Blog & News
California Achieves Lowest Uninsured Rate Ever in 2022 (Cross-Post)
November 13, 2023:The following blog is cross-posted from The California Health Care Foundation.
Author: Lacey Hartman, Senior Research Fellow, SHADAC
Maintaining Gains Hinges on Transitioning People Who Lose Medi-Cal to Other Coverage in Coming Months
The share of Californians under age 65 (“nonelderly”) without health insurance reached a historic low in 2022. Based on the most recent California Health Interview Survey (CHIS), the percentage of nonelderly Californians without health insurance dropped to 6.2% in 2022, a statistically significant decline from 2021 (7.4%). The rate of nonelderly people without coverage for a year or more also reached a historic low in 2022. Commonly called the “long-term uninsured,” their rate dropped from 5.7% in 2021 to 4.5% in 2022, another statistically significant decline.
Disparities in Coverage by Race and Ethnicity Narrow, but Inequities Persist
California’s Latino/x population experienced the largest improvement in coverage between 2021 and 2022; the share who reported being uninsured at the time of the survey dropped from 11.4% in 2021 to 9.1% in 2022, a change that was statistically significant. The Latino/x rate in 2022 also represents a historic low for this group.
The uninsured rate for White Californians also declined by a statistically significant but smaller amount, from 3.6% to 2.8%. There were no other statistically significant changes between 2021 and 2022 by race/ethnicity. Although there have been important gains in narrowing disparities in coverage by race and ethnicity in the state, Latino/x Californians continue to be uninsured at rates triple that of their White counterparts. Black and Asian Californians are uninsured at twice the rate of White Californians. Due to small sample sizes for American Indians and Native Hawaiian / Pacific Islanders in the survey, it was not possible to produce reliable uninsured rates for those groups.
Discussion
The fact that fewer nonelderly Californians were without coverage in 2022 than ever before is clearly good news. However, in 2023, the federal continuous coverage requirement for Medicaid came to an end. It’s estimated that as many as 2–3 million Californians may leave Medi-Cal as a result. How many Californians ultimately lose their Medi-Cal coverage and whether those leaving the program get connected to other coverage will have a huge impact on the state’s uninsured rate going forward.
These issues — as well as other challenges, such as inflation — may make holding onto California’s coverage gains difficult in the coming years. It will be vital to continue monitoring data from 2023 and future years to fully understand the impact of the pandemic — and the end of associated coverage protections, as well as other policy changes — on California’s health coverage landscape.
Blog & News
2022 ACS Tables: State and County Uninsured Rates, with Comparison Year 2021
November 17, 2023:Each year, SHADAC uses data released from the American Community Survey (ACS) via the U.S. Census Bureau's data.census.gov tool to produce estimates of uninsurance at the state and county level.*
Click on a state below in the interactive map to see a PDF table of uninsured rates by state and sub-state geographies, but also by demographic characteristics (e.g., age, race/ethnicity, and poverty level) for 2022 and comparison year 2021.
Click here to view uninsurance estimates for the United States.
Click here to view uninsurance estimates for Puerto Rico and its municipios.
Note: These tables present uninsured rates, which indicate the share of the population that is uninsured. For example, a 10 percent uninsured rate for adult women indicates that 10 percent of all adult women are uninsured.
Maps & Tables of Private, Public, & Uninsured Changes from 2021 to 2022
- Private Coverage Rates by State, Change from 2021 to 2022, for All People
- Public Coverage Rates by State, Change from 2021 to 2022, for All People
- Uninsurance Rates by State, Change from 2021 to 2022, for All People
About the ACS
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million U.S. households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates.
The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.
*Why Aren’t Estimates Provided for All Counties?
Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
How Are These Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for State Health Compare. The definitional differences are as follows:
Family
The Census Bureau defines a family as “all related people in a household.”
SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
To learn more about the 2020 update of SHADAC's Health Insurance Unit (HIU) see our HIU resource page, which houses two issue briefs: The first describes the SHADAC HIU, its purpose, the most recent update, and improvements to HIU data inputs; and the second outlines the impacts of using the SHADAC HIU in analysis so that researchers can assess whether the SHADAC HIU is suitable for their research and what the potential impacts of its use might be. The page also provides a link to STATA and SAS codes to aid in the use of the HIU variable.
Family Income
The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guidelines (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
To learn more about the difference between FPL and FPG, read our updated blog post from April 2023.
Related ACS Materials:
- An Annual Conversation with the U.S. Census Bureau: 2022 Health Insurance Coverage Estimates from the ACS and CPS
- 2022 ACS: Declining Uninsured Rates for the U.S. and States are Supported by Private and Public Coverage Increases
- CPS ASEC: 2022 National Health Insurance Coverage Estimates Show Falling Rates of Uninsurance and Direct-Purchase Coverage (Infographic)
Publication
An Annual Conversation with the U.S. Census Bureau: 2022 Health Insurance Coverage Estimates from the ACS and CPS
On Thursday, September 28th at 1:00 PM CST, SHADAC hosted a webinar covering the release of new 2022 health insurance coverage estimates from two key, large-scale federal data sources: The American Community Survey (ACS) and the Current Population Survey (CPS).
Estimates from both surveys were presented at: the national and state levels, as well as by coverage type, and a range of other demographic categories (age, geography, poverty level, and more), during the webinar. Technical and analytic insight was provided from experts at the U.S. Census Bureau, which administers both the ACS and CPS, and SHADAC researchers joined with our special guests from the Census Bureau to answer questions from attendees after the presentation.
Attendees were able to learn about:
- New 2022 health insurance coverage estimates
- When to use which estimates from the ACS vs the CPS
- How to access the estimates via Census reports and the data.census.gov website
- How to access state-level estimates from the ACS using SHADAC tables and State Health Compare web tool
Speakers
Kathleen T. Call, Moderator
Principal Investigator
SHADAC Dr. Call has been an Investigator with SHADAC since its launch in 2001. She is also a Professor in the Division of Health Policy and Management at the University of Minnesota (UMN), School of Public Health (SPH). She demonstrates her commitment to community-engaged scholarship through her leadership in the Clinical and Translational Science Institute, and the Interdisciplinary Research Leaders (IRL) program, and by co-chairing the UMN, SPH Health Equity Work Group.
|
Katherine Keisler-Starkey, Speaker Economist in Health and Disability Statistics Branch United States Census Bureau Katherine Keisler-Starkey is an economist in the Health and Disability Statistics Branch in the U.S. Census Bureau’s Social, Economic and Housing Statistics Division. In her position, Ms. Starkey provides subject matter expertise on health topics for the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and has authored the Census Bureau’s Health Insurance Coverage in the United States report for the last four years. Her research interests focus on Applied Microeconomics, including Health Economics, Public Finance, and Labor Economics, and she is the author of several topically focused Census working papers and blogs in these areas. |
Robert Hest, Speaker
Senior Research Fellow
SHADAC Robert Hest joined SHADAC in 2017 and was recently made Senior Research Fellow. Mr. Hest provides expertise in survey data, data analysis and processing, and project management. Mr. Hest also manages SHADAC’s State Health Compare website, coordinating data processing, quality assurance, dissemination, and documentation of data.
|
Sharon Stern, Speaker
Assistant Division Chief
United States Census Bureau Sharon Stern is the Assistant Division Chief for employment characteristics in the U.S. Census Bureau’s Social, Economic and Housing Statistics Division. In her position, Ms. Stern oversees statistics on the labor force, health insurance and disability from several Census Bureau surveys. She has authored a wide variety of Census Bureau reports and papers on topics related to poverty, disability, and health insurance.
|
Related Resources
SHADAC
- Webinar slides from SHADAC
- CPS ASEC: 2022 National Health Insurance Coverage Estimates Show Falling Rates of Uninsurance and Direct-Purchase Coverage (Infographic) (Blog)
- 2022 ACS: Declining Uninsured Rates for the U.S. and States are Supported by Private and Public Coverage Increases (Blog)
U.S. Census Bureau
- Webinar slides from Census Bureau
- Health Insurance Coverage in the United States: 2022 (Report)
- Health Insurance Coverage of U.S. Workers Increased in 2022: Health Insurance Rates for Working-Age Adults Higher by Race, Hispanic Origin, Region (Blog)
- Uninsured Rates Decreased in Over Half of U.S. States in 2022: Changes in Types of Health Insurance Coverage Contributed to Declines in Uninsured Rates From 2021 to 2022 (Blog)