Since its inception, SHADAC has been dedicated to conducting research and providing technical assistance in order to examine characteristics of and trends in health insurance coverage and access to care and associations with overall physical, social, and mental health status. Our work on these topics includes technical briefs describing the complexity of measuring health insurance coverage and understanding the strengths and weaknesses of various data sources, e.g., federal and state-specific surveys, towards the goal of improving estimates of health insurance coverage, which is critical to the evaluation of federal and state health reform efforts.
We also have conducted research studies of access to care during the coronavirus pandemic, insurance churning in Medicaid, and insurance-based discrimination. We have helped states field their own health insurance surveys or used federal data to help states target their coverage-related efforts as well as produced 50-state analyses of geographic disparities in coverage and key measures of health care access with data from State Health Compare.
Below, you'll find examples of SHADAC projects and blogs in this area of expertise.
Related SHADAC Projects
Minnesota’s Community and Uninsured Profile
Minnesota’s Community and Uninsured Profile is an interactive tool that provides rates and counts of uninsured Minnesotans at a range of geographic levels (from ZIP code to county to legislative district to the state as a whole) and with in-depth demographic and community characteristics using data from the American Community Survey (ACS).
This data resource allows policymakers, researchers, and community members themselves to explore and understand the current landscape of uninsurance in Minnesota. Whether it is used to support equity-focused work, community needs assessments, grant writing, or targeted coverage programs, this tool can provide key information that can drive policy, outreach efforts, and much more.
Originally created as part of the ‘Minnesota’s Uninsured and the Communities in Which They Live’ project funded by the Blue Cross and Blue Shield of Minnesota Foundation, this tool aims to:
- Provide information on Minnesota uninsured people and populations
- Assist policymakers in developing & evaluating enrollment and outreach strategies
- Understand uninsured community and population characteristics in Minnesota
- Create a tool that can be used to understand and evaluate equity work, inform strategic planning, assess community needs, and support grant writing for related and relevant programs
We have also created an interactive map with this information, giving users another way to explore and understand the data. This blog reviews profile’s accompanying interactive map, including varied geographical breakdowns and other filters like social vulnerability index and hospital & school locations.
Survey Data Season
Each year, SHADAC covers the release of data from multiple federal surveys, including:
- The National Health Interview Survey (NHIS) in June
- The Medical Expenditure Panel Survey (MEPS) in July
- The Behavior Risk Factor Surveillance System (BRFSS) in August
- The Current Population Survey (CPS) in September
- The American Community Survey (ACS) in September through January
Such surveys are conducted by a variety of agencies, including:
- The National Center for Health Statistics (NCHS)
- The Agency for Healthcare Research Quality (AHRQ)
- The Centers for Disease Control and Prevention (CDC)
- The U.S. Census Bureau
With a particular focus on health insurance coverage, SHADAC researchers cover each data release with a blog, infographic, report, or other product that shares key findings or important data to note from all surveys. This period of data and product releases is something we call Survey Data Season (SDS).
Examples of popular annual resources from Survey Data Season include:
ACS Tables: State and County Uninsured Rates
Each year, SHADAC uses data released from the American Community Survey (ACS) to produce estimates of uninsurance at the state and county level. This resource provides users with PDFs for all 50 states and includes sub-state categories and demographic characteristics like poverty level and race and ethnicity.
Annual Webinar on ACS and CPS Coverage Estimates with a Census Bureau Expert
This webinar, hosted annually by SHADAC, breaks down the latest full-year health insurance coverage estimates from the American Community Survey (ACS) and the Current Population Survey (CPS). The webinar includes an audience Q&A opportunity with an expert from the Census Bureau, which conducts both surveys.
Employer-Sponsored Insurance Report Using MEPS Data
This annual report uses MEPS data to understand the landscape of employer-sponsored insurance (ESI), the dominant form of health insurance coverage in the United States. Accompanying this narrative are detailed 50-state comparison tables that allow for cross-state analysis of ESI trends over time.
Blog Reviewing NHIS Full-Year Health Insurance Coverage Estimates
The first full-year health insurance estimates are released from the National Health Interview Survey (NHIS) each year, and SHADAC publishes a corresponding annual blog in which we analyze the coverage estimates from NHIS via the early release program and provide trend comparisons to the previous year. See our most recent blog using 2024 NHIS data, and the previous year’s blog using 2023 NHIS data.
Visit the Survey Data Season hub page to find this year’s data release dates and a compilation of all products we have made so far. You can also find our related ‘Survey Data Season Essentials’ blog series below, covering topics related to survey data and research:
- Survey Data Season Essentials: What Is the BRFSS and How Can Researchers Use It?
- Survey Data Season Essentials: ACS vs CPS: What Is the Difference Between These Two Federal Surveys?
CHCF: Health Coverage and Access Research
For over 10 years, SHADAC has worked with the California Health Care Foundation (CHCF) to provide expert input, data analysis, and discussion on numerous projects and briefs. Much of SHADAC’s work supported by CHCF centers issues of health insurance coverage and access to health care for Californians using data from the California Health Interview Survey (CHIS).
For example, SHADAC researchers authored the brief, “Language Barriers and Health Equity: The Challenges Faced by Californians with Limited English Proficiency,” which used pooled data from the 2021 and 2022 California Health Interview Survey to provide a comprehensive overview of adults with LEP in California, including demographic characteristics, access to care, health outcomes, and communication challenges with health care providers, along with policy implications and potential for future research. Another CHCF brief on health care access authored by SHADAC used data from the 2021 CHIS to explore how telehealth use and experiences varies across subpopulations in the state in order to understand health care access as well as the overall experience of telehealth compared to in-person care.
Our work with CHCF has also examined disparities in health insurance coverage and access, including, for example, this data brief on whether and how access to care shifted during the pandemic for people with Medi-Cal compared to those with employer coverage.
Discrimination and Health Care Access in Minnesota Using MNHA Data
The Minnesota Health Access Survey (MNHA) is a biennial survey that measures Minnesotans’ experiences accessing and using health care in Minnesota (find more info on SHADAC’s work with MNHA here). Recent work from SHADAC researchers and co-authors has used MNHA data to examine various forms of provider discrimination and how this could impact health care access and related phenomena, such as forgone care. This includes work published in journals as well as blogs published on SHADAC’s website.
One study published in the Journal of General Internal Medicine analyzed 2021 and 2023 MNHA data, finding that transgender and non-binary adults had over seven times the odds of provider discrimination compared with cisgender men. Another published study examines provider discrimination based on a number of demographic factors. One of the study’s findings was that experiencing provider discrimination based on either insurance status or based on gender or sexual orientation was associated with forgone care.
One blog details analysis of 2021 MNHA data that showed “the majority (58.9%) of transgender and non-binary respondents reported experiencing gender-based discrimination [...]—a stark contrast from the statewide average of 6.0%.” A companion blog found that discrimination from health care providers based on SOGI were significantly higher among lesbian/gay (36.1%) and bisexual/pansexual (26.1%) populations compared with the state average (6%).
Past Work
Reduced Access to Health Care due to Coronavirus Pandemic - SHADAC COVID-19 Survey
SHADAC conducted a two-part survey initially designed to measure the impacts of the novel coronavirus on a variety of experiences for adults in the United States. The survey was conducted as part of the AmeriSpeak omnibus survey conducted by NORC at the University of Chicago using a mix of phone and online modes among a nationally representative sample of 1,007 respondents age 18 and older. The first iteration of the survey was fielded in late April 2020, and questions focused on health insurance coverage, access to and cost of care during the pandemic, as well as COVID-related stressors and coping mechanisms. A second version of the survey was again fielded in April of 2021, with questions aimed at understanding respondents’ experiences with illness and death due to COVID-19 for themselves, their families, and their contacts. A collective list of products we have produced using results from the SHADAC COVID-19 Survey can be found here.
Impacts of the Affordable Care Act Medicaid Expansion in California
With funding from the California Health Care Foundation, SHADAC conducted an analysis of the impact of the Medicaid expansion on healthcare coverage, access, health status, affordability, and disparities in these outcomes by race/ethnicity for low-income Californians. Researchers on this project used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 data years and a difference-in-differences approach that compared California with non-expansion states.
MACPAC Analysis of Insurance Churning
SHADAC conducted a quantitative analysis for MACPAC that explored the magnitude and type of churn among the Medicaid population. Specifically, the study used the Survey of Income and Program Participation Panel (SIPP) to examine the characteristics of those who churned with those who had continuous Medicaid coverage throughout the year and explored possible causes of churn. The study produced descriptive statistics to address many of the research questions and regression analysis to explore life events that potentially cause churn. The study team was able to produce state-level estimates by leveraging the large sample size of the American Community Survey (ACS) to enhance the statistical power of the SIPP by post stratifying the individual weights to match a variety of relevant population estimates in the ACS.
The Intersection of Structural Risk Factors and Insurance-based Discrimination on Healthcare Access Inequities
Social risk factors independently influence experiences of discrimination and they converge leaving some people even more vulnerable leading to worse access to healthcare. Supported by a grant from the Robert Wood Johnson Foundation (RWJF) and in collaboration with the Minnesota of Department of Health and Minnesota Department of Human Services, researchers conducted an evaluation on the effects of insurance-based discrimination and other social risk factors (e.g., low income, minority status) on disparities in access to healthcare services.