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NHIS: 2.4 million more uninsured working-aged adults in first six months of 2019May 28, 2020:
The number of nonelderly adults (age 18-64) without health insurance coverage increased to 27.2 million in the first six months of 2019 (January-June), up from 24.8 million in the same period in 2018. This put the uninsured rate for the first half of 2019 at 13.7%, an increase from 12.5% in the same period in 2018.
This finding comes from new health insurance coverage estimates for Q1-Q2 2019 from the National Health Interview Survey (NHIS). These estimates were released by the National Center for Health Statistics (NCHS) as part of the NHIS Early Release Program and are the first available coverage estimates for 2019 from a federal survey and the first estimates since the NHIS was redesigned for 2019. Though this post compares the 2019 estimates from the redesigned NHIS to 2018 NHIS estimates from the prior version of the survey, readers should take caution in making this comparison, as the survey redesign and co-occurrent changes to survey weighting may have affected estimates of health insurance coverage. A short summary of the NHIS redesign is provided at the end of this post.
Though current rates of health insurance coverage have been substantially altered by the ongoing coronavirus pandemic and resulting economic upheaval, estimates of health insurance coverage in 2019 are an important baseline and provide information about changes to the coverage landscape that were ongoing before COVID-19.
Uninsurance Increased, Public and Private Coverage Remained Stable in First Half of 2019
The new NHIS estimates show that overall rates of uninsurance among the nonelderly adult population increased to 13.7%. Rates of private and public health insurance coverage among this same population remained statistically unchanged from 2018, a trend echoed among all other age groups, none of which experienced statistically significant changes in rates of uninsurance or public or private coverage.
Uninsurance Increased among Other Subpopulations (Income and Race/Ethnicity)
Among nonelderly adults above 200% of the Federal Poverty Level (FPL), the uninsured rate increased to 8.5% in January-June 2019 from 7.6% in the same period in 2018. Rates of public and private coverage were stable for this income group, and no other income group saw significant changes in either rates of uninsurance or public or private coverage over the same period.
The uninsured rate for non-Hispanic, White nonelderly adults rose to 9.8% in the first half of 2019, up from 8.6% in the same period of 2018. This increase in uninsurance among White adults was accompanied by a decrease in private coverage, falling to 74.8% in the first six months of 2019 from 76.9% in the first half of 2018. The rate of public coverage among Whites was stable, as was uninsurance and private coverage for all other reported racial/ethnic groups in the report.
Changes in Coverage Type among Children by Income
Uninsurance Fell among Children in Poverty
Among children (age 0-17) below 100% FPL, the percent without health insurance coverage decreased to 3.4% during January-June 2019 from 6.4% in the same period in 2018. Rates of public and private coverage for this group were statistically unchanged during the same period.
Public Coverage Decreased among Children 100-200% FPL
Among children with family incomes of 100-200% FPL, rates of public coverage decreased to 69.8% in the first half of 2019 from 75.7% during the same period in 2018. The percent uninsured and with private coverage were statistically stable for this group at 6.1% and 27.1%, respectively, during the first six months of 2019.
Shift from Public to Private Coverage among Children above 200% FPL
For children in families with incomes above 200% FPL, rates of private coverage rose by 2.8 percentage points from 78.7% to 81.5% in the first halves of 2018 and 2019, respectively—an increase which mostly offset the 2.5 percentage-point drop in public coverage from 18.6% to 16.1% over the same period. The percent of uninsured children in this income category remained stable, however, at 3.7%.
2019 NHIS Redesign
The NHIS recently underwent a substantial redesign of its content and structure, culminating in the launch of the redesigned survey instrument in January 2019. Per the survey overview page from NCHS, the goals of the redesign were to “improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.”1
One of the largest changes made under the redesign is the elimination of the family questionnaire, which previously asked questions about the family as a whole as well as separately of each member of the family. Most of the family questionnaire content was moved to revised sample adult and sample child questionnaires, which are asked of one adult and one selected at random from members of the household and has the effect of substantially reducing the available sample size. For example, the January-June 2019 early release report had a total sample of 21,902 persons, whereas the same report in 2018 was based on a sample size of 39,112 persons. This also appears to have resulted in a substantial decrease in the number of available estimates of health insurance coverage by subpopulation and geography published in the January-June Early Release report. However, NCHS anticipates that the redesign’s reduction in respondent burden will result in more sample adult and sample child interviews due to higher response rates.
About the Numbers
The above estimates provide a point-in-time measure of health insurance coverage, indicating the percent of persons with that type of coverage at the time of the interview. The 2019 estimates are for the months of January to June 2019 (Q1 and Q2) and are based on a sample of 21,902 persons from the civilian noninstitutionalized population.
Differences described in this post are statistically significant at the 95% confidence level unless otherwise specified.
For more information about the early 2019 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
Cohen, R.A., Terlizzi, E.P., Martinez, M.E., & Cha, A.E. (2020). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–June 2019. Available from https://www.cdc.gov/nchs/nhis/healthinsurancecoverage.htm
1 National Center for Health Statistics (NCHS). (2019, November 27). 2019 Questionnaire Redesign. Available from https://www.cdc.gov/nchs/nhis/2019_quest_redesign.htm