


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.

 


State by State Health Data Source Updated on NCHS Web Site

April 19, 2017

CDC’s National Center for Health Statistics has updated its Stats of the States feature on the NCHS web site.  This resource features the latest state-by-state comparisons on key health indicators ranging from birth topics such as teen births and cesarean deliveries to leading causes of death and health insurance coverage.

Tabs have been added to the color-coded maps to compare trends on these topics between the most recent years (2015 and 2014) and going back a decade (2005) and in some cases further back.

To access the main “Stats of the States” page, use the following link:

https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm


Health Insurance Data from the National Health Interview Survey

September 16, 2016

The National Health Interview Survey (NHIS) has monitored the health of the nation since 1957 and collects data on a broad range of health topics through personal household interviews. NHIS has collected health insurance data periodically since 1959 and annually since 1989. The NHIS health insurance questions have changed and expanded over time to reflect changes in health insurance coverage as well as questionnaire design. Since 1997, the content and flow of the health insurance section has remained relatively stable, incorporating new programs where necessary. For example, new questions added in 2014 obtain information about whether coverage was obtained through the Federal Health Insurance Marketplace and state-based exchanges.

The NHIS allows for both point-in-time uninsured estimates as well as full-year and part-year uninsured estimates. Three estimates of lack of health insurance coverage are published for each calendar quarter: (a) uninsured at the time of interview, (b) uninsured at least part of the year prior to interview (which includes persons uninsured for more than a year), and (c) uninsured for more than a year at the time of interview. In addition, NHIS provides estimates of both public and private coverage as well as enrollment in high-deductible health plans and exchange-based coverage. The NHIS may be used to monitor changes in health insurance coverage throughout the year as the survey is fielded continuously throughout the year.

To see the latest quarterly numbers on health insurance coverage through January-March 2016, check out: Health Insurance Coverage: Estimates from the National Health Interview Survey, January-March 2016, released on September 7, 2016.


Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-March 2016

September 7, 2016

uninsured092016

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author of “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2016

Q: How have trends in health insurance coverage in the United States changed in the first quarter of 2016 compared to last year, and compared to 2010 when the Affordable Care Act was established?

RC: In the first 3 months of 2016, 27.3 million — or 8.6 percent of persons of all ages — were uninsured. This is 1.3 million fewer persons than in 2015 and 21.3 million fewer persons than in 2010. In 2015, the uninsured rate is in the single digits for the first time since the National Health Interview Survey began measuring health insurance in 1959.

Also, from January through March 2016, among adults aged 18 to 64, 11.9 percent were uninsured at the time of interview, 19.5 percent had public coverage, and 70.2 percent had private health insurance coverage. Among the 138.2 million adults in this age group with private coverage, 9.2 million or 4.7 percent were covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.


Q: What explains the drop in the uninsured rate during the first quarter of 2016, after the rate was essentially unchanged during the last three periods for 2015?

RC: The estimates for the previous three reports are based on an average over 6 months, 9 months, and 12 months of data for the November 2015, February 2016, and May 2016 reports respectively.


Q: How is health insurance coverage looking this year for our youngest population – children under 18 years of age?

RC: In the first quarter of 2016, 5 percent of children under 18 years of age were uninsured; 42.1 percent had public coverage, and 54.9 percent had private coverage. The percentage of children who were uninsured decreased from 13.9 percent in 1997 to 5 percent in the first 3 months of 2016.


Q: Where do high-deductible plans through private health insurance fit into 2016 estimates compared to earlier years?

RC: Forty percent of persons under age 65 with private health insurance were enrolled in a high-deductible health plan in the first 3 months of 2016. The percentage who were enrolled in a high deductible health plan increased almost 15 percentage points from 25.3 percent in 2010 to 40 percent in 2016’s first quarter. More recently, the percentage enrolled in a high-deductible plan increased from 36.7 percent in 2015 to 40 percent in 2016.


Q: What are the trends among race and ethnicity groups in health insurance coverage this year and compared over time?

RC: In the first 3 months of 2016, 24.5 percent of Hispanic, 13 percent of non-Hispanic black, 8.4 percent of non-Hispanic white, and 6.7 percent of non-Hispanic Asian adults aged 18 to 64 lacked health insurance coverage. There were significant decreases in the percentage of uninsured adults observed between 2015 and the first 3 months of 2016 among these four race and ethnicity groups. Hispanic adults had the greatest percentage point decrease of 16.1 percentage points in the uninsured rate between 2013 and the first 3 months of 2016.


Number of Uninsured in U.S. Continues to Decline

November 6, 2015

NCHS has released selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the January–June 2015 National Health Interview Survey (NHIS), along with comparable estimates from the 2010–2014 NHIS.

Key Findings:

  • In the first 6 months of 2015, 28.5 million persons of all ages (9%) were uninsured at the time of interview—7.5 million fewer persons than in 2014 and 16.3 million fewer than in 2013.
  • Among adults aged 18–64, the percentage uninsured decreased from 16.3% in 2014 to 12.7% in the first 6 months of 2015. There was a corresponding increase in private coverage, from 67.3% to 70.6%. In 2013, among adults aged 18–64, 20.4% were uninsured and 64.2% had private coverage.
  • Among children under age 18 years, the percentage with private coverage increased from 52.6% in 2013 to 56.0% in the first 6 months of 2015, reversing a 14-year trend of declining rates of private coverage.
  • Among those under age 65, the percentage with private coverage through the Health Insurance Marketplace or state-based exchanges increased from 2.5% (6.7 million) in the fourth quarter of 2014 to 4.0% (10.7 million) in the second quarter

Insurance Status by State Medicaid Expansion Status: Early Release of Estimates From the National Health Interview Survey, 2013–September 2014

May 21, 2015

Under the Affordable Care Act, states have the option to expand Medicaid coverage to all eligible persons with incomes up to 138% of the federal poverty level (FPL). Previous research has shown that there have already been significant decreases in the percentages of persons who were uninsured between 2013 and the first 9 months of 2014.

Using data from 2013 and the second and third quarters (April through September) of the 2014 National Health Interview Survey (NHIS), a new NCHS report examines changes in the percentage of persons who were uninsured, by state Medicaid expansion status, age, and poverty status.

Data from the second and third quarters of the 2014 NHIS were chosen for this analysis because they capture the surge in enrollment in the Health Insurance Marketplace and state-based exchange plans that occurred in March and the beginning of April 2014. Data from the fourth quarter of the 2014 NHIS are not yet available.

Key Findings from the Report:

  • The percentage of adults aged 18–64 who were uninsured at the time of interview decreased from 20.4% in 2013 to 15.9% in April–September 2014.
  • Adults aged 18–64 with family incomes less than or equal to 138% of the FPL in Medicaid expansion states had a larger decrease in the percentage uninsured (10.2 percentage points) than those with similar income in nonexpansion states (3.3 percentage points) from 2013 to April–September 2014.
  • Between 2013 and April–September 2014, the percentage of uninsured adults aged 18–34 with incomes less than or equal to 138% FPL decreased 9.1 percentage points in Medicaid expansion states, compared with only 0.7 percentage points in nonexpansion states.
  • The greatest absolute decrease in the percentage uninsured from 2013 to April–September 2014 (12.1 percentage points) was among adults aged 45–64 with incomes less than or equal to 138% FPL in Medicaid expansion states.