CPS ASEC: 2021 National Health Insurance Coverage Estimates Show Falling Uninsured and Private Coverage Rates Across Population Demographics (Infographic)
September 13, 2022:
The U.S. Census Bureau has released an initial report detailing the state of health insurance coverage in the United States for 2021. Drawing on data from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), the report highlights good news overall as the percentage of the population without health insurance coverage at any point in 2021 fell to 8.3% from 8.6% in 2020—a decrease of 0.4 percentage points (PP) or approximately 1.1 million people (27.2 million in 2021 vs. 28.3 million in 2020).
While this year marks a return to a more standard release of health insurance coverage estimates after COVID-related factors impacted the release of 2020 from the CPS and, to a larger degree, the American Community Survey (ACS), the report did not include any state-level estimates from the ACS, as have been provided in past years. Instead, the Census Bureau plans to release all data relating to the ACS on Thursday, September 15, 2022.
The CPS ASEC does provide important breakdowns of available health insurance coverage estimates at the national level, including by age, race and ethnicity, immigration status, marital status, geographic region, employment, poverty status, and Medicaid expansion status.
The following blog and infographic explore changes in coverage rates by demographic for nonelderly adults (age 19-64) and for children (age 0-18), who experienced a greater number of changes in insurance coverage both overall and across categories than their adult counterparts.
Changes in Uninsurance by Age and Characteristics
Among nonelderly adults (age 19-64), the overall rate of uninsurance remained statistically unchanged from the previous year, reported at 11.6% in 2021 compared to 11.9% in 2020.
Comparatively, children (age 0-18) had an uninsured rate of 5.0% in 2021, a decrease from 5.6% the previous year.
Race and ethnicity
While uninsurance rates also remained unchanged across a number of racial and ethnic groups in 2021—7.5% for White adults, 7.7% for Asian adults, and 25.1% for Hispanic adults—the rate of uninsurance fell significantly among Black nonelderly adults, decreasing to 12.7% in 2021 from 14.2% in 2020.
Similarly, while uninsurance rates remained stable for children of several racial and ethnic groups in 2021—3.4% for White children and 8.6% for Hispanic children—the rate of uninsurance dropped significantly among Black children, falling to 4.3% in 2021 from 5.9% in 2020. Asian children, however, saw an increase in rates of uninsurance, rising to 4.6% in 2021 from 2.8% in 2020.
The rate of uninsurance among native-born nonelderly adults fell to 9.1% in 2021 from 9.6% in 2020, while the uninsurance rate among foreign-born adults remained statistically unchanged at 22.8% in 2021 compared to 22.9% in 2020.
Rates of uninsurance also fell among native-born children, decreasing to 4.5% in 2021 from 5.2% in 2020, while again, the uninsurance rate for foreign-born children was statistically unchanged at 18.6% in 2021.
When examining coverage by poverty level, rates of uninsurance among nonelderly adults were broadly unchanged for each measurable category: 24.0% among those with incomes below 100% poverty, 16.7% for those between 100%-399% poverty, and 4.5% for those living at or above 400% poverty.
In 2021, rates of uninsurance were unchanged for children in the two lower poverty level categories—8.3% for those in families with incomes below 100% poverty and 6.4% for those living in families with incomes between 100%-399% poverty. However, uninsured rates fell to 1.7% among children in families with incomes at or above 400% of poverty, a decrease of 0.4 PP from 2020.
Medicaid expansion status
As of January 1, 2021, 36 states and the District of Columbia have chosen to act on the option provided by the Affordable Care Act (ACA) and expand Medicaid eligibility requirements. Comparing rates of uninsurance by expansion and nonexpansion states revealed parallel trends for both nonelderly adults and children.
In 2021, the overall uninsured rate remained statistically unchanged from 2020 (9.0% in both years) for adults living in expansion states. However, uninsurance dropped from 17.7% in 2020 to 16.7% in 2021 for adults living in nonexpansion states.
Similarly, children in expansion states saw no change in uninsured rates for 2021 compared to 2020 (4.0% in both years). And again, uninsurance fell in nonexpansion states, falling to 7.1% in 2021 from 8.6% in 2020.
Other Notable Coverage Changes
Public and private coverage
Other notable overarching trends included a higher percentage of the population with public coverage, increasing 1.2 PP to 35.7% in 2021 from 34.5% in 2020, and a consequent decrease in the percentage of the population with private coverage, measuring at 66.0% in 2021, a decrease of 0.6 PP from 2020 (66.5%). The largest drivers of public and private coverage changes were a 0.9 PP increase in Medicaid coverage (18.9% in 2021, up from 17.9% in 2020) and a 0.2 PP drop in employment-based coverage (54.3% in 2021, down from 54.6% in 2020).
Of particular note in the report was a consistent correlation between poverty level for both adults and children and changes in rates of public and private insurance coverage between 2020 and 2021.
Rates of public coverage rose among adults in all poverty categories, increasing 2.4 PP to 51.8% among those with incomes below 100% of poverty, 0.8 PP to 25.4% for those between 100%-399% of poverty, and 0.5 PP to 5.7% among those living at or above 400% of poverty.
Rates of public coverage also increased by 2.0 PP to 44.2% among children in families with incomes between 100%-399% and by 1.2 PP to 7.2% for children in families at or above 400% of poverty. Rates of public coverage were unchanged among children below 100% of poverty (79.7%).
Looking at private coverage changes, uninsurance rates remained unchanged among adults in all poverty categories at 27.1%, 61.8%, and 91.8% for those with incomes below 100% of poverty, between 100%-399% of poverty, and at or above 400% of poverty, respectively.
Similarly, rates of private coverage were largely unchanged among children in families with incomes below 100% of poverty and those in families at or above 400% of poverty at 15.5% and 93.2%, respectively. Rates of private coverage did decrease in one category: children in families with incomes between 100%-399% of poverty, dropping by 1.5 PP to 53.4% in 2021.
Overall, rates of uninsurance fell amongst workers, decreasing to 10.7% in 2021 from 11.2% in 2020, driven by a decrease in adults who worked less than full-time year-round (15.1% in 2021 vs. 16.4% in 2020). Among those who worked full-time year-round, uninsurance did increase to 9.1% in 2021 from 8.4% in 2020, and among those who did not work in 2021, the rate of uninsurance remained unchanged at 14.8%.
Access the U.S. Census Bureau's "Health Insurance Coverage in the United States: 2021 - Current Population Reports".
Related Releases and Products
As previously mentioned, the Census Bureau will be releasing the full roster of 2021 estimates from the American Community Survey (ACS) on Thursday, September 15. SHADAC will be monitoring this release and providing updates, along with several blog posts analyzing the estimates, as soon as they are available.
In a follow-up to several blogs and reports released in 2021 that detailed the effects of COVID-19 on the 2020 CPS and ACS health insurance coverage data estimates, a new blog from the Census Bureau looks at the continuing impact of the pandemic on survey data collection and release processes and nonresponse bias.
Though data collection operations were mostly able to resume as normal, lower-than-usual response rates persisted into 2022, measuring at 72% compared to 76% in 2021. Prior to the pandemic (2018 and earlier), the CPS enjoyed some of the highest response rates across a number of federal surveys, consistently recording percentages in the high 80s and low 90s.
Additionally, the blog notes the continued presence of measurable nonresponse bias, particularly in categories of income statistics and poverty rates. While the CPS standard weighting methodology (described fully in the ASEC technical documentation) was able to account for differences in survey estimates and administrative data prior to 2019, figures in the blog show that both standard and even alternative weights employed by the Census Bureau have not been able to fully adjust for differences between respondents and nonrespondents since 2020, highlighting the fact that certain pandemic-era challenges still persist.
All changes are statistically significant at the 90 percent confidence level.
All estimates come from the 2021 and 2022 Current Population Survey Annual Social and Economic Supplement, which provide data for years 2020 and 2021, respectively.
Both the 2020 and 2021 estimates use 2020 Census-based population controls, meaning that estimates for 2020 listed in the current report may not always match those listed in the report published in September 2021, which used 2010 Census-based population controls.
Uninsured estimates represent individuals with no health insurance coverage for the entire calendar year.
Estimates of health insurance coverage type represent individuals with that type of coverage at any point during the calendar year. Types of health insurance coverage are not mutually exclusive.