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Census Bureau: 'Health Insurance Coverage U.S. – 2021' – Insurance News Net

WASHINGTON, Sept. 16 (TNSrep) — The U.S. Census Bureau issued the following report (No. P60-278) by Katherine Keisler-Starkey and Lisa N. Bunch entitled “Health Insurance Coverage in the U.S.: 2021.”
Here are excerpts:
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Contents
Introduction … 1
What Is Health Insurance Coverage? … 1
Highlights … 2
Estimates of Health Insurance Coverage in the United States … 2
Health Insurance Coverage by Type and Selected Characteristics … 3
Health Insurance Coverage by Age … 3
Private Coverage … 5
Public Coverage … 5
Uninsured Rates for Children and Working-Age Adults by Selected Characteristics … 7
Children Under Age 19 … 7
Working-Age Adults 19 to 64 Years Old … 7
Public and Private Health Insurance Coverage by Selected Characteristics … 10
Public and Private Health Insurance Coverage by Age Categories … 10
Public and Private Health Insurance Coverage by Social and Demographic Characteristics … 12
Summary … 14
Additional Information About Health Insurance Coverage … 14
State and Local Estimates of Health Insurance Coverage … 14
Additional data … 14
Data.census.gov … 15
Public-Use Microdata … 15
Census Data API … 15
Source and Accuracy of the Estimates … 15
Comments … 16
Endnotes … 16
TABLE
Table 1. Number and Percentage of People by Health Insurance Coverage Status and Type: 2020 to 2021 … 4
FIGURES
Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2020 to 2021 … 3
Figure 2. Percentage of People Uninsured by Age Group: 2020 and 2021 … 5
Figure 3. Percentage of People With Selected Coverage Types and Uninsured by Age Group: 2020 and 2021 … 6
Figure 4. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2020 and 2021 … 8
Figure 5. Percentage of Working-Age Adults Without Health Insurance Coverage by Selected Characteristics: 2020 and 2021 … 9
Figure 6. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2020 and 2021 … 10
Figure 7. Health Insurance by Type and Income-to-Poverty Ratio for Children Under the Age of 19 and Adults Aged 19 to 64: 2020 and 2021 … 11
Figure 8. Health Insurance Coverage by Characteristics: 2020 and 2021 … 13
APPENDIXES
Appendix A. Effects of 2020 Census-Based Population Controls on 2020 Health Insurance Coverage Estimates … 19
Endnotes … 19
Appendix B. Estimates of Health Insurance Coverage: 2013 to 2021 … 23
Survey Redesign … 23
Recent Changes in the Health Insurance Landscape … 23
Estimates of Health Insurance Coverage: 2013 to 2021 … 24
Uninsured Rate … 24
Private Health Insurance Coverage … 25
Public Health Insurance Coverage … 26
Endnotes … 27
Appendix C … 29
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INTRODUCTION
Health insurance offers a means for financing a person’s health care expenses. Health insurance coverage provides access to medical care, protection from high unexpected costs, and more economic stability for people and families. While the majority of people have private health insurance, primarily through an employer, others obtain coverage through programs offered by the government. Other individuals do not have health insurance coverage at all (refer to the “What Is Health Insurance Coverage?” text box).
Year-to-year, the rate of health insurance coverage and the distribution of coverage types may change due to economic trends, shifts in the demographic composition of the population such as population aging, and policy changes that affect access to care. Economic changes include job losses associated with the COVID-19 pandemic and related recession in 2020 and the subsequent employment gains occurring with economic recovery in 2021. Recent policy changes include increased federal funding for Medicaid in response to the COVID-19 pandemic. Specifically, Congress extended mandated continuous coverage for those with Medicaid for the duration of the pandemic and introduced additional measures to increase access to care by reducing the cost of coverage./1
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What Is Health Insurance Coverage?
Health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) refers to comprehensive coverage at any time during the calendar year for the civilian, noninstitutionalized population of the United States.* For reporting purposes, the U.S. Census Bureau broadly classifies health insurance coverage as private insurance or public insurance.
Private Coverage
* Employment-based: Plan provided through an employer or union.
* Direct-purchase: Coverage purchased directly from an insurance company, or through a federal or state Marketplace (e.g., healthcare.gov).
* TRICARE: Coverage through TRICARE, formerly known as Civilian Health and Medical Program of the Uniformed Services.
Public Coverage
* Medicare: Federal program that helps to pay health care costs for people aged 65 and older and for certain people under age 65 with long-term disabilities.
* Medicaid: This report uses the term Medicaid to include the specific Medicaid government program and other programs for low-income individuals administered by the states such as Children’s Health Insurance Program (CHIP) and Basic Health Programs.
* CHAMPVA and VA: Civilian Health and Medical Program of the Department of Veterans Affairs, as well as care provided by the Department of Veterans Affairs and the military.
Additionally, people are considered uninsured if they only had coverage through the Indian Health Service (IHS), as IHS coverage is not considered comprehensive.
* Comprehensive health insurance covers basic health care needs. This definition excludes single service plans such as accident, disability, dental, vision, or prescription medicine plans.
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This report presents statistics on health insurance coverage in the United States in 2021 and changes in health insurance coverage rates between 2020 and 2021. The statistics in this report are based on information collected by the Current Population Survey Annual Social and Economic Supplement (CPS ASEC).* Estimates for 2020 in this report will not match those published last year due to the implementation of the 2020 Census-based population controls. Appendix A provides details.
The CPS is the longest-running household survey conducted by the U.S. Census Bureau. The key purpose of the CPS ASEC is to provide timely and detailed estimates of economic wellbeing, of which health insurance is an important part. The Census Bureau has integrated improvements to the CPS ASEC as the needs of data users and the health insurance environment have changed. For information on changes to the CPS ASEC over time and 2021 health insurance coverage estimates in the context of a longer time frame, refer to Appendix B.
The 2021 estimates highlighted in this report are based on responses collected from February 2022 to April 2022. Respondents were asked to report any health insurance coverage they had during the previous calendar year. People are only considered uninsured if they had no coverage at any time during the year./2
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* The Census Bureau reviewed this data product for unauthorized disclosure of confidential information and approved the disclosure avoidance practices applied to this release. CBDRB-FY22-355. All comparative statements have undergone statistical testing and are statistically significant at the 90 percent confidence level unless otherwise noted.
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Highlights
* More people were insured in 2021 than 2020. In 2021, 8.3 percent of people, or 27.2 million, did not have health insurance at any point during the year, representing a decrease in the uninsured rate and number of uninsured from 2020 (8.6 percent or 28.3 million) (Table 1).
* In 2021, private health insurance coverage continued to be more prevalent than public coverage, at 66.0 percent and 35.7 percent, respectively./3
* Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 54.3 percent of the population for some or all of the calendar year, followed by Medicaid (18.9 percent), Medicare (18.4 percent), direct-purchase coverage (10.2 percent), TRICARE (2.5 percent), and VA and CHAMPVA coverage (1.0 percent) (Table 1 and Figure 1)./4
* Overall, public coverage increased between 2020 and 2021. In 2021, 35.7 percent of people held public coverage for some or all of the year, marking a 1.2 percentage-point increase from 2020.
* Between 2020 and 2021, the rate of Medicaid coverage increased by 0.9 percentage points to cover 18.9 percent of people (Table 1 and Figure 1)./5
* The uninsured rate among children under the age of 19 decreased 0.6 percentage points to 5.0 percent between 2020 and 2021, driven in part by an increase in public coverage (Figure 2).
* In 2021, 7.9 percent of fulltime, year-round workers had public health insurance, up 1.8 percentage points from 2020. Among less than fulltime, year-round workers, the percentage with public coverage increased 1.6 percentage points to 22.6 percent during this period (Figure 8).
ESTIMATES OF HEALTH INSURANCE COVERAGE IN THE UNITED STATES
This report classifies health insurance coverage into three different groups: overall coverage, private coverage, and public coverage (refer to the “What Is Health Insurance Coverage?” text box). In the CPS ASEC, people are considered to be insured if they were covered by any type of health insurance for part or all of the previous calendar year. People are considered uninsured if, for the entire year, they were not covered by any type of insurance./6
In 2021, most people (91.7 percent) had health insurance coverage at some point during the calendar year (Table 1 and Figure 1). That is, 8.3 percent of people were uninsured for the entire calendar year. More people had private health insurance (66.0 percent) than public coverage (35.7 percent).
Employer-based insurance was the most common subtype of health insurance in the civilian, noninstitutionalized population (54.3 percent), followed by Medicaid (18.9 percent), Medicare U.S. Census Bureau Health Insurance Coverage in the United States: 2021 3 (18.4 percent), direct-purchase insurance (10.2 percent), TRICARE (2.5 percent), and VA and CHAMPVA health care (1.0 percent) (Table 1).
The percentage of people covered by any type of health insurance in 2021 was higher than in 2020. The percentage of people covered by public health insurance increased by 1.2 percentage points between 2020 and 2021, offsetting the 0.6 percentage-point decrease in private coverage over the same period.
Of the subtypes of private health insurance, employment-based coverage and direct-purchase insurance did not statistically change between 2020 and 2021. The percentage of people covered by TRICARE decreased to 2.5 percent between 2020 and 2021./7,/8
Of the three subtypes of public health insurance, both Medicare and Medicaid rates increased between 2020 and 2021, while the VA and CHAMPVA rate did not have any significant change. The rate of Medicaid coverage increased by 0.9 percentage points to 18.9 percent in 2021. The percentage of people covered by Medicare increased by 0.5 percentage points to 18.4 percent in 2021. This increase was in part due to growth in the number of people aged 65 and over./9
HEALTH INSURANCE COVERAGE BY TYPE AND SELECTED CHARACTERISTICS
Health Insurance Coverage by Age
Age is associated with the likelihood that a person has health insurance coverage, as well as with health coverage type. Older adults (aged 65 and over) and children (under the age of 19) are more likely to have health insurance coverage than those aged 19 to 64, in part because their age makes them eligible for certain public health insurance programs. Medicare provides health coverage benefits for most adults aged 65 and older. Children and young adults may receive coverage through a parent or guardian’s plan up to the age of 26, and children under the age of 19 may qualify for coverage through Medicaid or the Children’s Health Insurance Program (CHIP)./10
Between 2020 and 2021, there was a 0.6 percentage-point decrease in the uninsured rate for children under age 19. In 2020, 5.6 percent of children were uninsured for the entire calendar year, while in 2021 the uninsured rate for children under age 19 fell to 5.0 percent. For all other age groups, there were no significant changes in the uninsured rate between 2020 and 2021 (Figure 2). There were differences in the uninsured rate between age groups in 2021. For working-age adults, 14.9 percent of those aged 19 to 25 were uninsured for the entire calendar year of 2021, followed by those aged 26 to 34 (13.5 percent), adults aged 35 to 44 (11.9 percent), and those aged 45 to 64 (9.4 percent) (Figure 2). In 2021, 1.2 percent of adults aged 65 and older were uninsured for the entire calendar year. For adults, the uninsured rate decreases as age increases.
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Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2020 to 2021
Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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Table 1. Number and Percentage of People by Health Insurance Coverage Status and Type: 2020 to 2021
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements(CPS ASEC).
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Figure 2. Percentage of People Uninsured by Age Group: 2020 and 2021
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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Private Coverage
Private coverage rates varied by broad age groups (Figure 3). For example, the percentage of working-age adults aged 19 to 64 covered by private coverage was 72.5 percent, compared with 61.9 percent of children under age 19 and 48.7 percent of those aged 65 and older in 2021. Among adults aged 19 to 64 with private coverage, most people had employment-based coverage (62.9 percent of all adults aged 19 to 64). About 24.4 percent of adults aged 65 and older had employment-based coverage, and 21.9 percent held coverage they purchased directly./11
Between 2020 and 2021, there was no statistical change in private coverage or private coverage subtypes such as employment-based or direct-purchase for most broad age groups. Among those aged 65 and older, however, the percentage of people with direct-purchase coverage decreased by 1.4 percentage points to 21.9 percent.
Public Coverage
In 2021, more than one-third of children under age 19 had public health coverage, compared with 18.7 percent of adults aged 19 to 64. Most adults aged 65 and older (93.5 percent) held public coverage. Among children under age 19, most of those with public health insurance were covered through Medicaid or CHIP (35.9 percent); among adults aged 65 and older, 93.4 percent were covered through the Medicare program. About 15.4 percent of working-age adults were covered through Medicaid, and 3.8 percent held Medicare.
Between 2020 and 2021, public coverage rates increased among children under age 19 and adults aged 19 to 64 by 1.3 percentage points and 0.9 percentage points, respectively./12
For these groups, this increase was driven by an increase in Medicaid coverage. Medicaid increased 1.2 percentage points for children under age 19 and 0.9 percentage points for working-age adults over this period. Medicaid also increased 1.1 percentage points for those aged 65 and older between 2020 and 2021./13
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Figure 3. Percentage of People With Selected Coverage Types and Uninsured by Age Group: 2020 and 2021
Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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UNINSURED RATES FOR CHILDREN AND WORKINGAGE ADULTS BY SELECTED CHARACTERISTICS
As described above, most adults aged 65 and older were covered by health insurance, primarily through Medicare. Among children under age 19 and workingage adults aged 19 to 64, however, health insurance status varies across groups, and some groups may experience changes in coverage while others do not.
Children Under Age 19
Although the uninsured rate decreased by 0.6 percentage points for all children between 2020 and 2021, changes in health insurance coverage in 2021 among children under age 19 did not occur equally across groups (Figure 4). The percentage of non-Hispanic White children without health insurance coverage was not statistically different in 2021 compared with 2020. However, the uninsured rate decreased for Black children (by 1.6 percentage points) and increased for Asian children (by 1.8 percentage points) to 4.3 percent and 4.6 percent, respectively.14 In 2021, 8.6 percent of Hispanic children were uninsured, which is not statistically different from 2020./15,16,17
In 2021, 4.5 percent of native-born children were uninsured, representing a 0.7 percentage-point decrease compared to 2020./18
However, among foreign-born children, 18.6 percent were uninsured, including 5.2 percent of children who were naturalized citizens and 22.6 percent of children who were not citizens./19
Health insurance rates for children also varied by region./20
For example, 6.8 percent of children living in the South were uninsured in 2021, 0.9 percentage points lower than in 2020 (7.7 percent). The uninsured rates for children in the Northeast (3.0 percent), children in the Midwest (3.7 percent), and children in the West (4.7 percent) were not statistically different from 2020 and were lower than the uninsured rate for children in the South./21
The Patient Protection and Affordable Care Act (ACA) provides the option for states to expand Medicaid eligibility to people whose income-to-poverty ratio falls under a particular threshold. As of January 1, 2021, 36 states and the District of Columbia had expanded Medicaid eligibility requirements (“expansion states”). The remaining 14 states had not expanded Medicaid eligibility (“non-expansion states”). The uninsured rate for children living in non-expansion states decreased by 1.6 percentage points to 7.1 percent. The uninsured rate for children living in expansion states in 2021 (4.0 percent) was not statistically different from 2020.
Working-Age Adults 19 to 64 Years Old
Adults aged 19 to 64 may have different health insurance outcomes from other age groups because they do not qualify for programs such as CHIP, and only qualify for Medicare under limited circumstances. In 2021, 11.6 percent of adults aged 19 to 64 did not have health insurance coverage, which was not statistically different from 2020 (Figure 5). However, there were some differences between groups in these years.
The uninsured rate decreased by 1.6 percentage points for Black adults aged 19 to 64 between 2020 and 2021 to 12.7 percent. There was no significant change for White (7.5 percent), Asian (7.7 percent), or Hispanic (25.1 percent) adults in this age group (Figure 5)./22
There was also a significant decrease in the uninsured rate for native-born adults aged 19 to 64. In 2021, 9.1 percent of native-born adults aged 19 to 64 were uninsured, compared to 9.6 percent in 2020. There was no significant change in the uninsured rate for foreign-born adults aged 19 to 64 (22.8 percent) and no change in the uninsured rate for either naturalized citizens (10.3 percent) or noncitizens (33.1 percent).
For many adults aged 19 to 64, health insurance coverage is related to employment status, such as working full-time, year-round; working less than full-time, year-round; or not working at all. In 2021, 10.7 percent of workers were uninsured, representing a decline of 0.4 percentage points compared to 2020. Among fulltime, year-round workers aged 19 to 64, the uninsured rate rose by 0.6 percentage points to 9.1 percent. For adults aged 19 to 64 who worked less than full-time, year-round, the uninsured rate fell from 16.4 percent in 2020 to 15.1 percent in 2021./23 These differences may reflect changes in the composition of the labor force through the pandemic and economic recovery.
Marital status is related to health insurance coverage, as many married adults share their health plan. Among adults aged 19 to 64 in 2021, those who were married were less likely to be uninsured (8.1 percent) than separated adults (19.0 percent), never married adults (15.8 percent), divorced adults (12.5 percent), or widowed adults (12.3 percent)./24 Health insurance rates for adults aged 19 to 64 also varied by region. For example, 7.7 percent of adults living in the Midwest in 2021 were uninsured, a 0.9 percentage-point decrease from 2020./25 There were no significant changes in the uninsured rates for adults aged 19 to 64 in other regions./26
For adults aged 19 to 64, health insurance coverage may be related to both poverty status and whether or not they live in an expansion state./27 For example, uninsured rates were lower for all income-to-poverty groups in expansion states compared to uninsured rates in non-expansion states. In 2021, the uninsured rate for those in poverty in non-expansion states was 35.7 percent, compared to 17.2 percent in expansion states. For those in poverty in non-expansion states, the uninsured rate fell by 2.7 percentage points between 2020 and 2021. In contrast, there was no significant change in the uninsured rate for other income-to-poverty groups (Figure 6)./28
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Figure 4. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2020 and 2021
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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Figure 5. Percentage of Working-Age Adults Without Health Insurance Coverage by Selected Characteristics: 2020 and 2021
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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Figure 6. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2020 and 2021
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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PUBLIC AND PRIVATE HEALTH INSURANCE COVERAGE BY SELECTED CHARACTERISTICS
Public and Private Health Insurance Coverage by Age Categories
The CPS ASEC can also be used to look more closely at health insurance coverage by type for selected social and economic characteristics. Examining changes in health coverage by type also highlights how these changes affect the uninsured rate for different groups.
Health insurance coverage and type is associated with family income-to-poverty ratio, which provides a measure of a family’s economic resources. Family resources may determine the ability to afford private health insurance, and families below certain income-to-poverty thresholds may qualify for public health insurance options. Further, policies implemented in response to the COVID-19 pandemic may have increased access to and affordability of public and private health coverage.
As the income-to-poverty ratio increases, the percent uninsured declines for children under age 19 and working-age adults aged 19 to 64 (Figure 7). Among working-age adults, those living in poverty had the highest uninsured rate for the full calendar year (24.0 percent), while those living at or above 400 percent of the poverty line had the lowest uninsured rate for all of 2021 (4.5 percent).
Among children living in families below 100 percent of poverty and children living in families between 100 and 399 percent of poverty, there was no statistically significant change in the uninsured rate between 2020 and 2021 (Figure 7). In 2021, 8.3 percent of children living in families below 100 percent of poverty did not have health insurance at any time, and 6.4 percent of children living in families between 100 and 399 percent of poverty did not have health insurance. However, for children living in families at 400 percent of poverty or above, the uninsured rate decreased 0.4 percentage points to 1.7 percent in 2021./29 There was no significant change in the uninsured rate for adults aged 19 to 64 by income-to-poverty ratio or for children in other income-to-poverty groups (Figure 7).
For private insurance, 15.5 percent of children under age 19 and 27.1 percent of working-age adults living in poverty held private health coverage. Each group with a higher income-to-poverty ratio had a higher rate of private insurance. Those living at or above 400 percent of the poverty line were the most likely to have private health insurance (93.2 percent for children under age 19 and 91.8 percent for adults aged 19 to 64) (Figure 7). The rate of private coverage fell by 1.5 percentage points between 2020 and 2021 among children living in families between 100 and 399 of poverty./30 However, there was no statistical change in private coverage rates for other age and income-to-poverty groups.
In contrast, those living in poverty were the most likely to have public insurance (79.7 percent for children under age 19 and 51.8 percent for working-age adults aged 19 to 64), while those living at or above 400 percent of the poverty line were the least likely to have public health insurance (7.2 percent for children under age 19 and 5.7 percent for working-age adults). The percentage of people with public insurance decreases as the income-to-poverty ratio increases. Between 2020 and 2021, public coverage increased for people in most age and income-to-poverty categories. The public coverage rate was not statistically different between 2020 and 2021 for children in poverty./31
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Figure 7. Health Insurance by Type and Income-to-Poverty Ratio for Children Under the Age of 19 and Adults Aged 19 to 64: 2020 and 2021
Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC)
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PUBLIC AND PRIVATE HEALTH INSURANCE COVERAGE BY SOCIAL AND DEMOGRAPHIC CHARACTERISTICS
Differences in coverage type and changes in coverage can be seen across groups. For example, in 2021, Hispanic individuals had the highest uninsured rate (18.3 percent), followed by Black (9.0 percent), Asian (6.2 percent), and non-Hispanic White (5.2 percent) people (Appendix Table C-1).
Lower uninsured rates for non-Hispanic White and Asian individuals reflect higher private coverage rates./32 In 2021, non-Hispanic White individuals had the highest rate of private coverage (73.2 percent), followed by Asian (72.4 percent), Black (55.1 percent), and Hispanic individuals (48.8 percent) (Figure 8). Although there was no significant change in private coverage between 2020 and 2021 for Hispanic, Asian, and Black individuals, private coverage rates declined by 0.7 percentage points among non-Hispanic White individuals (Figure 8).
Between 2020 and 2021, most race and Hispanic origin groups saw an increase in public coverage rates. The increase in public coverage rates was similar for three groups. Non-Hispanic White individuals had public coverage increase 1.3 percentage points (to 34.6 percent), Black individuals had an increase of 1.4 percentage points (to 42.7 percent), and Hispanic individuals had an increase of 1.1 percentage points (to 37.0 percent). However, there was no significant change in public coverage rates for Asian individuals.
People in both expansion and non-expansion states also experienced an increase in public coverage rates between 2020 and 2021. Those in expansion states had a 1.4 percentage-point increase in public health insurance coverage (37.0 percent), while those in non-expansion states had a 1.0 percentage-point increase in public coverage (33.1 percent). Between 2020 and 2021, private coverage rates in expansion states fell 0.9 percentage points to 67.1 percent.
When looking at health insurance by work experience or disability status, we restrict our analyses to adults aged 15 to 64. For many adults aged 15 to 64, health insurance coverage is related to work status as many workers may be covered by their employers’ health plans. Indeed, workers were more likely than nonworkers to be covered by private health insurance. In 2021, 85.0 percent of full-time, year-round workers were covered through a private insurance plan, compared with 66.5 percent of those working less than full-time, year-round. Those who did not work were the least likely to have private health insurance coverage at 50.3 percent. Both full-time, year-round workers and those who did not work experienced a decrease in private coverage rates between 2020 and 2021 (by 2.0 percentage points and 1.6 percentage points, respectively).
Rates of public coverage followed a different pattern. Nonworkers were more likely than workers to have public coverage (41.2 percent of nonworkers and 12.1 percent of workers). Full-time, year-round workers were the least likely to have public coverage at 7.9 percent, while 22.6 percent of workers who worked less than fulltime, year-round were covered by public coverage in 2021.
Between 2020 and 2021, there was an increase in public coverage across work statuses. The percentage of full-time, year-round workers with public coverage increased by 1.8 percentage points, while public insurance coverage rates for those who worked less than full-time, year-round increased by 1.6 percentage points. For nonworkers, public coverage increased by 1.8 percentage points.
People with a disability were less likely than people with no disability to have private health insurance coverage and more likely to have public coverage. In 2021, 46.3 percent of adults with a disability had private coverage, compared with 73.9 percent of adults with no disability. At the same time, 52.3 percent of adults with a disability and 17.2 percent with no disability had public coverage. Between 2020 and 2021, public coverage increased 0.9 percentage points among people with no disability but did not statistically change for people with a disability during this period./33
There are also differences in the distribution of coverage type by marital status. For example, in 2021, 81.7 percent of married adults aged 19 to 64 held private coverage, compared to 63.1 percent of those who were not married. Married adults were also less likely to hold public coverage (13.4 percent) than their nonmarried counterparts (24.2 percent). Although there was no significant change in private coverage for either group between 2020 and 2021, the percentage of married adults with public coverage increased by 1.1 percentage points. Public coverage rates also increased among those who were not married by 0.7 percentage points during the same period.
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Figure 8. Health Insurance Coverage by Characteristics: 2020 and 2021
Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar22.pdf>.
Source: U.S. Census Bureau, Current Population Survey, 2021 and 2022 Annual Social and Economic Supplements (CPS ASEC).
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SUMMARY
This past year the uninsured rate decreased by 0.4 percentage points. Overall, private coverage continued to be more prevalent than public insurance. Private coverage rates decreased, while the rate of public health coverage increased between 2020 and 2021. People in many social and demographic groups saw their uninsured rate decline since 2020, driven in part by an increase in public health coverage rates. Changes in coverage between 2020 and 2021 may be related to changes in labor force composition through the pandemic and recent economic recovery, as well as to policies addressing the COVID-19 pandemic.
ADDITIONAL INFORMATION ABOUT HEALTH INSURANCE COVERAGE
State and Local Estimates of Health Insurance Coverage The Census Bureau publishes annual estimates of health insurance coverage by state and other smaller geographic units based on data collected in the American Community Survey (ACS). Single-year estimates are available for geographic units with a population of 65,000 or more. Five-year estimates are available for all geographic units, including census tracts and block groups.
The Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program also produces single-year estimates of health insurance for all states and counties. These estimates are based on statistical models using data from a variety of sources including current surveys, administrative records, and annual population estimates. In general, SAHIE estimates have lower variances than ACS estimates but are released later because they incorporate these additional data into their models.
SAHIE estimates are available at <www.census.gov/programssurveys/sahie.html>. The most recent estimates are for 2020.
Additional data
The CPS ASEC is used to produce additional health insurance coverage tables. These tables are available on the Census Bureau’s Health Insurance website. The website may be accessed through the Census Bureau’s home page at <www.census.gov> or directly at <www.census.gov/data/tables/2022/demo/healthinsurance/p60-278.html>.
U.S. Census Bureau Health Insurance Coverage in the United States: 2021 15 For assistance with health insurance data, contact the Census Bureau Customer Services Center at 1-800-923-8282 (toll free), or search your topic of interest using the Census Bureau’s “Question and Answer Center” found at <https://ask.census.gov>.
Data.census.gov
Data.census.gov is a platform to access data and digital content from the Census Bureau. It allows access to the Census Bureau’s most popular surveys and programs such as the CPS, ACS, decennial census, economic census, and more.
The Census Bureau created easy ways to visualize, customize, and download data through a single platform on data.census.gov in response to user feedback. To learn more about data.census.gov, check out the release notes at <https://www2.census.gov/data/api-documentation/data-censusgov-release-notes.pdf>.
In addition to the detailed and historical tables available online, data users of all skill levels can create custom statistics from Public Use Microdata files using the Microdata Access Tool (MDAT) available at <data.census.gov/mdat>. The MDAT provides data users the ability to create customized tables using public-use data from the CPS ASEC.
Public-Use Microdata
Microdata for the CPS ASEC are available online at <www.census.gov/data/datasets/timeseries/demo/cps/cps-asec.html>. Technical methods have been applied to CPS microdata to avoid disclosing the identities of individuals from whom data were collected.
Census Data API
The Census Data Application Programming Interface (API) gives the public access to pre-tabulated data from various Census Bureau data programs. It is an efficient way to query data directly from Census Bureau servers with many advantages, including the ability to easily download target variables and geographies and immediately access the most current data. Users can find which datasets are currently available via API at <www.census.gov/data/developers/data-sets.html>.
SOURCE AND ACCURACY OF THE ESTIMATES
The estimates in this report are from the CPS ASEC. The CPS is the longest-running survey conducted by the Census Bureau. The CPS is a household survey primarily used to collect employment data. The sample universe for the basic CPS consists of the resident civilian, noninstitutionalized population of the United States. People in institutions, such as prisons, long-term care hospitals, and nursing homes, are not eligible to be interviewed in the CPS. Students living in dormitories are included in the estimates only if information about them is reported in an interview at their parents’ home. Since the CPS is a household survey, people who are homeless and not living in shelters are not included in the sample.
The CPS ASEC collects data in February, March, and April each year, asking detailed questions categorizing income into over 50 sources. The key purpose of the CPS ASEC is to provide timely and comprehensive estimates of income, poverty, and health insurance and to measure change in these national-level estimates.
The CPS ASEC is the official source of national poverty estimates calculated in accordance with the Office of Management and Budget’s Statistical Policy Directive 14.
The CPS ASEC collects data in the 50 states and the District of Columbia; these data do not represent residents of Puerto Rico or U.S. Island Areas.34 The 2021 CPS ASEC sample consists of about 90,800 addresses. The CPS ASEC includes military personnel who live in a household with at least one other civilian adult, regardless of whether they live off post or on post. All other armed forces personnel are excluded. The estimates in this report are controlled to March 2022 independent estimates of national population by age, sex, race, and Hispanic origin. Beginning with the “Health insurance Coverage in the United States: 2021″ report, population estimates are based on 2020 Census population counts and are updated annually taking into account births, deaths, emigration, and immigration. For more information, refer to Appendix A.
The estimates in this report (which may be shown in text, figures, and tables) are based on responses from a sample of the population and may differ from actual values because of sampling variability or other factors. As a result, apparent differences between the estimates for two or more groups may not be statistically significant. All comparative statements have undergone statistical testing and are statistically significant at the 90 percent confidence level unless otherwise noted. In this report, the variances of estimates were calculated using the Successive Difference Replication (SDR) method.
Beginning with the 2011 CPS ASEC report, the standard errors and confidence intervals displayed in the text tables were calculated using the SDR method. In previous years, the standard errors of CPS ASEC estimates were calculated using the Generalized Variance Functions approach. Under this approach, generalized variance parameters were used in formulas provided in the source and accuracy statement to estimate standard errors. Further information on replicate weights, standard errors, income top-coding and data swapping on the public-use file, and changes to the CPS ASEC data file is available at <https:// www2.census.gov/programssurveys/cps/techdocs/cpsmar22.pdf>.
COMMENTS
The Census Bureau welcomes the comments and advice of data and report users. If you have suggestions or comments on the health insurance coverage report, contact:
Sharon Stern Assistant Division Chief, Employment Characteristics Social, Economic, and Housing Statistics Division U.S. Census Bureau Washington, DC 20233-8500 or e-mail <[email protected]>.
ENDNOTES
1 For more information, refer to “Families First Coronavirus Response Act, P.L. 116-127,” March 18, 2020, <www.congress.gov/116/plaws/publ127/PLAW116publ127.pdf>; Congressional Research Service, “Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127,” R46316, April 17, 2020, <https://crsreports.congress.gov/product/pdf/R/R46316>; “American Rescue Plan Act of 2021,” P.L. 117-2, March 11, 2021, <www.congress.gov/117/plaws/publ2/PLAW-117publ2.pdf>; Katie Keith, “Final Coverage Provisions In the American Rescue Plan and What Comes Next,” Health Affairs Blog, DOI: 10.1377/ hblog20210311.725837, March 11, 2021.
2 The CPS ASEC also includes a measure of health insurance coverage held at the time of the interview. Although this measure of coverage cannot predict coverage in a given calendar year, it offers a snapshot of health insurance coverage early in the year when CPS ASEC data are collected.
3 Some people may have more than one coverage type during the calendar year.
4 The final category includes CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) coverage and care provided by the Department of Veterans Affairs and the military.
5 Throughout this report, details may not sum to totals because of rounding.
6 Infants born after the calendar-year reference period are excluded from estimates in this report.
7 Although TRICARE imposed a monthly enrollment fee on certain retired beneficiaries and their dependents in 2021, enrollment remained relatively stable at about 9.5 million people in 2018 and 9.6 million people in 2019, 2020, and 2021 according to TRICARE beneficiary data. Given the small sample size and relative stability in enrollment reported by the Military Health System, it is difficult to determine whether the apparent decline in the CPS ASEC between 2020 and 2021 reflects real change in TRICARE coverage. For more information, refer to the Annual Evaluation of the TRICARE Program, <www.health.mil/Military-Health-Topics/Access-CostQuality-and-Safety/Health-Care-ProgramEvaluation/Annual-Evaluation-of-theTRICARE-Program>.
8 The percentage-point change in the overall rate of employment-based coverage was not statistically different from the percentage-point change in the rate of direct-purchase coverage or the percentage-point change in the rate of TRICARE coverage.
9 The proportion of the population 65 years and older with Medicare coverage did not statistically change between 2020 and 2021. However, the percentage of the U.S. population 65 years and older increased between 2020 and 2021.
10 CHIP is a public program that provides health insurance to children in families with income too high to qualify for Medicaid, but who are likely unable to afford private health insurance.
11 Although most people aged 65 and older held coverage through Medicare, 51.4 percent of people aged 65 and older reported holding more than one type of coverage concurrently for some or all of calendar year 2021.
12 The percentage-point change in the rate of public coverage for children under age 19 was not statistically different from the percentage-point change in the rate of public coverage for working-age adults aged 19 to 64.
13 The percentage-point change in the rate of Medicaid coverage for children under age 19 was not statistically different from the percentage-point change in the rate of Medicaid coverage for working-age adults aged 19 to 64 or adults aged 65 and older. The percentage-point change in the rate of Medicaid coverage for working-age adults aged 19 to 64 was not statistically different from the percentage-point change in the rate of Medicaid coverage for adults aged 65 and older.
14 In 2021, the percentage of Asian children without health insurance coverage was not statistically different from the percentage of non-Hispanic White children without coverage or Black children without coverage.
15 Federal surveys give respondents the option of reporting more than one race. Therefore, two basic ways of defining a race group are possible. A group, such as Asian, may be defined as those who reported Asian and no other race (the race-alone or single-race concept) or as those who reported Asian, regardless of whether they also reported another race (the race-alone-or-in-combination concept). The body of this report (text, figures, and tables) shows data using the first approach (race alone). Use of the single-race population does not imply that it is the preferred method of presenting or analyzing data. The Census Bureau uses a variety of approaches. Data for American Indians and Alaska Natives, Native Hawaiians and Other Pacific Islanders, and those reporting two or more races are not shown separately. In this report, the term “non-Hispanic White” refers to people who are not Hispanic and who reported White and no other race. The Census Bureau uses non-Hispanic Whites as the comparison group for other race groups and Hispanics. Because Hispanic people may be any race, data in this report for Hispanic people overlap with data for racial groups. Of those who reported only one race, 16.6 percent of White householders, 5.6 percent of Black householders, and 2.9 percent of Asian householders also reported being Hispanic. Data users should exercise caution when interpreting aggregate results for the Hispanic population and for race groups because these populations consist of many distinct groups that differ in socioeconomic characteristics, culture, and recency of immigration. Data were first collected for Hispanic people in 1972.
16 The small sample size of the Asian population and the fact that the CPS ASEC does not use separate population controls for weighting the Asian sample to national totals contributes to the large variances surrounding estimates for this group. As a result, the CPS ASEC may be unable to detect statistically significant differences between some estimates for the Asian population.
17 The percentage-point change in the uninsured rate was not statistically different between non-Hispanic White children, Black children, and Hispanic children.
18 In 2021, the percentage of native-born children with health insurance coverage was not statistically different from the percentage of naturalized children with coverage. The percentage-point change in the uninsured rate was not statistically different between native-born children, foreign-born children, naturalized citizen children, and noncitizen children.
19 Between 2020 and 2021, there was no statistical change in the uninsured rate for children who were foreign-born, naturalized citizens, or noncitizens.
20 For information about how the Census Bureau classifies regions, refer to <https://www2.census.gov/geo/pdfs/maps-data/ maps/reference/us_regdiv.pdf>.
21 In 2021, the percentage of children in the Northeast without health insurance coverage was not statistically different from the percentage of children in the Midwest without coverage. The percentage-point change in the uninsured rate was not statistically different between children in the Northeast, Midwest, South, or West.
22 The percentage-point change in the uninsured rate was not statistically different for Black individuals and Asian individuals.
23 In 2021, the percentage of adults who worked less than full-time with no health insurance coverage was not statistically different from the percentage of adults who did not work with no health insurance coverage. The percentage-point change in the uninsured rate was not statistically different between those who did not work and workers or those who worked full-time, year-round.
24 In 2021, the percentage of widowed adults with no health insurance coverage was not statistically different from the percentage of divorced adults with no health insurance coverage.
25 The percentage-point change in the uninsured rate for those in the Midwest was not statistically different from the change for the people in the South or the West.
26 In 2021, the percentage of working-age adults in the Northeast with no health insurance coverage was not statistically different from the percentage of working-age adults in the Midwest with no health insurance coverage.
27 The Office of Management and Budget determined the official definition of poverty in Statistical Policy Directive 14. Appendix B of the “Poverty in the United States: 2021″ report provides a more detailed description of how the Census Bureau calculates poverty. More information is available at <www.census.gov/content/dam/Census/library/publications/2021/demo/p60-277.pdf>.
28 The percentage-point change in the uninsured rate was not statistically different between individuals in poverty in non-expansion states and individuals in other poverty groups in non-expansion states. The percentage-point change in the uninsured rate was not statistically different between individuals in poverty in non-expansion states and those between 100 and 399 percent of poverty in expansion states.
29 The percentage-point change in the uninsured rate was not statistically different for children in poverty, between 100 and 399 percent of poverty, or children in families above 400 percent of poverty.
30 The percentage-point change in the private coverage rate was not statistically different between children in families between 100 and 399 percent of poverty, children in families above 400 percent of poverty, children in families in poverty, and adults in poverty or adults between 100 and 399 percent of poverty.
31 The percentage-point change in the public coverage rate was not statistically different between children in poverty and those in other age and income groups.
32 In 2021, there was no statistical difference in health insurance coverage between non-Hispanic White individuals and Asian individuals.
33 There was no statistical change in private coverage among people with a disability or people with no disability between 2020 and 2021.
34 U.S. Island Areas include American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the Virgin Islands of the United States.
* * *
The report is posted at: https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278.pdf
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