Blog & News
Understanding the New CPS Processing System and New 2018 Health Insurance Coverage Estimates
November 01, 2022:On Tuesday, September 10th, the U.S. Census Bureau released estimates of income, poverty, and health insurance coverage for 2018 from two large-scale federal data surveys conducted annually and administered by the Bureau: the American Community Survey (ACS) and the Current Population Survey Annual Social and Economic Supplement (CPS ASEC). The CPS ASEC is a key source of data on poverty, health insurance coverage, health status, and medical out-of-pocket spending, in addition to a range of other economic and demographic characteristics for the United States population. For information on the ACS estimates see the recently published blog, “National Uninsurance Increased alongside Eight States; Three States Saw Decreases.”
The 2019 CPS ASEC (2018 calendar year estimates) is the first release of a “Production File” to feature a new data processing system that takes into account changes made to the health insurance questions in the 2014 CPS ASEC redesign. Changes include the addition of new variables related to types of coverage that a person held at the time of interview, Marketplace coverage, and sub-annual coverage.[1] For a detailed discussion of these changes, please see several papers produced by the Census Bureau that are available here. This blog briefly discusses the implication of the new processing system on the ability to trend estimates of health insurance coverage.
According to Census, health insurance estimates created using the new processing system should not be compared with estimates produced using the old processing system.1 Currently, the Census Bureau has released three files that that were produced using the new processing system: the 2017 CPS ASEC Research File, the 2018 CPS ASEC Bridge File, and the 2019 CPS ASEC Production File. The Census Bureau publication released this past week—“Health Insurance Coverage in the United States, 2018”—compares the calendar year 2018 health insurance estimates from the 2019 CPS ASEC Production File with the calendar year 2017 estimates from the 2018 Bridge File because both of these files use the new processing system.
The table below illustrates the importance of distinguishing between estimates of health insurance coverage produced by the old versus the new processing system.
Sources: The uninsurance estimates are from “Health Insurance Coverage in the United States, 2018” and “Health Insurance Coverage in the United States, 2017”.
For example, when comparing estimates of the 2017 national uninsured rate, the old processing system (2018 Production File) produces an estimate of 8.8 percent, while the new processing system (2018 Bridge File) produces an estimate of 7.9 percent, nearly a whole percentage point lower. When examining changes in the uninsured rate between 2017 and 2018, the Census Bureau uses the 2017 estimate from the 2018 Bridge File (7.9 percent), created using the new processing system, to compare against the 2018 estimate from the 2019 Production File (8.5 percent), also created using the new processing system.
Using only estimates from data produced by the new processing system thus allows for a true apples-to-apples comparison.
[1] Notes.
New variables: The Research and Bridge Files and the 2019 CPS ASEC contain several additional variables based on new content added to the survey, including variables related to Marketplace-purchased individual coverage (i.e., if coverage was purchased from Marketplace and if the individual received a tax subsidy), concurrent coverage, and variables based on alternative definitions of medical out-of-pocket expenditures.
Sub-annual coverage: Sub-annual coverage variables (i.e., if a person was covered for none, some, or all of the previous calendar year) are available for any coverage, private coverage, government coverage, and Medicaid coverage. Sub-annual coverage data are used to determine if a person had any coverage during the calendar year. Berchick, E.R., Barnett, J.C., and Upton, R.D. (2019). Health Insurance Coverage in the United States, 2018 [Report P60-267]. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf
Blog & News
2018 ACS: National Uninsurance Increased alongside Eight States; Three States Saw Decreases (Infographic)
September 10, 2019:New health insurance coverage estimates from the U.S. Census Bureau’s American Community Survey (ACS) show that the rate of uninsured individuals in the United States increased by 0.1 percentage points in 2018, representing 535,000 more Americans without health insurance coverage as compared to 2017. Rates of uninsurance also increased significantly in eight states, and rates decreased significantly in just three states.
Changes in Uninsurance from 2017 to 2018
Nationally, uninsurance increased from 8.7 percent to 8.9 percent from 2017 to 2018, according to new estimates from the ACS.
Eight states saw significant increases in uninsurance from 2017 to 2018, including Alabama, Arizona, Idaho, Michigan, Ohio, Tennessee, Texas, and Washington (Table 1). Among these states, Idaho saw the largest increase in uninsurance, at 1.0 percentage points.
Michigan and Washington experienced the smallest increases in uninsurance, at 0.2 and 0.3 percentage points. 2018 increases in uninsurance in Ohio and Tennessee follow previous increases in uninsurance in these states from 2016 to 2017.
State | 2017 Percent Uninsured | 2018 Percent Uninsured |
Percentage-Point Change, 2017-2018* |
Idaho | 10.1 | 11.1 | 1.0 |
Alabama | 9.4 | 10.0 | 0.6 |
Tennessee | 9.5 | 10.1 | 0.6 |
Arizona | 10.1 | 10.6 | 0.6 |
Ohio | 6.0 | 6.5 | 0.5 |
Texas | 17.3 | 17.7 | 0.4 |
Washington | 6.1 | 6.4 | 0.3 |
Michigan | 5.2 | 5.4 | 0.2 |
United States | 8.7 | 8.9 | 0.1 |
New York | 5.7 | 5.4 | -0.3 |
South Carolina | 11.0 | 10.5 | -0.5 |
Wyoming | 12.3 | 10.5 | -1.8 |
*Differences are calculated with unrounded numbers, which may produce different results from using the rounded values in the table.
Source. U.S. Census Bureau analysis of the American Community Survey. Health Insurance Coverage in the United States: 2018 [Report P60-267]. Table 6: Percentage of People Without Health Insurance Coverage by State: 2017 and 2018 [Excel file]. Retrieved from https://www.census.gov/data/tables/2019/demo/health-insurance/p60-267.html
Three states—New York, South Carolina, and Wyoming—each experienced statistically significant decreases in uninsurance from 2017 to 2018.
Of these states, Wyoming saw the largest drop in uninsurance at 1.8 percentage points. South Carolina also experienced a 0.5 percentage-point drop in uninsurance from 11.0 percent to 10.5 percent, reversing the significant increase experienced by the state from 2016 (10.0 percent) to 2017 (11.0 percent). New York also experienced a slightly smaller decrease of 0.3 percentage points in uninsured rates, from 5.7 percent in 2017 to 5.4 percent in 2018.
Uninsurance Levels in 2018
Texas continued to have the highest uninsured rate in 2018 at 17.7 percent—a 0.4 percentage-point increase from 17.3 percent in 2017.
The state with the lowest uninsured rate for 2018 was again Massachusetts, holding steady at 2.8 percent.
Among states that expanded Medicaid, Arizona, Michigan, Ohio, and Washington, saw increases in uninsurance, while only New York saw a decrease. State-level uninsured rates among expansion states ranged from a low of 2.8 percent in Massachusetts to a high of 12.6 percent in Alaska.
Overall, among states that did not expand Medicaid, Alabama, Idaho, Texas, and Tennessee each experienced an increase in uninsurance, while South Carolina and Wyoming experienced significant decreases. Individual state uninsured rates among non-expansion states ranged from a low of 5.5 percent in Wisconsin to a high of 17.7 percent in Texas.
SHADAC and Census Bureau Experts Will Share Insights during October 1st Webinar
On Tuesday, October 1st at 12:00 PM Central Time (1:00 PM Eastern), SHADAC will host a webinar to examine the new 2018 ACS and CPS estimates, with technical insight provided by researchers from SHADAC and from the U.S. Census Bureau, which administers both surveys.
Speakers will discuss the new national and state-level estimates, and attendees will learn:
- When to use which estimates from which survey
- How to access the estimates via Census reports and the new data.census.gov site
- How to access state-level estimates from the ACS using SHADAC tables
Attendees will have an opportunity to ask questions after the speaker presentations.
Notes
All differences described here are significant at the 90% confidence level.
All estimates are from the 2017 and 2018 American Community Surveys, as published here: https://www.census.gov/data/tables/2019/demo/health-insurance/p60-267.html
Publication
October 1st Webinar - An Annual Conversation with the U.S. Census Bureau: New Coverage Data from the ACS & CPS on the New Site for Census Bureau Data
Date: October 1, 2019
Time: 12:00 p.m. - 1:00 p.m. Central / 1:00 p.m. - 2:00 p.m. Eastern
New 2018 data on health insurance coverage from the American Community Survey (ACS) show a nationwide increase in uninsurance from 8.7 percent in 2017 to 8.9 percent in 2018. State-level estimates within the ACS indicated uninsurance also grew significantly in eight states while decreasing significantly in just three.
SHADAC hosted a webinar on Tuesday, October 1st, examining the new 2018 health insurance coverage data from both the ACS and the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), along with additional national and state-level ACS estimates of health insurance by coverage type released on Thursday, September 26th and those yet to be released on Thursday, October 17th.
SHADAC researchers were joined by experts at the U.S. Census Bureau,
which administers both the ACS and the CPS, and attendees learned about:
The new 2018 national and state coverage estimates
When to use which estimates from which survey
How to access the estimates via Census reports and the new site: data.census.gov
How to access state-level estimates from the ACS using SHADAC tables
SHADAC researchers and Census experts also answered questions from attendees after the presentation.
Slides from the webinar, as well as a transcript, are available for download.
Event Resources
2018 ACS: National Uninsurance Increased alongside Eight States; Three States Saw Decreases (SHADAC Blog and Infographic)
2018 ACS: Private Coverage Changes Split Evenly among States, Public Coverage Changes Experience Greater Variability than in 2017 (SHADAC Blog and Infographic)
SHADAC's State Health Compare (Data Dissemination Site)
2017 ACS Tables: State and County Uninsured Rates, with Comparison Year 2016 (SHADAC Resource)
U.S. Census Bureau: Health Insurance (Data Dissemination Site)
U.S. Census Bureau Health Insurance (PDF Report)
U.S. Census Bureau Statistical Testing Tool
U.S. Census Bureau Explore Census Data (Data Dissemination Site)