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Health Insurance Coverage Type (2020)*

Measure Overview

Knowing who has health insurance coverage and what type of coverage they have, and, importantly, who doesn't have coverage, is a foundational building block in understanding health needs of a population (ability to access and utilize care and services), understanding affordability (costs of care both in dollars and in behavior changes), and is an important consideration when assessing quality of care and health outcomes.

State Health Compare traditionally provides annually updated state-level measures of health insurance coverage using single-year data from the U.S. Census Bureau's American Community Survey (ACS); however, due to substantial disruptions to the data collection process and significant nonresponse bias in the 2020 ACS caused by the COVID-19 pandemic, SHADAC used the Current Population Survey (CPS) to produce a special, one-year only measure of state-level insurance coverage in 2020.

This measure shows the rates of different types of health insurance coverage (Medicare, employer-sponsored insurance [ESI], Medicaid, individual, as well as uninsurance) for 2020 only, and can be viewed by a limited set of breakdowns such as age, health status, and poverty level.

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Notes

* SHADAC chose to use data from the Current Population Survey (CPS) instead of the American Community Survey (ACS) to produce 2020 health insurance coverage estimates because the 2020 ACS' data collection was disrupted by the COVID-19 pandemic. More information is available in an accompanying blog post.
Data collection for the 2021 CPS (2020 estimates) was also impacted by the COVID-19 pandemic, which likely caused measurable non-response bias and may have worsened existing data issues such as the persistent undercount of Medicaid coverage. Users should treat these estimates with caution. More information is available in a September, 2021 Census blog post, "How Did the Pandemic Affect Survey Response: Using Administrative Data to Evaluate Nonresponse in the 2021 Current Population Survey Annual Social and Economic Supplement."

Estimates of uninsurance represent the percent who were uninsured all year. Estimates of other coverage types represent the percent who had that type of coverage at any point during the year.

Respondents are asked about their health insurance coverage and may select multiple types of coverage. SHADAC's primary source of coverage hierarchy is applied to assign one coverage type to each respondent. If multiple sources of coverage were reported for an observation, primary source of coverage was assigned in the following order: 1) Medicare (for people age 19 or older); 2) employer-sponsored insurance (ESI), TRICARE or other military health care, or VA; 3) Medicaid; 4) Individual coverage; and 5) Medicare (for people age 18 or under). Private coverage includes employer (plus TRICARE and VA) and individual coverage. Public coverage includes Medicaid (plus CHIP and state-specific public programs) and Medicare. The margin of error (MOE) represents the uncertainty of an estimate due to sampling variability; the calculated MOE is 95%. N/A indicates that data were not available or suppressed because the number of sample cases was too small.

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