NCHStats

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.

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.

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.

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.

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