SHADAC Expertise

Health Coverage and Access to Care

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.

Related SHADAC work
Click on any title below to learn more about the project.

Minnesota’s Community and Uninsured Profile

The Community and Uninsured Profile provides rates and counts of Minnesotans at a range of geographic levels using data from the American Community Survey (ACS). This resource was originally developed as part of “Minnesota’s Uninsured and the Communities in Which They Live,” a project funded by the Blue Cross Blue Shield Foundation of Minnesota that supports targeted outreach and enrollment activities of health insurance navigators and provides information about the uninsured to Minnesota policymakers as they develop strategies to reach the remaining uninsured in Minnesota. Users can explore characteristics of the total population and the uninsured population in a specific ZIP code while also overlaying in-depth community characteristics. In addition, users can look at rates and characteristics of the community and uninsured within the state as a whole, by region, county, and state legislative district. Users can also filter by MNsure rating areas -- the geographic regions health insurers use to set premiums on MNsure.

Examining Gender-Based Discrimination in Health Care Access by Gender Identity in Minnesota

The biennial 2021 Minnesota Health Access Survey (MNHA) asked respondents how often their gender, sexual orientation, gender identity, or gender expression causes health care providers to treat them unfairly. We compared rates of gender-based discrimination and health care access in the Minnesota adult population and examined differences in access to care among cisgender (cis) and gender minorities who report gender-based discrimination (see Definition Box). We explored the impact of gender-based discrimination on health care access by comparing access rates among people who did and did not experience discrimination for cis men, cis women, transgender and non-binary populations in Minnesota. 

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.

Minnesota Health Access (MNHA) Survey

The Minnesota Health Access (MNHA) Survey, conducted collaboratively between SHADAC and the Minnesota Department of Health (MDH), is a large-scale telephone and mail survey that collects information on the health of Minnesotans and how they access health insurance and health care services. The survey is conducted every two years and results are presented in a follow-up report from MDH.

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.

SHADAC Expertise

Federal Survey Data Release Schedule

American Community Survey (ACS

An ongoing general household survey conducted by the U.S. Census Bureau provides annual estimates of health insurance coverage at the national, state, and sub-state geographies.  For a full range of available products from SHADAC’s coverage of the 2022 health insurance data release (2021 estimates) click here.

September 14, 2023
• 2022 ACS 1-year data file


January 2023
​• 2017-2021 5-Year Public Use Microdata Sample (PUMS) file

October 2022
• 2021 ACS 1-Year Public Use Microdata Sample (PUMS) file

September 2022
• 2021 ACS 1-year data file (i.e., on

Other Resources
• An Assessment of the COVID-19 Pandemic’s Impact on the 2020 ACS 1-Year Data Analytic Paper
• Introduction to the American Community Survey Public Use Microdata Sample (PUMS) file

Current Population Survey (CPS)

A monthly household survey conducted by the U.S. Census Bureau for the Bureau of Labor Statistics. Data on income and health insurance coverage is collected in its Annual Social and Economic Supplement administered in February through April. Annual health insurance estimates are provided for the nation and states. 


September 12, 2023
• 2022 Income, Poverty and Health Insurance statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC)


September 2022
• 2021 Income, Poverty and Health Insurance statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC)

Medical Expenditure Panel Survey (MEPS

MEPS is a two-component survey sponsored by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality. The MEPS-Insurance Component (IC) is a survey of employers that provide data on employer-based health insurance. The MEPS-Household Component (HC) is a panel household survey that is supplemented with data from the respondents' medical providers.



July 2023
2022 MEPS-IC Private Sector Tables - National Estimates
• 2022 MEPS-IC Private Sector Tables - State Estimates
• 2022 MEPS-IC Private Sector Tables -Metro Estimates

National Health Interview Survey (NHIS)

A continuous cross-sectional household interview survey conducted by the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). It provides information on the health of the U.S. population and includes questions about health insurance coverage, health care utilization and access, and health conditions and behaviors, in addition to demographic and socioeconomic characteristics. 


Estimates for sub-annual time periods are released through the NHIS Early Release Program in September, November/December, and February/March each year.


June 2023
• 2022 NHIS Public Use Files

May 2022
• Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2021

Behavioral Risk Factor Surveillance System (BRFSS)

A state-based survey sponsored by the Centers for Disease Control and Prevention that focuses on population health, risk factors, and health behaviors for the adult population. 


August 2023
2022 Annual Survey Data 

Household Pulse Survey

A near-real-time experimental survey from the U.S. Census Bureau. Typically released on a monthly basis.

Note: Based on previous data release calendars. 

Page last updated September 2023