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NHIS: National Rates of Health Insurance Coverage for Third Quarter of 2021 Statistically Unchanged from 2020January 25, 2021:
On Wednesday, January 19, the National Center for Health Statistics (NCHS) announced that health insurance coverage estimates from the National Health Interview Survey (NHIS) Early Release Program are now available for Quarter 3 of 2021 (July-September)
At a high level, the new estimates show no significant changes in coverage type (public, private) or uninsured rate across all ages and income groups when compared to the same time period in 2020, as discussed below.
Among nonelderly adults (ages 18 to 64) surveyed between July and September of 2021, 13.0% were uninsured at the time of interview, 21.1% had public coverage, and 67.3% had private coverage. Comparatively, these rates measured at 14.1%, 20.3%, and 67.4% from July to September in 2020, as shown in Figure 1.
Again among nonelderly adults at three differing thresholds of family income as a percentage of the federal poverty level (less than 100% FPL, 100%-199% FPL, and 200%+ FPL), rates of uninsurance as well as public and private coverage remained statistically unchanged in Q3 2021 from Q3 2020.
Looking at the below than 100% FPL category for nonelderly adults from July-September 2021, 21.7% were uninsured, 52.3% had public coverage, and 27.2% had private coverage. These rates were 28.6%, 51.3%, and 22.3%, respectively in 2020 (Figure 2).
COVID-19 and Cautions for 2020 NHIS Estimates
As has been extensively documented in reports from both SHADAC and NCHS, COVID-19 caused numerous disruptions to federal survey data collection and production efforts. For the NHIS in particular, personal visits were suspended beginning on March 19, 2020, and data collection in late Q1 and for all of Q2 in 2020 switched to a telephone-only mode. Personal visits (with telephone attempts first) resumed in all areas in September 2020.
Data collection methodologies were not the only casualty of the pandemic, however. While the initial NCHS report examined preliminary nonresponse bias in Q1 and Q2 of 2020, the same team published a follow-up report in September 2021 looking at effects of the pandemic on estimates for the entire year, including July to December 2020. Though in-person operations resumed, lingering concerns about low response rates and possible loss of coverage caused survey conductors to replace approximately half of the usual sample for the last 5 months of 2020 with a longitudinal component where a subset of the 2019 sample adults were re-interviewed over the telephone using the 2020 NHIS questionnaire. This process change means that comparisons between estimates from July–December 2020 and other time periods may be impacted by these differences in survey mode and methodology.
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 2021 estimates discussed in this blog are only from Q3 (July-September) as well as the same period in 2020.
Differences described in this post are statistically significant at the 95% confidence level unless otherwise specified.
Cohen, R.A. & Cha, A.E. (2022, January 19). Health Insurance Coverage: Early Release of Quarterly Estimates from the National Health Interview Survey, July 2020–September 2021. National Center for Health Statistics (NCHS). https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201902.pdf.
Dahlhamer, J.M., Bramlett, M.D., Maitland, A., & Blumberg, S.J. (February 2021). Preliminary evaluation of nonresponse bias due to the COVID-19 pandemic on National Health Interview Survey estimates, April-June 2020. National Center for Health Statistics (NCHS). https://www.cdc.gov/nchs/data/nhis/earlyrelease/nonresponse202102-508.pdf
Bramlett, M.D., Dahlhamer, J.M., & Bose, J. (September 2021). Weighting procedures and bias assessment for the 2020 National Health Interview Survey. National Center for Health Statistics (NCHS). https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2020/nonresponse-report-508.pdf