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2021 NHIS Full-Year Health Insurance Estimates Early Release: Coverage Rates Remain Stable Overall, Changes Visible across Demographic GroupsMay 10, 2022:
The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2021 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. The estimates captured in this report are some of the first available coverage estimates for 2021 from a federal survey.
National-level estimates are available by breakdowns including age, sex, poverty status, race and ethnicity, and by state Medicaid expansion status. The NHIS full-year estimates for 2021 do not include either full or partial state-level data, as has been the case since the survey was redesigned in 2019. However, NCHS periodically releases state-level estimates of coverage, which SHADAC has previously covered on our blog and will continue to monitor and report on any future releases.
Changes between the 2020 and 2021 coverage estimates were minimal when examining rates of private coverage and those without health insurance coverage. However, the 2021 report indicates a slight uptick in public coverage which is consistent with trends in survey and administrative data since the start of the coronavirus (COVID-19) pandemic in the United States. The rates across all coverage types experienced several more notable shifts when examined by sex as well as race and ethnicity.
Changes in the NHIS
The COVID-19 pandemic significantly impacted 2020 NHIS field procedures (including interview format), response rates, and resulting data analytic files, though NCHS found minimal nonresponse bias in the 2020 NHIS. A recent SHADAC issue brief reported on these and other changes to federal surveys that were similarly impacted by the pandemic.
It is also worth noting that 2021 NHIS coverage estimates are based on information collected from 29,696 sample adults and 8,293 sample children. In 2019, the NHIS underwent a substantial redesign of its content and structure and one of the largest changes, the elimination of the family questionnaire, has resulted in a substantial reduction of the available sample size for the survey (though the NCHS also estimates a positive effect on higher response rates). It is likely that a survey with a larger sample size would find more significant year-over-year changes in coverage rates.
Notes on Race and Ethnicity Estimates from NHIS
The NHIS Early Release report from which the figures for the race/ethnicity category are drawn does not further disaggregate statistics by more detailed race and ethnicity categories. Individuals not identifying as Hispanic; non-Hispanic White, Black, or Asian; or identifying with multiple, non-Hispanic race categories are classified as “multiple races or any other race.”
Additionally, there are many factors that historically widen disparities in coverage across race and ethnicity; race-based discrimination in employment and systemic racism are two possible contributors.
Cohen, R.A., Cha, A.E., Terlizzi, E.P., & Martinez, M.E. (2022, May 5). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2021. National Center for Health Statistics (NCHS). https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202205.pdf