Health Insurance Coverage in the United States: 2018 Current Population Reports By Edward R. Berchick, Jessica C. Barnett, and Rachel D. Upton Issued September 2019 P60-267 Acknowledgments Edward R. Berchick, Jessica C. Barnett, and Rachel D. Upton prepared this report under the direction of Laryssa Mykyta, Chief of the Health and Disability Statistics Branch. Sharon Stern, Assistant Division Chief for Employment Characteristics, of the Social, Economic, and Housing Statistics Division, provided overall direction. Vonda Ashton, David Watt, Susan S. Gajewski, Mallory Bane, and Nancy Hunter, of the Demographic Surveys Division, and Lisa Cheok of the Associate Directorate for Demographic Programs, processed the Current Population Survey 2019 Annual Social and Economic Supplement file. Andy Chen, Kirk E. Davis, Raymond Dowdy, Lan N. Huynh, Chandararith R. Phe, and Adam W. Reilly programmed and produced the detailed and publication tables under the direction of Hung X. Pham, Chief of the Tabulation and Applications Branch. Victoria Velkoff, Chief of the American Community Survey Office, provided overall direction for the implementation of the 2018 American Community Survey. Donna M. Daily, Nicole Butler, Dameka M. Reese, and Michelle Wiland of the American Community Survey Office oversaw the data collection including content, group quarters, and self-response. Kenneth B. Dawson, Reyan Azeem, and Arumugam Sutha of the Decennial Information Technology Division directed the edit and processing tasks for the 2018 1-Year American Community Survey file. Samantha Spiers, under the supervision of KeTrena Phipps and David V. Hornick, of the Demographic Statistical Methods Division, conducted the statistical review of all Current Population Survey data. Michael D. Starsinic, under the supervision of Mark Asiala, both of the Decennial Statistical Studies Division, conducted the statistical review of all American Community Survey data. Lisa Cheok of the Associate Directorate for Demographic Programs, provided overall direction for the survey implementation. Roberto Cases and Aaron Cantu of the Associate Directorate for Demographic Programs, and Charlie Carter and Agatha Jung of the Information Technology Directorate prepared and programmed the computer-assisted interviewing instrument used to conduct the Annual Social and Economic Supplement. Jessica Hays and Linda Orsini prepared the maps under the direction of Kevin Hawley, Chief of the Cartographic Products and Services Branch, Geography Division. Additional people within the U.S. Census Bureau also made significant contributions to the preparation of this report. Douglas Conway, Adriana Hernandez Viver, Heide Jackson, Katherine Keisler, Matthew Marlay, Amy Steinweg, Jonathan Vespa, and Susan Walsh reviewed the contents. Census Bureau field representatives and telephone interviewers collected the data. Without their dedication, the preparation of this report or any report from the Current Population Survey would be impossible. Faye Brock, Linda Chen, and Michael K. Shelton provided publication management, graphics design and composition, and editorial review for print and electronic media under the direction of Janet Sweeney, Chief of the Graphic and Editorial Services Branch, Public Information Office. Linda Vaughn of the U.S. Census Bureau’s Administrative and Customer Services Division provided printing management. Health Insurance Coverage in the United States: 2018 Issued September 2019 P60-267 U.S. Department of Commerce Wilbur Ross, Secretary Karen Dunn Kelley, Deputy Secretary U.S. CENSUS BUREAU Steven Dillingham, Director Suggested Citation Berchick, Edward R., Jessica C. Barnett, and Rachel D. Upton Current Population Reports, P60-267, Health Insurance Coverage in the United States: 2018, U.S. Government Printing Office, Washington, DC, 2019. U.S. CENSUS BUREAU Steven Dillingham, Director Ron S. Jarmin, Deputy Director and Chief Operating Officer Victoria A. Velkoff, Associate Director for Demographic Programs David G. Waddington, Chief, Social, Economic, and Housing Statistics Division Contents TEXT Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . What Is Health Insurance Coverage? . . . . . . . . . . . . . . . . . . . . . . . . . . Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calendar-Year Coverage in 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Change in Coverage Between 2017 and 2018 . . . . . . . . . . . . . . . . . . Coverage at the Time of Interview . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Insurance Coverage During the Calendar Year . . . . . . . . . . . Health Insurance Coverage by Age . . . . . . . . . . . . . . . . . . . . . . . . . . . Children Without Health Insurance Coverage . . . . . . . . . . . . . . . . . . Health Insurance Coverage by Selected Social and Economic Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Insurance Coverage by Household Income and Income-to-Poverty Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Insurance Coverage by Selected Demographic Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State Estimates of Health Insurance Coverage . . . . . . . . . . . . . . . . . Health Insurance Coverage in the American Community Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . More Information About Health Insurance Coverage . . . . . . . . . . . . Additional Data and Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State and Local Estimates of Health Insurance Coverage . . . . . . . . Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sources of Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Statistical Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 2 3 3 4 5 7 9 9 11 15 16 17 21 21 21 21 21 21 TEXT TABLES U.S. Census Bureau Table 1. Number and Percentage of People by Type of Health Insurance: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Table 2. Percentage of People by Type of Health Insurance Coverage by Age: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . 6 Table 3. Percentage of People by Type of Health Insurance Coverage for Selected Ages and Characteristics: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table 4. Percentage of People by Type of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 5. Percentage of People by Type of Health Insurance Coverage by Selected Demographic Characteristics: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 6. Number and Percentage of People Without Health Insurance Coverage by State: 2017 and 2018 . . . . . . . . . . . . . 19 Health Insurance Coverage in the United States: 2018 iii FIGURES Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2017 to 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Figure 2. Percentage of People by Type of Coverage at the Time of Interview and Change Between 2018 and 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Figure 3. Subannual Health Insurance Coverage: 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Figure 4. Percentage of People Uninsured by Age: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Figure 5. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Figure 6. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2017 to 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Figure 7. Uninsured Rate: 2008 to 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Figure 8. Uninsured Rate by State: 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Figure 9. Change in the Uninsured Rate by State: 2017 and 2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Figure A1. Measuring Health Insurance Coverage With the Current Population Survey Annual Social and Economic Supplement (CPS ASEC): A History of Improvement . . . . . . . . 28 APPENDIXES Appendix A. ESTIMATES OF HEALTH INSURANCE COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Quality of Health Insurance Coverage Estimates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Historical Comparisons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comparison of Estimates of Health Insurance Coverage in 2017, Traditional Processing System and Updated Processing System . . . . . . . . . . . . . . . . . . . . . . . . . Appendix B. REPLICATE WEIGHTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix C. ADDITIONAL DATA AND CONTACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Customized Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Data.census.gov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public-Use Microdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CPS ASEC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Topcoding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 27 28 29 31 33 33 33 33 33 33 33 33 APPENDIX TABLES Appendix Table 1. Number of People by Type of Health Insurance Coverage by Age: 2017      and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Appendix Table 2. Number of People by Type of Health Insurance Coverage for Selected      Ages and Characteristics: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Appendix Table 3. Number of People by Type of Health Insurance Coverage by Household      Income and Income-to-Poverty Ratio: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . 25 Appendix Table 4. Number of People by Type of Health Insurance Coverage by Selected      Demographic Characteristics: 2017 and 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 iv Health Insurance Coverage in the United States: 2018 U.S. Census Bureau Health Insurance Coverage in the United States: 2018 Introduction Health insurance is a means for financing a person’s health care expenses. While the majority of people have private health insurance, primarily through an employer, many others obtain coverage through programs offered by the government. Other individuals do not have health insurance coverage at all (see the text box “What Is Health Insurance Coverage?”). Year to year, the prevalence of health insurance coverage and the distribution of coverage types may change due to economic trends, shifts in the demographic composition of the population, and policy changes that affect access to care. This report presents statistics on health insurance coverage in the United States in 2018 and changes in health insurance coverage between 2017 and 2018.1, 2 The statistics in this report are primarily based on information collected in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), a survey conducted by the U.S. Census Bureau. State-level estimates are based on information from a second Census Bureau survey, the American ¹ For a discussion of the quality of CPS ASEC health insurance coverage estimates and measuring change over time with the CPS ASEC, see Appendix A. 2 The Census Bureau reviewed this data product for unauthorized disclosure of confidential information and approved the disclosure avoidance practices applied to this release. CBDRB-FY19-POP001-0018. Community Survey (ACS), which has a larger sample size that makes it well-suited for subnational levels of geography. For the past several years, the Census Bureau has been engaged in implementing improvements to the CPS ASEC. These changes have been implemented in a two-step process, beginning with questionnaire design changes incorporated over the period of 2014 to 2016 and followed by more recent changes to the data processing system. This report is the first time health insurance coverage measures reflect both data collection and processing system changes. The 2017 and 2018 estimates used in this report are based on the updated processing system, and, therefore, the What Is Health Insurance Coverage? Health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) refers to comprehensive coverage during the calendar year for the civilian, noninstitutionalized population.* For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private insurance or public insurance. Private Coverage Public 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). 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: Medicaid, the Children’s Health Insurance Program (CHIP), and individual state health plans. • CHAMPVA or 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. • TRICARE: Coverage through TRICARE, formerly known as Civilian Health and Medical Program of the Uniformed Services. Additionally, people are considered uninsured if they only had coverage through the Indian Health Service (IHS), as IHS coverage is not considered comprehensive. For more information, see Appendix A, “Estimates of Health Insurance Coverage.” * Comprehensive health insurance covers basic healthcare needs. This definition excludes single-service plans such as accident, disability, dental, vision, or prescription medicine plans. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 1 2017 estimates may differ from those released in September 2018. See Appendix A for more information.3 lower than the rate in 2017 (92.1 percent) (Table 1).5 •• In 2018, private health insurance coverage continued to be more prevalent than public coverage, covering 67.3 percent of the population and 34.4 percent of the population, respectively.6 Of the subtypes of health insurance coverage, employer-based insurance remained the most common, covering 55.1 percent of the population for all or part of the calendar year (Figure 1 and Table 1). Highlights • • In 2018, 8.5 percent of people, or 27.5 million, did not have health insurance at any point during the year. The uninsured rate and number of uninsured increased from 2017 (7.9 percent or 25.6 million) (Figure 1 and Table 1).4 The percentage of people with health insurance coverage for all or part of 2018 was 91.5 percent, •• Between 2017 and 2018, the percentage of people with public coverage decreased 0.4 percentage points. The percentage of people covered by Medicaid 3 Given the effect of the new health insurance questions introduced in 2014, the new relationship categories introduced in 2015–2016, and the 2019 implementation of an updated processing system, the CPS ASEC estimates in this report are not comparable to previously published estimates. See Appendix A for more details. 4 Infants born after the end of the calendar-​ year reference period are excluded from estimates in this report, with the exception of estimates of coverage at the time of interview. 5 All comparative statements in this report have undergone statistical testing, and comparisons are significant at the 90 percent confidence level unless otherwise noted. 6 Some people may have more than one coverage type during the calendar year. decreased by 0.7 percentage points to 17.9 percent (Figure 1 and Table 1).7 The rate of Medicare coverage increased by 0.4 percentage points to 17.8 percent.8, 9 •• The percentage of people with private coverage or any of the three subtypes of private coverage (employment-based, directpurchase, and TRICARE) did not statistically change between 2017 and 2018. •• The percentage of uninsured children under the age of 19 increased by 0.6 percentage 7 Throughout this report, details may not sum to totals because of rounding. 8 This increase was partly due to growth in the number of people aged 65 and over. Among those 65 years and older, the Medicare coverage rate did not statistically change between 2017 and 2018. However, the percentage of the U.S. population 65 years and older increased between 2017 and 2018. 9 In 2018, the percentage of people covered by Medicaid was not statistically different from the percentage covered by Medicare. Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2017 to 2018 (Population as of March of the following year) No statistical change between years Change: 2017 to 2018 2018 Type of Coverage Uninsured With health insurance Any private plan Employment-based Direct-purchase TRICARE Any public plan Medicare Medicaid VA and CHAMPVA1 +0.5* –0.5* 8.5 91.5 –0.4 –0.3 –0.2 +0.1 67.3 55.1 10.8 2.6 34.4 –0.4* +0.4* –0.7* Z 17.8 17.9 1.0 0.0 Z Represents zero or rounds to zero. 1 Includes CHAMPVA (Civilian Health Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs and the military. * Denotes a statistically significant change between 2017 and 2018 at the 90 percent confidence level. 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. For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 2 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau Table 1. Number and Percentage of People by Type of Health Insurance: 2017 and 2018 (Numbers in thousands. Margins of error in thousands or percentage points as appropriate. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see ) 2017 Coverage type Change in number 2018 Change in percent Number Margin of error¹ (±) Percent Margin of error¹ (±) Number Margin of error¹ (±) Percent Margin of error¹ (±) 2018 less 2017 2018 less 2017 Total . . . . . . . . . . . . . . . 322,490 135 X X 323,668 133 X X *1,178 X Any health plan. . . . . . . . . . . . . 296,890 622 92.1 0.2 296,206 641 91.5 0.2 –684 *–0.5  Any private plan2, 3. . . . . . . . . .   Employment-based². . . . . .   Direct-purchase². . . . . . . . . .    Marketplace coverage2 . .   TRICARE2. . . . . . . . . . . . . . . . 218,209 178,751 35,499 11,217 8,207 1,129 1,106 704 380 549 67.7 55.4 11.0 3.5 2.5 0.3 0.3 0.2 0.1 0.2 217,780 178,350 34,846 10,743 8,537 1,222 1,283 647 428 508 67.3 55.1 10.8 3.3 2.6 0.4 0.4 0.2 0.1 0.2 –430 –401 –653 –474 330 –0.4 –0.3 –0.2 –0.2 0.1  Any public plan2, 4. . . . . . . . . . .   Medicare². . . . . . . . . . . . . . . .   Medicaid². . . . . . . . . . . . . . . .   VA or CHAMPVA2, 5. . . . . . . . 112,151 56,170 59,814 3,229 928 361 892 188 34.8 17.4 18.5 1.0 0.3 0.1 0.3 0.1 111,330 57,720 57,819 3,217 962 401 891 182 34.4 17.8 17.9 1.0 0.3 0.1 0.3 0.1 –821 *1,550 *–1,995 –12 *–0.4 *0.4 *–0.7 Z Uninsured⁶. . . . . . . . . . . . . . . . . 25,600 596 7.9 0.2 27,462 630 8.5 0.2 *1,862 *0.5 * Changes between the estimates are statistically different from zero at the 90 percent confidence level. X Not applicable. Z Represents or rounds to zero. ¹ A margin of error (MOE) is a measure of an estimate’s variability. The larger the MOE in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. MOEs shown in this table are based on standard errors calculated using replicate weights. For more information, see “Standard Errors and Their Use” at . ² The estimates by type of coverage are not mutally exclusive; people can be covered by more than one type of health insurance during the year. ³ Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. ⁵ Includes CHAMPVA, as well as care provided by the Department of Veterans Affairs and the military. ⁶ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. points between 2017 and 2018, to 5.5 percent (Table 2). •• Between 2017 and 2018, the percentage of people without health insurance coverage at the time of interview decreased in three states and increased in eight states (Figure 9 and Table 6).10 Calendar-Year Coverage in 2018 This report classifies health insurance coverage into three categories: overall coverage, private coverage, and public coverage (see Text Box “What Is Health Insurance Coverage?”). In the CPS ASEC, people are considered to have coverage if they were covered by health insurance for part or all of the previous calendar year. This report also presents estimates of the uninsured rate. People were considered uninsured if, for the entire year, they were not covered by any type of health insurance.11 In 2018, most people (91.5 percent) had health insurance coverage at some point during the calendar year (Figure 1 and Table 1). That is, 8.5 percent of people were uninsured for the entire calendar year. More people had private health insurance (67.3 percent) than public coverage (34.4 percent).12 Employer-based insurance was the most common subtype of health insurance (55.1 percent), followed by Medicaid (17.9 percent), Medicare (17.8 percent), direct-purchase Infants born after the end of the calendaryear reference period are excluded from estimates in this report, with the exception of estimates of coverage at the time of interview. 12 See text box “What Is Health Insurance Coverage?” for definitions of private and public coverage. 11 10 Estimates are from the 2017 and 2018 American Community Survey, 1-year estimates. For more information, see the text box “Health Insurance Coverage in the American Community Survey.” U.S. Census Bureau insurance (10.8 percent), TRICARE (2.6 percent), and VA or CHAMPVA health care (1.0 percent) (Table 1).13, 14 Direct-purchase insurance includes coverage obtained through a state or federal marketplace. In 2018, 3.3 percent of people, or 30.8 percent of people with direct-purchase insurance, obtained their coverage through a state or federal marketplace. Change in Coverage Between 2017 and 2018 The percentage of people covered by any type of health insurance in 2018 was lower than the percentage in 2017. This decline appears to 13 In 2018, the percentage of people with Medicare was not statistically different from the percentage of people with Medicaid. 14 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. Health Insurance Coverage in the United States: 2018 3 Coverage at the Time of Interview Starting this year, the CPS ASEC includes two types of health insurance coverage measures: health insurance coverage during the previous calendar year and health insurance coverage at the time of the interview. The first measure, health insurance coverage at any time during the previous calendar year, is used throughout this report. The second measure captures coverage held at the time of interview (between February and April). This information describes health insurance coverage in early 2019, not for the full calendar year. In early 2019, 90.9 percent of people had health insurance coverage at the time of interview, a 0.4 percentage-point decrease from early 2018. As the main measure of coverage in the CPS ASEC captures whether a person had coverage at any point in time in the calendar year, estimates of current coverage tend to be lower than the calendar-year estimates. Between early 2018 and early 2019, Medicaid coverage at the time of interview decreased by 0.7 percentage points, and Medicare coverage at the time of interview increased. No other subtype of coverage saw a statistically significant change during this time. Figure 2. Percentage of People by Type of Coverage at the Time of Interview and Change Between 2018 and 2019 (Population as of March of the calendar year) No statistical change between years Change: 2018 to 2019 2019 Type of Coverage Uninsured With health insurance Any private plan Employment-based Direct-purchase TRICARE Any public plan Medicare Medicaid VA and CHAMPVA1 9.1 90.9 66.1 54.0 10.2 2.6 34.0 18.0 17.3 1.0 +0.4* –0.4* –0.4 –0.4 –0.2 +0.1 –0.3 +0.4* –0.7* Z Z Represents zero or rounds to zero. 1 Includes CHAMPVA (Civilian Health Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs and the military. * Denotes a statistically significant change between 2018 and 2019 at the 90 percent confidence level. Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance. For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 4 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau be driven by a 0.4 percentage-point decrease in public health insurance (Table 1). Medicaid coverage decreased by 0.7 percentage points between 2017 and 2018.15 The rate of Medicare coverage moved in the opposite direction, increasing by 0.4 percentage points. This increase was partly due to growth in the number of people aged 65 and over and not a change in Medicare coverage for adults in this age range. The percentage of people covered by private health insurance, or any of its three subtypes (employment-based, direct-purchase, and TRICARE), did not statistically change between 2017 and 2018. 15 Unless otherwise stated, all changes correspond to the percentage-point difference in coverage rates between 2017 and 2018. Health Insurance Coverage During the Calendar Year individuals held this type of coverage for 1 to 11 months during 2018.16 People may have health insurance coverage for part or all of the calendar year. Among the 296.2 million people covered at any point during 2018, most—96.4 percent—had health insurance coverage for all 12 months, while 3.6 percent had coverage for 1 to 11 months (Figure 3). That is, most people with coverage during 2018 had coverage throughout the entire calendar year. Similarly, the majority of people with private coverage (95.2 percent) and public coverage (94.2 percent) were covered for the entire calendar year. Only 4.8 and 5.8 percent of people with private and public coverage held that type of coverage for part of the year, respectively. Such While most people have a single type of insurance, some people may have more than one type of coverage during the calendar year. They may have multiple types of coverage at one time to supplement their primary insurance type, or they may switch coverage types over the course of the year. 16 Some people may transition from one type of coverage to another type of coverage during the calendar year. For example, some people may switch from employer-based (which is private) to Medicare coverage (which is public) during the calendar year. Such people would be considered to have full-year overall coverage. However, they would have private coverage for part of the year and public coverage for part of the year. Therefore, the percentage with partyear private coverage and the percentage with part-year public coverage may not sum to the total with part-year overall coverage. Figure 3. Subannual Health Insurance Coverage: 2018 (Numbers in percents. Population as of March of the following year) Part-year coverage Full-year coverage Any health plan 96.4 Any private plan 95.2 Any public plan 94.2 3.6 4.8 5.8 91.2 Medicaid One type 8.8 More than one type of coverage during the calendar year More than one type 85.5 14.5 83.8 Concurrent coverage, all 12 months Concurrent coverage, 1 to 11 months 10.3 5.9 Concurrent coverage, no months1 1 This group had more than one type of coverage during 2018, but did not have concurrent coverage within any single month. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 5 6 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau 271,424 77,487 193,937 29,811 40,222 40,662 83,242 51,066 Age Under age 65. . . . . . . . . . . . . . . .  Under age 196. . . . . . . . . . . . .  Aged 19 to 64. . . . . . . . . . . . .   Aged 19 to 25⁷. . . . . . . . . .   Aged 26 to 34. . . . . . . . . . .   Aged 35 to 44. . . . . . . . . . .   Aged 45 to 64. . . . . . . . . . . Aged 65 and older. . . . . . . . . . . 270,881 77,333 193,548 29,297 40,768 41,027 82,455 52,788 323,668 Number 2018 90.8 95.0 89.0 86.3 86.0 88.6 91.7 99.0 92.1 0.2 0.3 0.2 0.6 0.5 0.4 0.3 0.1 0.2 Margin of Per- error² cent (±) 2017 90.0 94.5 88.3 85.7 86.1 87.5 90.7 99.1 91.5 0.2 0.3 0.3 0.6 0.5 0.5 0.3 0.1 0.2 Margin of Per- error² cent (±) 2018 *–0.7 *–0.6 *–0.8 –0.7 Z *–1.0 *–1.0 Z *–0.5 Change (2018 less 2017)1, * 70.3 61.6 73.8 70.0 70.4 75.0 76.1 53.7 67.7 0.4 0.6 0.4 0.8 0.7 0.6 0.5 0.8 0.3 Margin of Per- error² cent (±) 2017 70.2 61.8 73.5 69.9 71.3 73.7 75.8 52.4 67.3 0.4 0.7 0.4 0.9 0.8 0.6 0.5 0.7 0.4 Margin of Per- error² cent (±) 2018 Private health insurance3 –0.1 0.2 –0.2 –0.1 1.0 *–1.2 –0.4 *–1.3 –0.4 Change (2018 less 2017)1, * 23.6 37.0 18.3 18.8 18.5 16.3 18.9 94.2 34.8 0.3 0.6 0.3 0.7 0.6 0.6 0.4 0.3 0.3 Margin of Per- error² cent (±) 2017 22.8 35.7 17.6 18.3 17.5 16.2 18.1 94.1 34.4 0.3 0.7 0.3 0.7 0.6 0.5 0.4 0.3 0.3 Margin of Per- error² cent (±) 2018 Public health insurance⁴ *–0.8 *–1.3 *–0.6 –0.5 *–1.0 Z *–0.8 –0.1 *–0.4 Change (2018 less 2017)1, * 9.2 5.0 11.0 13.7 14.0 11.4 8.3 1.0 7.9 0.2 0.3 0.2 0.6 0.5 0.4 0.3 0.1 0.2 Margin of Per- error² cent (±) 2017 10.0 5.5 11.7 14.3 13.9 12.5 9.3 0.9 8.5 0.2 0.3 0.3 0.6 0.5 0.5 0.3 0.1 0.2 Margin of Per- error² cent (±) 2018 Uninsured⁵ *0.7 *0.6 *0.8 0.7 Z *1.0 *1.0 Z *0.5 Change (2018 less 2017)1, * * Changes between the estimates are statistically different from zero at the 90 percent confidence level. Z Represents or rounds to zero. ¹ Details may not sum to totals because of rounding. ² A margin of error (MOE) is a measure of an estimate’s variability. The larger the MOE in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. MOEs shown in this table are based on standard errors calculated using replicate weights. For more information, see “Standard Errors and Their Use” at . ³ Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. ⁵ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. ⁶ Children under the age of 19 are eligible for Medicaid/CHIP. ⁷ Individuals aged 19 to 25 may be eligible to be a dependent on a parent’s health insurance plan. 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 322,490 Number Total . . . . . . . . . . . . . . . . . . . . . . Characteristic 2017 Any health insurance Total (Numbers in thousands. Margins of error in percentage points. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see ) Percentage of People by Type of Health Insurance Coverage by Age: 2017 and 2018 Table 2. In 2018, 14.5 percent of people with health insurance coverage, or 42.9 million people, had more than one type of health insurance coverage over the course of the year. Among this group, most people (83.8 percent) held more than one type of coverage in each month during the year, while 10.3 percent had more than one type within a single month for just part of the year (1 to 11 months). The remaining 5.9 percent held more than one type across the year, but did not have multiple types of coverage within any single month. 19 (94.5 percent) and adults aged 19 to 64 (88.3 percent) (Table 2). Health Insurance Coverage by Age In 2018, children under the age of 19 had a lower overall coverage rate than adults aged 65 and over but a higher rate than adults aged 19 to 64. Children’s coverage is likely influenced by some children from lower income families being eligible for health coverage through programs such as Medicaid or the Children’s Health Insurance Program (CHIP), Age is strongly associated with the likelihood that a person has health insurance and the type of health insurance a person has. In 2018, adults aged 65 and over had the highest coverage rate (99.1 percent), followed by children under the age of In 2018, 94.1 percent of adults aged 65 and over were covered by a public plan (primarily Medicare), and 52.4 percent were covered by a private plan, which may have supplemented their public coverage. Between 2017 and 2018, the percentage of adults aged 65 and over with private coverage decreased by 1.3 percentage points. Their rates of overall health insurance coverage and public coverage did not statistically change during this time. and by some children receiving coverage through a parent or guardian’s health plan.17 In 2018, 61.8 percent of children under the age of 19 had private health insurance, and 35.7 percent had public coverage. Unlike for adults 65 and older, between 2017 and 2018, the rates of overall health insurance coverage and public coverage decreased for children under the age of 19 and their rate of private coverage did not statistically change. For children, coverage overall decreased by 0.6 percentage points (to 94.5 percent), and public coverage declined by 1.3 percentage points (to 35.7 percent). The latter change was likely due to 17 The Children’s Health Insurance Program (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. Figure 4. Percentage of People Uninsured by Age: 2017 and 2018 (Population as of March of the following year) 13.7 14.3 2018 2017 14.0 13.9 12.5 11.4 9.3 8.3 5.0 5.5 1.0 0–18* 19–25 26–34 Age 35–44* 45–64* 0.9 65 and older * Denotes a statistically significant change between 2017 and 2018 at the 90 percent confidence level. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 7 a 1.2 percentage-point decrease in Medicaid and CHIP coverage.18 Adults aged 19 to 64 had a lower rate of health insurance coverage in 2018 (88.3 percent) than both children and older adults. This group, in other 18 The percentage-point change in the overall rate of coverage for children was not statistically different from the percentage-point change in the rate of private coverage or the percentagepoint change in the rate of Medicaid coverage. The percentage-point change in the rate of public coverage for children was not statistically different from the percentage-point change in the rate of Medicaid coverage. words, had the highest uninsured rate of the three broad age groups examined, at 11.7 percent. Adults aged 19 to 64 were nonetheless more likely than the other two broad age groups to be covered by private health insurance (73.5 percent). They were also less likely to have public coverage (17.6 percent). The prevalence of health insurance and, therefore, the uninsured rate varied within the 19-to-64 age group. Among adults aged 19 to 64, the population aged 19 to 25 was among the most likely to be uninsured, with a coverage rate of 85.7 percent and an uninsured rate of 14.3 percent. In general, the uninsured rate decreased as age increased (Figure 4).19 Between 2017 and 2018, the uninsured rate increased by 1.0 19 The percentage of people aged 19 to 25 without health insurance coverage was not statistically different from the percentage of people aged 26 to 34 without coverage. Figure 5. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2017 and 2018 2018 2017 (Population as of March of the following year) 5.5 5.0 Total* Income-to-Poverty Ratio Below 100% of poverty 6.7 6.1 Between 100% and 399% of poverty At or above 400% of poverty* Race and Hispanic Origin 1.9 2.6 7.8 7.5 1 White, not Hispanic* Black Asian 4.2 3.7 4.6 4.5 4.1 3.6 Hispanic (any race)* 7.7 Nativity 5.1 4.7 Native-born citizen* Naturalized citizen 8.6 6.4 Noncitizen Region Northeast Midwest 15.6 3.6 3.4 3.8 4.1 South* 4.8 4.4 West 6.5 Medicaid Expansion Status2 Non-expansion state* Expansion state 8.7 3.9 3.7 7.0 18.3 7.7 7.9 Denotes a statistically significant change between 2017 and 2018 at the 90 percent confidence level. Federal surveys give respondents the option of reporting more than one race. This figure shows data using the race-alone concept. For example, Asian refers to people who reported Asian and no other race. 2 Expansion status as of January 1, 2018. See Table 6: Number and Percentage of People Without Health Insurance Coverage by State: 2017 and 2018. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . * 1 Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 8 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau percentage point for both adults aged 35 to 44 and adults aged 45 to 64 to 12.5 percent and 9.3 percent, respectively.20 The percentage of people uninsured did not significantly increase or decrease for any other age group between the ages of 19 and 64. Children Without Health Insurance Coverage In 2018, 5.5 percent of children under the age of 19 did not have health insurance coverage, a 0.6 percentage-​​ point increase from 2017. For many selected characteristics, the percentage of children (under 19 years of age) without health insurance coverage was significantly higher in 2018 than in 2017 (Figure 5). However, the change was not uniform across groups. For example, the uninsured rate did not significantly change for children in either of the income-to-poverty categories for families with income less than 400 percent of poverty. However, it increased 0.7 percentage points for children living in families at or above 400 percent of poverty. In both years, the percentage of children without health insurance coverage decreased as the income-to-poverty ratio increased. Other characteristics also reveal that the percentage of children without insurance and changes between 2017 and 2018 did not occur equally across groups. For example, children living in the South were more likely to be uninsured than children living in other regions in the United States.21 Between 2017 and 2018, their uninsured rate increased 1.2 percentage points to 7.7 percent. The uninsured rate for children did not statistically change for any other region. 20 The change for people aged 35 to 44 was not statistically different from the change for people aged 45 to 64. 21 For information about how the Census Bureau classifies regions, see . U.S. Census Bureau Hispanic children were more likely to be uninsured than children from other races and non-Hispanic origin groups. Between 2017 and 2018, the uninsured rate increased 1.0 percentage point for Hispanic children and 0.5 percentage points for non-Hispanic Whites.22 Children in other racial groups did not experience statistical changes in their uninsured rate between 2017 and 2018. Health Insurance Coverage by Selected Social and Economic Characteristics The prevalence of health insurance coverage varies across certain social and economic characteristics. In 2018, individuals aged 15 to 64 with a disability were more likely to be insured (90.4 percent) than were individuals with no disability (88.5 percent) (Table 3). 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 2018, 44.7 percent of people with a disability had private coverage, compared with 74.9 percent of adults with no disability, a 30.2 percentage-point difference. At the same time, 53.9 percent of adults with a disability and 16.0 percent with no disability had public coverage, a 37.9 percentagepoint difference. Between 2017 and 2018, coverage decreased 1.1 percentage points for people with a disability and 0.7 percentage points for people with no disability. These decreases were not statistically different from one another. Public coverage decreased by 0.6 percentage points for adults with no disability, but did not statistically change for those with a disability. For many adults aged 15 to 64, health insurance coverage is also related to work status, such as working fulltime, year-round; working less than 22 The change between 2017 and 2018 for non-Hispanic White children was not statistically different from the change for Hispanic children. full-time, year-round; or not working at all during the calendar year.23 In 2018, 89.3 percent of all workers had health insurance coverage. Full-time, year-round workers were more likely to be covered by health insurance (90.5 percent) than the population working less than fulltime, year-round (86.2 percent) or nonworkers (86.9 percent) (Table 3). Between 2017 and 2018, health insurance coverage rates for workers and nonworkers decreased by 0.8 percentage points and 0.7 percentage points, respectively. Coverage rates also declined 0.9 percentage points for both people who worked fulltime, year-round and for people who worked less than full-time, year-round. These percentage-point decreases were not statistically different from one another. Workers were more likely than nonworkers to be covered by private health insurance. In 2018, 85.1 percent of full-time, year-round workers and 68.5 percent of people who worked less than full-time, year-round had private coverage, compared with 51.3 percent of nonworkers. Nonworkers, however, were more likely than workers to be covered by public health insurance. Specifically, in 2018, nonworkers were almost four times as likely to have public coverage (40.2 percent) than workers (11.1 percent). Among the latter group, 7.2 percent of people who worked fulltime, year-round and 21.3 percent of people who worked less than full-time, year-round had public coverage. Many adults obtain health insurance coverage through their spouse, and, therefore, health insurance coverage is related to marital status. In 2018, married adults aged 19 to 64 were more likely to be insured than any other 23 In this report, a full-time, year-round worker is a person who worked 35 or more hours per week (full-time) and 50 or more weeks during the previous calendar year (year-round). For school personnel, summer vacation is counted as weeks worked if they are scheduled to return to their job in the fall. Health Insurance Coverage in the United States: 2018 9 10 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau 164,250 44,573 24,977 17,735 39,255 22,514 44,774 26,179 17,683 38,441 21,890 97.3 89.9 91.7 94.4 86.0 73.2 89.5 92.3 87.5 87.7 81.4 84.8 0.3 0.5 0.6 0.4 0.5 1.1 0.2 0.3 1.4 0.7 1.5 0.4 0.2 0.5 0.5 0.2 0.2 0.6 0.2 0.2 0.2 96.6 89.3 91.0 93.8 85.1 71.0 88.7 91.7 86.3 87.0 80.1 84.0 88.3 86.9 86.2 90.5 89.3 90.4 88.5 88.7 91.5 0.4 0.6 0.6 0.3 0.5 1.2 0.3 0.3 1.6 0.7 2.0 0.5 0.3 0.4 0.5 0.3 0.3 0.7 0.3 0.3 0.2 *–0.7 –0.5 –0.8 *–0.7 *–0.9 *–2.2 *–0.8 *–0.7 –1.3 –0.7 –1.3 *–0.8 *–0.8 *–0.7 *–0.9 *–0.9 *–0.8 *–1.1 *–0.7 *–0.8 *–0.5 Change Margin (2018 Per- of error² less cent (±) 2017)1, * 2018 93.2 72.9 79.1 87.6 65.3 38.3 74.4 82.4 55.7 65.2 53.6 64.9 73.8 52.1 68.7 85.8 80.8 46.0 75.2 73.1 0.5 0.7 0.9 0.5 0.6 1.0 0.4 0.4 2.2 1.0 2.0 0.6 0.4 0.7 0.7 0.3 0.3 1.2 0.3 0.4 0.3 Margin Per- of error² cent (±) 92.9 73.8 78.7 87.2 64.3 37.0 74.2 82.3 55.6 64.7 52.4 64.7 73.5 51.3 68.5 85.1 80.5 44.7 74.9 72.8 67.3 0.5 0.8 0.8 0.5 0.7 1.2 0.4 0.4 2.2 1.0 2.3 0.6 0.4 0.8 0.7 0.4 0.4 1.2 0.4 0.4 0.4 –0.4 0.9 –0.3 –0.4 *–1.0 –1.2 –0.3 –0.1 –0.1 –0.4 –1.2 –0.2 –0.2 –0.8 –0.2 *–0.6 –0.3 –1.2 –0.3 –0.3 –0.4 Change Margin (2018 Per- of error² less cent (±) 2017)1, * 2018 Private health insurance3 2017 67.7 Total Any health insurance 6.0 20.9 16.2 9.0 24.5 37.8 18.2 13.2 36.7 25.9 31.1 22.2 18.3 40.2 21.9 7.6 11.7 53.5 16.6 19.3 34.8 0.5 0.7 0.7 0.4 0.6 1.1 0.3 0.3 2.2 0.9 1.9 0.5 0.3 0.7 0.6 0.2 0.2 1.1 0.3 0.3 0.3 Margin Per- of error² cent (±) 2017 5.7 19.3 15.8 8.5 24.4 36.9 17.5 12.6 34.9 25.3 29.7 21.6 17.6 40.2 21.3 7.2 11.1 53.9 16.0 18.8 34.4 0.4 0.7 0.7 0.4 0.6 1.3 0.3 0.3 2.2 1.0 1.8 0.5 0.3 0.7 0.6 0.2 0.2 1.1 0.3 0.3 0.3 –0.3 *–1.5 –0.4 –0.5 –0.1 –0.9 *–0.7 *–0.6 –1.8 –0.6 –1.4 –0.6 *–0.6 Z –0.6 *–0.4 *–0.6 0.4 *–0.6 *–0.6 *–0.4 Change Margin (2018 Per- of error² less cent (±) 2017)1, * 2018 Public health insurance⁴ 2.7 10.1 8.3 5.6 14.0 26.8 10.5 7.7 12.5 12.3 18.6 15.2 11.0 12.5 12.9 8.6 9.9 8.4 10.8 10.6 7.9 0.3 0.5 0.6 0.4 0.5 1.1 0.2 0.3 1.4 0.7 1.5 0.4 0.2 0.5 0.5 0.2 0.2 0.6 0.2 0.2 0.2 Margin Per- of error² cent (±) 2017 3.4 10.7 9.0 6.2 14.9 29.0 11.3 8.3 13.7 13.0 19.9 16.0 11.7 13.1 13.8 9.5 10.7 9.6 11.5 11.3 8.5 0.4 0.6 0.6 0.3 0.5 1.2 0.3 0.3 1.6 0.7 2.0 0.5 0.3 0.4 0.5 0.3 0.3 0.7 0.3 0.3 0.2 *0.7 0.5 0.8 *0.7 *0.9 *2.2 *0.8 *0.7 1.3 0.7 1.3 *0.8 *0.8 *0.7 *0.9 *0.9 *0.8 *1.1 *0.7 *0.8 *0.5 Change Margin (2018 Per- of error² less cent (±) 2017)1, * 2018 Uninsured⁵ * Changes between the estimates are statistically different from zero at the 90 percent confidence level. 1 Details may not sum to totals because of rounding. 2 A margin of error (MOE) is a measure of an estimate’s variability. The larger the MOE in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms t​ he 90 percent confidence interval. MOEs shown in this table are based on standard errors calculated using replicate weights. For more information, see “Standard Errors and Their Use” at . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. 4 Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. 5 Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. 6 The sum of those with and without a disability does not equal the total because disability status is not defined for individuals in the U.S. armed forces. 7 The combined category “married” includes three individual categories: “married, civilian spouse present,” “married, U.S. armed forces spouse present,” and “married, spouse absent.” 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 15,197 15,159 164,126 Total, 26 to 64 years old . . Educational Attainment No high school  diploma. . . . . . . . . . . . . . . . . High school graduate  (includes equivalency) . . Some college, no  degree. . . . . . . . . . . . . . . . . . Associate’s degree. . . . . . . . Bachelor’s degree. . . . . . . . . Graduate or  professional degree. . . . . . 101,805 3,385 18,683 4,200 65,475 Marital Status Married7. . . . . . . . . . . . . . . . . . 102,487 Widowed. . . . . . . . . . . . . . . . . 3,331 Divorced. . . . . . . . . . . . . . . . . 19,241 Separated. . . . . . . . . . . . . . . . 4,249 Never married. . . . . . . . . . . . 64,629 87.5 55,573 89.0 87.1 43,271 193,548 91.4 111,950 193,937 Total, 19 to 64 years old . . 90.1 91.6 89.2 89.4 92.1 Margin Per- of error² cent (±) 2017 155,221 15,438 194,434 Disability Status6 With a disability . . . . . . . . . . 15,683 With no disability. . . . . . . . . 194,458 Work Experience All workers. . . . . . . . . . . . . . . 154,657  Worked full-time,   year-round. . . . . . . . . . . . 109,932  Worked less   than full-time,   year-round. . . . . . . . . . . . 44,725 Did not work at  least 1 week. . . . . . . . . . . . . 56,436 210,794 323,668 211,093 Total, 15 to 64 years old . . Number 2018 322,490 Number 2017    Total. . . . . . . . . . . . . Characteristic /techdocs/cpsmar19.pdf>) (Numbers in thousands. Margins of error in percentage points. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. ⁵ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 323,172 43,320 59,133 55,304 44,539 34,142 23,291 63,939 323,668 Number 2018 321,907 45,388 61,072 53,665 43,645 32,895 22,674 63,151 Household Income Less than $25,000. . . . . . . $25,000 to $49,999 . . . . . $50,000 to $74,999 . . . . . $75,000 to $99,999 . . . . . $100,000 to $124,999. . . $125,000 to $149,999 . . . $150,000 or more. . . . . . . Income-to-Poverty  Ratio Total, poverty universe. . Below 100 percent of  poverty. . . . . . . . . . . . . . . Below 138 percent of  poverty. . . . . . . . . . . . . . . Between 100 to 199  percent of poverty. . . . . Between 200 to 299  percent of poverty. . . . . Between 300 to 399  percent of poverty. . . . . At or above 400  percent of poverty. . . . . 322,490 Number 2017    Total. . . . . . . . . . . . Characteristic /techdocs/cpsmar19.pdf>) (Numbers in thousands. Margins of error in percentage points. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . Figure 6. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2017 to 2018 (Civilian noninstitutionalized population) 2017 2018 Expansion states1 2017 2018 Non-expansion states1 36.9 35.6 15.4 16.9 20.4 21.2 12.0 12.7 2.9 Below 100% of poverty* 1.5 Between 100% and 399% of poverty* 4.5 3.5 At or above 400% of poverty* Below 100% of poverty Between 100% and 399% of poverty Percentage-point change in uninsured rate between 2017 and 2018 0.8 6.2 At or above 400% of poverty* 1.7 0.9 0.6 –1.4 * Denotes a statistically significant difference at the 90 percent level. 1 Medicaid expansion status as of January 1, 2018. For a list of expansion and non-expansion states, see Table 6: Number and Percentage of People Without Health Insurance Coverage by State: 2017 to 2018. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 13 14 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau 247,193 195,183 42,461 19,498 59,033 277,057 45,433 21,880 23,553 Nativity Native-born . . . . . . . . . . . . . . Foreign-born. . . . . . . . . . . . .  Naturalized citizen. . . . . .  Not a citizen. . . . . . . . . . . . 93.6 82.6 92.2 73.8 92.3 94.8 90.7 93.6 83.8 91.9 92.1 90.4 93.1 88.3 89.6 95.5 95.2 92.7 92.7 92.1 0.2 0.6 0.6 1.0 0.2 0.2 0.5 0.7 0.6 0.5 0.2 0.4 0.2 2.6 0.4 0.4 0.3 0.2 0.2 0.2 Margin Per- of error² cent (±) 2017 93.2 81.1 91.2 71.4 91.8 94.6 90.3 93.2 82.2 90.9 91.6 90.4 92.3 86.9 88.9 94.8 94.7 92.1 92.4 91.5 0.2 0.6 0.6 1.0 0.2 0.2 0.5 0.6 0.6 0.7 0.2 0.4 0.2 3.4 0.4 0.5 0.3 0.2 0.3 0.2 Margin Per- of error² cent (±) 2018 *–0.4 *–1.6 *–0.9 *–2.3 *–0.6 –0.2 –0.4 –0.5 *–1.6 *–1.0 *–0.5 Z *–0.7 –1.4 *–0.6 *–0.7 *–0.4 *–0.5 *–0.3 *–0.5 Change (2018 less 2017)1,* 69.3 57.7 65.4 50.5 69.9 75.1 55.5 72.4 50.7 62.9 68.4 62.9 71.6 53.1 62.4 59.0 61.8 69.0 72.2 0.4 0.8 1.0 1.1 0.4 0.4 1.0 1.4 0.9 1.1 0.4 0.7 0.5 4.9 0.7 1.0 0.6 0.4 0.4 0.3 Margin Per- of error² cent (±) 69.1 56.0 64.0 48.4 69.3 74.8 55.4 73.1 49.6 62.0 68.1 63.4 70.9 50.0 61.5 59.7 62.0 68.7 72.0 67.3 0.4 0.9 1.0 1.1 0.4 0.4 1.1 1.3 1.0 1.3 0.4 0.7 0.5 5.1 0.6 1.0 0.7 0.4 0.4 0.4 Margin Per- of error² cent (±) 2018 Private health insurance3 2017 67.7 Total Any health insurance –0.2 *–1.6 –1.3 *–2.1 *–0.5 –0.3 –0.1 0.7 *–1.1 –0.8 –0.3 0.5 *–0.8 –3.1 –0.8 0.7 0.2 –0.3 –0.2 –0.4 Change (2018 less 2017)1,* 35.4 30.9 35.9 26.3 34.1 33.3 41.9 26.6 37.5 42.6 33.6 35.7 32.3 41.5 40.9 40.2 36.8 33.3 34.6 34.8 0.3 0.8 1.0 1.0 0.3 0.3 0.9 1.2 0.7 1.2 0.3 0.6 0.4 5.2 0.6 1.0 0.6 0.3 0.4 0.3 Margin Per- of error² cent (±) 2017 34.9 31.2 36.4 26.2 33.8 33.2 41.2 26.1 36.5 42.4 33.2 35.3 32.0 42.4 40.6 38.0 35.6 32.9 34.4 34.4 0.3 0.7 1.0 1.0 0.3 0.3 0.9 1.1 0.8 1.2 0.4 0.6 0.5 4.6 0.5 1.0 0.7 0.4 0.4 0.3 Margin Per- of error² cent (±) 2018 Public health insurance⁴ *–0.5 0.2 0.5 –0.1 –0.3 –0.1 –0.7 –0.5 *–1.0 –0.2 –0.4 –0.5 –0.3 0.8 –0.3 *–2.1 *–1.2 *–0.4 –0.2 *–0.4 Change (2018 less 2017)1,* 6.4 17.4 7.8 26.2 7.7 5.2 9.3 6.4 16.2 8.1 7.9 9.6 6.9 11.7 10.4 4.5 4.8 7.3 7.3 7.9 0.2 0.6 0.6 1.0 0.2 0.2 0.5 0.7 0.6 0.5 0.2 0.4 0.2 2.6 0.4 0.4 0.3 0.2 0.2 0.2 Margin Per- of error² cent (±) 2017 6.8 18.9 8.8 28.6 8.2 5.4 9.7 6.8 17.8 9.1 8.4 9.6 7.7 13.1 11.1 5.2 5.3 7.9 7.6 8.5 0.2 0.6 0.6 1.0 0.2 0.2 0.5 0.6 0.6 0.7 0.2 0.4 0.2 3.4 0.4 0.5 0.3 0.2 0.3 0.2 Margin Per- of error² cent (±) 2018 Uninsured⁵ *0.4 *1.6 *0.9 *2.3 *0.6 0.2 0.4 0.5 *1.6 *1.0 *0.5 Z *0.7 1.4 *0.6 *0.7 *0.4 *0.5 *0.3 *0.5 Change (2018 less 2017)1,* * Changes between the estimates are statistically different from zero at the 90 percent confidence level. Z Represents or rounds to zero. ¹ Details may not sum to totals because of rounding. 2 A margin of error (MOE) is a measure of an estimate’s variability. The larger the MOE in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. MOEs shown in this table are based on standard errors calculated using replicate weights. For more information, see “Standard Errors and Their Use” at . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) and care provided by the Department of Veterans Affairs and the military. ⁵ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. ⁶ The “Outside metropolitan statistical areas” category includes both micropolitan statistical areas and territory outside of metropolitan and micropolitan statistical areas. For more information, see “About Metropolitan and Micropolitan Statistical Areas” at . ⁷ Federal surveys now 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). This table shows data using the first approach (race alone). The 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. Information on people who reported more than one race, such as White and American Indian and Alaska Native or Asian and Black or African American, is available from the 2010 Census through American FactFinder. About 2.9 percent of people reported more than one race in the 2010 Census. Data for American Indians and Alaska Natives, Native Hawaiians and Other Pacific Islanders, and those reporting two or more races are not shown separately. 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement. 277,848 45,820 22,296 23,524 247,472 194,679 42,758 19,770 59,925 42,300 43,032 1,069 61,264 1,113 60,419 Race⁷ and Hispanic Origin White. . . . . . . . . . . . . . . . . . . .  White, not Hispanic. . . . . Black . . . . . . . . . . . . . . . . . . . . Asian . . . . . . . . . . . . . . . . . . . . Hispanic (any race). . . . . . . . 22,720 22,922 281,369 104,716 176,653 71,750 71,971 279,458 103,823 175,635 261,336 83,508 323,668 Number 2018 260,958 83,539 322,490 Number 2017 Residence Inside metropolitan  statistical areas. . . . . . . . . .  Inside principal cities. . . .  Outside principal cities. . Outside metropolitan  statistical areas6 . . . . . . . . . Family Status In families. . . . . . . . . . . . . . . .  Householder . . . . . . . . . . .   Related children    under age 18. . . . . . . .    Related children     under age 6. . . . . . . In unrelated  subfamilies. . . . . . . . . . . . . . Unrelated individuals. . . . . .    Total. . . . . . . . . . . . . . Characteristic /techdocs/cpsmar19.pdf>) (Numbers in thousands. Margins of errors in percentage points. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . In 2018, 73.1 percent of Asians and 55.4 percent of Blacks had private coverage. Rates of public coverage followed a different pattern than private coverage rates. In 2018, the public coverage rate was the highest for Blacks (41.2 percent), followed by Hispanics (36.5 percent), and non-Hispanic Whites (33.2 percent). Asians had the lowest rate of health insurance coverage through public programs, at 26.1 percent in 2018. Between 2017 and 2018, the overall health insurance coverage rate decreased by 1.6 percentage points for Hispanics, but did not statistically change for the other three race groups.40 Hispanics experienced decreases in both their private coverage rate (1.1 percentage points) and public coverage rate (1.0 percentage point) between 2017 and 2018.41 Neither the rates of private coverage nor public coverage changed for any other race group during this time. Health insurance status is also related to nativity. In 2018, the overall health 40 The small sample size of the Asian population and the fact that the CPS 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 may be unable to detect statistically significant differences between some estimates for the Asian population. The ACS, based on a larger sample of the population, is a better source for estimating and identifying changes for small subgroups of the population. 41 Changes in overall coverage, private coverage, and public coverage for Hispanics were not statistically different from one another. 16 Health Insurance Coverage in the United States: 2018 insurance coverage rate for the native-born population (93.2 percent) was larger than that of the foreignborn population (81.1 percent), which includes naturalized citizens (91.2 percent) and noncitizens (71.4 percent) (Table 5). These coverage rates were all statistically lower than the rates in 2017. Specifically, between 2017 and 2018, the percentage of the native-born population with health insurance coverage decreased by 0.4 percentage points. Public coverage decreased 0.5 percentage points for the nativeborn population, and private coverage did not statistically change.42 The foreign-born population experienced a 1.6 percentage-point decrease in their overall coverage. This was driven by a 1.6 percentagepoint decrease in private coverage; the public coverage rate for the foreign-born population did not statistically change.43 State Estimates of Health Insurance Coverage The ACS, which has a larger sample size than the CPS ASEC, provides an estimate of health insurance coverage at the time of the interview (see text box, “Health Insurance Coverage in the American Community Survey”). The larger sample size offers an 42 The change in overall coverage for the native-born population was not statistically different from their change in public coverage. 43 The change in overall coverage for the foreign-born population was not statistically different from their change in private coverage. U.S. Census Bureau opportunity to look at coverage rates for smaller geographies, such as for all 50 states and the District of Columbia. During 2018, the percentage of people without health insurance at the time of interview ranged from 2.8 percent (Massachusetts) to 17.7 percent (Texas) (Figure 8 and Table 6).44 Six states and the District of Columbia had an uninsured rate of less than 5.0 percent, and six states had an uninsured rate of 12.0 percent or more.45 The remainder of states had uninsured rates between 5.0 percent and 11.9 percent in 2018. Between 2017 and 2018, the percentage of people without health insurance coverage decreased in three states and increased in eight states (Figure 9 and Table 6). The magnitude of decreases were 1.8 percentage points (Wyoming), 0.5 percentage points (South Carolina), and 0.3 percentage points (New York).46 All increases were 1.0 percentage-point or less. Thirty-nine states and the District of Columbia did not have a statistically significant change in their uninsured rate.47 Health Insurance Coverage in the American Community Survey This report presents state-level estimates of health insurance coverage using data from the American Community Survey (ACS). The ACS is an ongoing survey that collects comprehensive information on social, economic, and housing topics. Due to its large sample size, the ACS provides estimates at many levels of geography and for smaller population groups. The ACS asks respondents to report their coverage at the time of interview, and the Census Bureau conducts the ACS throughout the year. The resulting measure of health coverage, therefore, reflects an annual average of current health insurance coverage status. This uninsured rate measures a different concept than the CPS ASEC measures. The ACS also allows us to view uninsured rates over a longer time period than the CPS ASEC (see Appendix A). As measured by the ACS, uninsured rates remained relatively stable between 2008 and 2013, but decreased sharply by 2.8 percentage points between 2013 and 2014 (Figure 7). Uninsured rates then decreased by 2.3 percentage points between 2014 and 2015 and 0.8 percentage points between 2015 and 2017. Between 2017 and 2018, the uninsured rate increased by 0.1 percentage points. Figure 7. Uninsured Rate: 2008 to 2018 18 Percent 16 14 44 The percentage of people without health insurance coverage in Massachusetts (2.8 percent) was not statistically different from the percentage without coverage in the District of Columbia (3.2 percent). 45 Consistent with Figure 8, classification into these categories is based on rounded uninsured rates. 46 The percentage-point decreases in Wyoming, South Carolina, and New York were not statistically different from one another. 47 After the release of the 2017 data products, the Census Bureau identified issues with data collection in Delaware. As a result, comparisons between 2017 and 2018 for Delaware are not made in this report. For more information, see . 12 10 8 6 4 2 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Note: Estimates reflect the population as of July of the calendar year. For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2008 to 2018 American Community Surveys, 1-Year Estimates. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 17 As part of the Patient Protection and Affordable Care Act, 31 states and the District of Columbia expanded Medicaid eligibility on or before January 1, 2018. (“expansion states”), the uninsured rate in 2018 was 6.6 percent, compared with 12.4 percent in states that did not expand Medicaid eligibility (“non-expansion states”). This rate is not statistically different from the 2017 rate for expansion states but is 0.2 percentage points higher than the 2017 rate in non-expansion states. In general, the uninsured rate in states that expanded Medicaid eligibility prior to January 1, 2018, was lower than in states that did not expand eligibility (Figure 8). In states that expanded Medicaid eligibility national average, while many nonexpansion states had uninsured rates above the national average (Figure 9). In 2018, the uninsured rates by state ranged from 2.8 percent to 12.6 percent in expansion states, and from 5.5 percent to 17.7 percent in nonexpansion states. Many Medicaid expansion states had uninsured rates lower than the Figure 8. Uninsured Rate by State: 2018 AK 0 (Civilian noninstitutionalized population) 500 Miles WA MT OR MN ID NH WI SD UT IN IL AZ OK NM MO ! ! TX ! 0 ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! DC NC TN SC GA LA 0 ! ! FL HI MD ! ! VA AR AL ! ! KY MS DE !! WV RI NJ OH CO KS CT PA IA NE NV MA NY MI WY CA ME VT ND Percent without health insurance coverage 12.0 or more 9.0 to 11.9 7.0 to 8.9 5.0 to 6.9 Less than 5.0 100 Miles 100 Miles A state with a circle around its abbreviation expanded Medicaid eligibility on or before January 1, 2018. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2018 American Community Survey, 1-Year Estimates. 18 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau Table 6. Number and Percentage of People Without Health Insurance Coverage by State: 2017 and 2018 (Numbers in thousands. Civilian noninstitutionalized population. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see ) 2017 uninsured State Medicaid expansion state?¹ Number Margin of error² (±) Percent    United States . . . 2018 uninsured Margin of error² (±) Number Margin of error² (±) Percent Difference in uninsured Margin of error² (±) Number Margin of error² (±) Percent Margin of error² (±) 28,019 188 8.7 0.1 28,554 182 8.9 0.1 *535 262 *0.1 0.1 Alabama. . . . . . . . . . . . . . Alaska . . . . . . . . . . . . . . . . Arizona . . . . . . . . . . . . . . . Arkansas. . . . . . . . . . . . . . California. . . . . . . . . . . . . . Colorado. . . . . . . . . . . . . . Connecticut. . . . . . . . . . . Delaware. . . . . . . . . . . . . . District of Columbia. . . . Florida. . . . . . . . . . . . . . . . No +Yes Yes Yes Yes Yes Yes Yes Yes No 449 98 695 232 2,797 414 194 N 26 2,676 16 6 20 10 34 13 12 N 4 43 9.4 13.7 10.1 7.9 7.2 7.5 5.5 N 3.8 12.9 0.3 0.8 0.3 0.3 0.1 0.2 0.3 N 0.6 0.2 481 90 750 244 2,826 422 187 54 22 2,728 15 6 24 10 43 17 11 6 3 40 10.0 12.6 10.6 8.2 7.2 7.5 5.3 5.7 3.2 13.0 0.3 0.9 0.3 0.3 0.1 0.3 0.3 0.7 0.5 0.2 *32 –8 *55 12 29 8 –7 N –4 52 22 9 31 14 55 22 16 N 5 59 *0.6 –1.0 *0.6 0.4 0.1 Z –0.2 N –0.6 0.1 0.5 1.2 0.4 0.5 0.1 0.4 0.5 N 0.8 0.3 Georgia. . . . . . . . . . . . . . . Hawaii . . . . . . . . . . . . . . . . Idaho. . . . . . . . . . . . . . . . . Illinois. . . . . . . . . . . . . . . . . Indiana. . . . . . . . . . . . . . . . Iowa. . . . . . . . . . . . . . . . . . Kansas. . . . . . . . . . . . . . . . Kentucky. . . . . . . . . . . . . . Louisiana. . . . . . . . . . . . . . Maine. . . . . . . . . . . . . . . . . No Yes No Yes +Yes Yes No Yes #Yes No 1,375 53 172 859 536 146 249 235 383 107 29 5 9 23 18 8 11 12 13 6 13.4 3.8 10.1 6.8 8.2 4.7 8.7 5.4 8.4 8.1 0.3 0.4 0.5 0.2 0.3 0.3 0.4 0.3 0.3 0.5 1,411 56 193 875 545 147 250 248 363 106 29 5 11 22 19 9 10 11 13 6 13.7 4.1 11.1 7.0 8.3 4.7 8.8 5.6 8.0 8.0 0.3 0.4 0.6 0.2 0.3 0.3 0.4 0.3 0.3 0.5 36 3 *21 15 9 1 1 12 *–19 –1 41 7 14 32 26 12 15 17 19 9 0.2 0.2 *1.0 0.2 0.1 Z Z 0.3 –0.4 –0.1 0.4 0.5 0.8 0.3 0.4 0.4 0.5 0.4 0.4 0.7 Maryland. . . . . . . . . . . . . . Massachusetts. . . . . . . . . Michigan. . . . . . . . . . . . . . Minnesota. . . . . . . . . . . . . Mississippi. . . . . . . . . . . . . Missouri. . . . . . . . . . . . . . . Montana . . . . . . . . . . . . . . Nebraska. . . . . . . . . . . . . . Nevada . . . . . . . . . . . . . . . New Hampshire. . . . . . . . Yes Yes ^Yes Yes No No +Yes No Yes ^Yes 366 190 510 243 352 548 88 157 333 77 15 10 15 11 15 17 6 7 13 5 6.1 2.8 5.2 4.4 12.0 9.1 8.5 8.3 11.2 5.8 0.2 0.1 0.2 0.2 0.5 0.3 0.5 0.4 0.4 0.4 357 189 535 244 354 566 86 158 336 77 15 11 14 10 12 18 5 8 13 5 6.0 2.8 5.4 4.4 12.1 9.4 8.2 8.3 11.2 5.7 0.2 0.2 0.1 0.2 0.4 0.3 0.5 0.4 0.4 0.4 –9 –1 *25 2 2 18 –2 1 4 Z 21 15 21 14 19 24 8 11 18 7 –0.1 Z *0.2 Z 0.1 0.3 –0.2 Z Z –0.1 0.4 0.2 0.2 0.3 0.6 0.4 0.7 0.6 0.6 0.5 New Jersey. . . . . . . . . . . . New Mexico . . . . . . . . . . . New York. . . . . . . . . . . . . . North Carolina. . . . . . . . . North Dakota. . . . . . . . . . Ohio. . . . . . . . . . . . . . . . . . Oklahoma. . . . . . . . . . . . . Oregon . . . . . . . . . . . . . . . Pennsylvania . . . . . . . . . . Rhode Island . . . . . . . . . . Yes Yes Yes No Yes Yes No Yes ^Yes Yes 688 187 1,113 1,076 56 686 545 281 692 48 17 12 27 24 5 22 12 12 21 4 7.7 9.1 5.7 10.7 7.5 6.0 14.2 6.8 5.5 4.6 0.2 0.6 0.1 0.2 0.6 0.2 0.3 0.3 0.2 0.4 655 196 1,041 1,092 54 744 548 293 699 42 21 12 24 25 4 20 13 13 17 5 7.4 9.5 5.4 10.7 7.3 6.5 14.2 7.1 5.5 4.1 0.2 0.6 0.1 0.2 0.6 0.2 0.3 0.3 0.1 0.5 *–33 9 *–72 16 –2 *58 3 12 7 –6 27 17 36 34 6 30 17 17 27 7 –0.3 0.4 *–0.3 Z –0.3 *0.5 Z 0.2 0.1 –0.5 0.3 0.8 0.2 0.3 0.9 0.3 0.5 0.4 0.2 0.6 South Carolina. . . . . . . . . South Dakota. . . . . . . . . . Tennessee. . . . . . . . . . . . . Texas . . . . . . . . . . . . . . . . . Utah. . . . . . . . . . . . . . . . . . Vermont . . . . . . . . . . . . . . Virginia . . . . . . . . . . . . . . . Washington . . . . . . . . . . . West Virginia. . . . . . . . . . Wisconsin. . . . . . . . . . . . . Wyoming . . . . . . . . . . . . . No No No No No Yes No Yes Yes No No 542 77 629 4,817 282 28 729 446 109 309 70 17 5 19 48 12 3 21 15 7 11 7 11.0 9.1 9.5 17.3 9.2 4.6 8.8 6.1 6.1 5.4 12.3 0.3 0.6 0.3 0.2 0.4 0.4 0.3 0.2 0.4 0.2 1.2 522 85 675 5,003 295 25 731 477 114 313 59 19 5 21 60 17 3 21 15 8 11 5 10.5 9.8 10.1 17.7 9.4 4.0 8.8 6.4 6.4 5.5 10.5 0.4 0.6 0.3 0.2 0.5 0.5 0.3 0.2 0.4 0.2 0.9 –19 *7 *46 *186 14 –3 2 *31 5 4 *–10 25 7 28 77 21 4 30 21 11 15 8 *–0.5 0.7 *0.6 *0.4 0.3 –0.5 Z *0.3 0.3 Z *–1.8 0.5 0.8 0.4 0.3 0.7 0.6 0.4 0.3 0.6 0.3 1.5 * Statistically different from zero at the 90 percent confidence level. ^ Expanded Medicaid eligibility after January 1, 2014, and on or before January 1, 2015. + Expanded Medicaid eligibility after January 1, 2015, and on or before January 1, 2016. # Expanded Medicaid eligibility after January 1, 2016, and on or before January 1, 2017. N Not available or not comparable. After the release of the 2017 data products, the Census Bureau identified issues with data collection in Delaware. As a result, 2017 estimates for Delaware are omitted from this table. For more information, see . Z Represents or rounds to zero. ¹ Medicaid expansion status as of January 1, 2018. For more information, see . ² Data are based on a sample and are subject to sampling variability. A margin of error is a measure of an estimate’s variability. The larger the margin of error is in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. Note: Differences are calculated with unrounded numbers, which may produce different results from using the rounded values in the table. Source: U.S. Census Bureau, 2017 and 2018 American Community Survey, 1-Year Estimates. U.S. Census Bureau Health Insurance Coverage in the United States: 2018 19 Figure 9. Change in the Uninsured Rate by State: 2017 and 2018 (Civilian noninstitutionalized population. States with names in bold experienced a statistically significant change between 2017 and 2018) 1 1 Massachusetts District of Columbia 1 Vermont 1 Hawaii 1 Rhode Island 2018 2017 16 18 Minnesota 1 Iowa Connecticut 1 New York 2 Michigan 1 1 Wisconsin Pennsylvania 1 Kentucky 1, 5 Delaware 2 New Hampshire 2 1 1 Maryland West Virginia 1 Washington 1 Ohio 1 Illinois 1 Oregon California 1 North Dakota 1 New Jersey 1 Colorado 1 Louisiana Maine Montana 1 Arkansas 3 Indiana 4 3 Nebraska Kansas Virginia United States Missouri Utah 1 New Mexico South Dakota Alabama Tennessee Wyoming South Carolina 1 Arizona North Carolina Idaho 1 Nevada Mississippi Alaska Florida Georgia Oklahoma Texas 3 0 2 4 6 8 10 12 14 20 Percent Expanded Medicaid eligibility as of January 1, 2014. Expanded Medicaid eligibility after January 1, 2014, and on or before January 1, 2015. 3 Expanded Medicaid eligibility after January 1, 2015, and on or before January 1, 2016. 4 Expanded Medicaid eligibility after January 1, 2016, and on or before January 1, 2017. 5 After the release of the 2017 data products, the Census Bureau identified issues with data collection in Delaware. As a result, 2017 estimates for Delaware are omitted from this figure. For more information, see . Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2017 and 2018 American Community Survey, 1-Year Estimates. 1 2 20 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau More Information About Health Insurance Coverage Additional Data and Contacts Detailed tables, historical tables, press releases, and briefings are available on the Census Bureau’s Health Insurance Web site. The Web site can be accessed at . Microdata are available for download on the Census Bureau’s Web site. Disclosure protection techniques have been applied to CPS microdata to protect respondent confidentiality. 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 ACS. Single-year estimates are available for geographic units with populations 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 states and all counties. These estimates are based on models using data from a variety of sources, including current surveys, administrative records, and intercensal 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 are available at . The most recent estimates are for 2017. U.S. Census Bureau 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, please write to: Sharon Stern Assistant Division Chief, Employment Characteristics Social, Economic, and Housing Statistics Division U.S. Census Bureau Washington, DC 20233-8500 or e-mail . Sources of Estimates The majority of the estimates in this report are from the 2018 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) Bridge File and the 2019 CPS ASEC. Data were collected in the 50 states and the District of Columbia.48 These data do not represent residents of Puerto Rico and the U.S. Island Areas.49 These data are based on a sample of about 95,000 addresses. The estimates in this report are controlled to independent national population estimates by age, sex, race, and Hispanic origin for March of the year in which the data are collected. Beginning with 2010, estimates are based on 2010 Census population counts and are updated annually taking into account births, deaths, emigration, and immigration. 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 48 For more information on the 2018 CPS ASEC Bridge File, see Appendix A. 49 The U.S. Island Areas include American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the Virgin Islands of the United States. 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 sample universe for the CPS ASEC is slightly larger than that of the basic CPS since it 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 are excluded. For further documentation about the CPS ASEC, see . Additional estimates in this report are from the American Community Survey (ACS). The ACS is an ongoing, nationwide survey designed to provide demographic, social, economic, and housing data at different levels of geography. While the ACS includes Puerto Rico and the group quarters population, the ACS data in this report focus on the civilian noninstitutionalized population of the United States (excluding Puerto Rico and some people living in group quarters). It has an annual sample size of about 3.5 million addresses. For information on the ACS sample design and other topics, visit . Statistical Accuracy The estimates in this report (which may be shown in text, figures, and tables) are based on responses from a sample of the population. Sampling error is the uncertainty between an Health Insurance Coverage in the United States: 2018 21 estimate based on a sample and the corresponding value that would be obtained if the estimate were based on the entire population (as from a census). All comparative statements in this report have undergone statistical testing, and comparisons are significant at the 90 percent confidence level unless otherwise noted. Data are subject to error arising from a variety of sources. Measures of sampling error are provided in the form of margins of error, or confidence intervals, for all estimates included in this report. In addition to sampling error, nonsampling error may be introduced during any of the operations used to collect and process survey data, such as editing, reviewing, or keying data from questionnaires. In this report, the variances of estimates were calculated using the Fay and Train (1995) Successive Difference Replication (SDR) method. Most of the data from the 2019 CPS ASEC were collected in March (with some data collected in February and April). Each year, the CPS ASEC sample ranges between 92,000 and 100,000 addresses. In 2019, the CPS ASEC sample had 95,000 addresses. Further information about the source and accuracy of the CPS ASEC estimates is available at . 22 Health Insurance Coverage in the United States: 2018 The remaining data presented in this report are based on the ACS sample collected from January 2018 through December 2018. For more information on sampling and estimation methods, confidentiality protection, and sampling and non­ sampling errors, please see the 2018 ACS Accuracy of the Data document located at . U.S. Census Bureau U.S. Census Bureau Health Insurance Coverage in the United States: 2018 23 2018 2017 2018 Total 2017 2018 Private health insurance3 Any health insurance 2017 2018 Public health insurance⁴ 2017 2018 Uninsured⁵ 616 243,910 285 73,052 511 170,857 301 25,105 301 35,082 182 35,915 312 74,754 212 52,296 Age Under age 65. . . . . . . . . . . 271,424 270,881 246,320  Under age 19⁶. . . . . . . . 77,487 77,333 73,631  Aged 19 to 64. . . . . . . . 193,937 193,548 172,689   Aged 19 to 25⁷. . . . . 29,811 29,297 25,741   Aged 26 to 34. . . . . . 40,222 40,768 34,600   Aged 35 to 44. . . . . . 40,662 41,027 36,013   Aged 45 to 64. . . . . . 83,242 82,455 76,334 Aged 65 and older. . . . . . 51,066 52,788 50,570 -684 218,209 1,129 217,780 1,222 671 *–2,410 190,775 1,001 190,109 1,173 284 *–579 47,743 509 47,817 541 577 *–1,831 143,032 725 142,291 795 252 *–636 20,873 304 20,492 300 273 *482 28,311 340 29,084 355 209 –98 30,480 258 30,252 261 344 *–1,580 63,367 422 62,462 450 261 *1,726 27,435 471 27,671 411 641 –666 74 –740 –380 *773 –228 *–905 236 64,059 28,636 35,424 5,606 7,450 6,624 15,743 48,092 -430 112,151 883 482 590 205 249 227 353 241 61,683 27,578 34,104 5,366 7,127 6,665 14,945 49,647 928 111,330 -821 929 *–2,377 529 *–1,057 610 *–1,319 212 –240 239 *–323 213 42 356 *–798 280 *1,556 962 25,104 3,856 21,248 4,070 5,621 4,649 6,908 496 25,600 575 235 455 183 202 181 273 69 596 26,971 4,281 22,690 4,192 5,686 5,112 7,701 491 27,462 619 222 521 195 214 207 254 66 630 *1,867 *425 *1,442 122 65 *463 *792 –4 *1,862 * Changes between the estimates are statistically different from zero at the 90 percent confidence level. ¹ Details may not sum to totals because of rounding. ² A margin of error (MOE) is a measure of an estimate’s variability. The larger the MOE in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. MOEs shown in this table are based on standard errors calculated using replicate weights. For more information, see “Standard Errors and Their Use” at . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. ⁵ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. ⁶ Children under the age of 19 are eligible for Medicaid/CHIP. ⁷ Individuals aged 19 to 25 years may be eligible to be a dependent on a parent’s health insurance plan. 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement.. 622 296,206 Margin Margin Change Margin Margin Change Margin Margin Change Margin Margin Change of of (2018 of of (2018 of of (2018 of of (2018 error² error² less error² error² less error² error² less error² error² less 1, 1, 1, Number Number Number (±) Number (±) 2017) * Number (±) Number (±) 2017) * Number (±) Number (±) 2017) * Number (±) Number (±) 2017)1,* 2017 322,490 323,668 296,890    Total. . . . . . . . . . . Characteristic /cpsmar19.pdf>) (Numbers in thousands. Margins of error in thousands. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. 4 Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. Educational Attainment No high school  diploma. . . . . . . . . . . . . . . High school  graduate (includes  equivalency) . . . . . . . . . . Some college, no  degree. . . . . . . . . . . . . . . . Associate’s degree. . . . . . Bachelor’s degree. . . . . . . Graduate or  professional degree. . . . Total, 26 to 64  years old . . . . . . . . . . . . . Marital Status Married7. . . . . . . . . . . . . . . . 102,487 101,805 Widowed. . . . . . . . . . . . . . . 3,331 3,385 Divorced. . . . . . . . . . . . . . . 19,241 18,683 Separated. . . . . . . . . . . . . . 4,249 4,200 Never married. . . . . . . . . . 64,629 65,475 93,342 2,921 16,255 3,365 54,976 48,286 586 Total, 19 to 64  years old . . . . . . . . . . . . . 795 145 387 157 565 440 37,290 534 193,937 193,548 172,689 707 674 101,329 545 693 694 138,618 Work Experience All workers. . . . . . . . . . . . . 154,657 155,221 139,401  Worked full-time,   year-round. . . . . . . . . . 109,932 111,950 100,445  Worked less   than full-time,   year-round. . . . . . . . . . 44,725 43,271 38,956 Did not work at  least 1 week. . . . . . . . . . . 56,436 55,573 49,407 339 700 641 322,490 323,668 296,890 Margin Margin of of error² error² Number Number Number (±) Number (±) 2017 622 296,206    Total. . . . . . . . . . . . Total, 15 to 64  years old . . . . . . . . . . . . . Characteristic /cpsmar19.pdf>) (Numbers in thousands. Margins of error in thousands. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. ⁴ Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. ⁵ Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. 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. Source: U.S. Census Bureau, Current Population Survey, 2018 Annual Social and Economic Supplement Bridge File and 2019 Annual Social and Economic Supplement.. Income-to-Poverty  Ratio Total, poverty universe. . 321,907 323,172 296,348 632 295,757 643 Below 100 percent of  poverty. . . . . . . . . . . . . . . . 39,431 38,056 33,168 768 31,844 696 Below 138 percent of  poverty. . . . . . . . . . . . . . . . 60,694 58,204 51,469 921 49,122 783 Between 100 and 199  percent of poverty. . . . . . 55,850 55,302 48,591 966 47,783 936 Between 200 and 299  percent of poverty. . . . . . 50,666 50,632 45,260 813 45,162 778 Between 300 and 399  percent of poverty. . . . . . 42,721 43,624 39,671 841 40,078 719 At or above 400  percent of poverty. . . . . . 133,239 135,559 129,659 1,400 130,890 1,237 Household Income  Less than $25,000 . . . . .  $25,000 to $49,999. . . .  $50,000 to $74,999. . . .  $75,000 to $99,999. . . .  $100,000 to $124,999. .  $125,000 to 149,999. . .  $150,000 or more. . . . . .    Total. . . . . . . . . . . . Characteristic /cpsmar19.pdf>) (Numbers in thousands. Margins of error in thousands. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . 3 Private health insurance includes coverage provided through an employer or union, coverage purchased directly, or TRICARE. 4 Public health insurance coverage includes Medicaid, Medicare, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), and care provided by the Department of Veterans Affairs and the military. 5 Individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. 6 The “Outside metropolitan statistical areas” category includes both micropolitan statistical areas and territory outside of metropolitan and micropolitan statistical areas. For more information, see “About Metropolitan and Micropolitan Statistical Areas” at . 277,057 277,848 259,349 45,433 45,820 37,541 21,880 22,296 20,162 23,553 23,524 17,379 527 413 212 235 352 38,442 2,404 500 227,127 395 184,107 212 38,618 237 18,422 363 49,236 39,542 2,558 Nativity Native-born . . . . . . . . . . . . . . Foreign-born. . . . . . . . . . . . .  Naturalized citizen. . . . . .  Not a citizen. . . . . . . . . . . . 42,300 247,193 247,472 228,272 195,183 194,679 185,061 42,461 42,758 38,525 19,498 19,770 18,257 59,033 59,925 49,469 43,032 279,458 281,369 257,348 2,610 257,764 2,584 103,823 104,716 93,869 1,877 94,638 1,825 175,635 176,653 163,480 2,458 163,126 2,373 71,750 71,971 260,958 261,336 241,786 83,539 83,508 77,427 Race⁷ and Hispanic  Origin White . . . . . . . . . . . . . . . . . . .  White, not Hispanic. . . . . Black . . . . . . . . . . . . . . . . . . . . Asian . . . . . . . . . . . . . . . . . . . . Hispanic (any race). . . . . . . . Residence Inside metropolitan statistical areas. . . . . . . . . .  Inside principal cities. . . .  Outside principal cities. . Outside metropolitan statistical areas6. . . . . . . . . . Family Status In families. . . . . . . . . . . . . . . .  Householder . . . . . . . . . . .   Related children    under age 18. . . . . . . .   Related children    under age 6. . . . . . . . . In unrelated subfamilies . . . Unrelated individuals. . . . . . 2018 Margin Margin of of error² error² Number Number Number (±) Number (±) 2017    Total. . . . . . . . . . . . . . 322,490 323,668 296,890 Characteristic /cpsmar19.pdf>) (Numbers in thousands. Margins of errors in thousands. Population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see . 2 See J. A. Klerman, M. Davern, K. T. Call, V. Lynch, and J. D. Ringel, “Understanding the Current Population Survey’s Insurance Estimates and the Medicaid ‘Undercount,’” Health Affairs, Web Exclusive: w991-w1001, 2009. 3 See K. Call, M. Davern, J. Klerman, and V. Lynch, “Comparing Errors in Medicaid Reporting across Surveys: Evidence to Date,” Health Services Research, 48:652–664, 2013. U.S. Census Bureau To ensure that data from the updated collection methods were released on schedule, the data were initially extracted and processed using legacy procedures. That is, estimates released from the CPS ASEC for calendar years 2013 through 2017 reflected questionnaire changes, but did not take full advantage of the new questionnaire content in data processing. While data collection methods reflected these changes immediately, data processing changes to take full advantage of this new content have only recently been finalized. The second phase of implementation, which occurred in 2019, updated the processing system that imputes missing data, determines family relationships (including among same-sex couples), and constructs key health insurance measures. Specifically, for health insurance coverage estimates, the updates to data processing include: (1) a refinement of the population that the health insurance estimates describe to exclude infants who were born after the end of the See the infographic “Improving Health Insurance Coverage Measurement: 1998-2014, A History of Research and Testing” at . 5 For more information, see J. Rothbaum, “Changes to Income Processing in the CPS ASEC” at . 4 calendar-year reference period, (2) an improvement to the imputation process for households with incomplete and missing data, (3) the ability to construct and release new measures, including about marketplace coverage, and (4) the use of subannual measures to capture when in the calendar year a person had health insurance coverage. These changes mean that files based on these processing updates reflect different types of coverage in their definitions of public, private, and military health insurance coverage. As such, they are not directly comparable to previously released files. In April 2019, the Census Bureau released a rerun of 2018 CPS ASEC public-use data using the updated processing system. These data had previously been released in September 2018 using the legacy edit procedures. The April 2019 release was accompanied by several working papers, notes, and tables summarizing differences in estimates from the two processing systems. Public-use metadata files, a data dictionary, and supplemental technical documentation is available on the Census Bureau Web site. Similar resources were released for the 2017 CPS ASEC.6 Evaluation of the updated processing system documented improvements in data quality.7 In particular, the estimate of the uninsured population with the updated processing system is lower than in the preceding CPS ASEC, as the updated processing system is designed to take full advantage of additional information on coverage. 6 For more information, see . 7 For more information, see E.R. Berchick and H.M. Jackson, “Health Insurance Coverage in the 2017 CPS ASEC Research File,” SEHSD Working Paper WP2019-01, 2019 at . Health Insurance Coverage in the United States: 2018 27 Comparisons between 2017 and 2018 estimates in this report are based on estimates derived from the updated processing system. In some cases, the 2017 estimates in this report diverge from the estimates published in the Health Insurance Coverage in the United States: 2017 report released September 2018, which were produced using the legacy processing system. As seen in the timeline below, this two-stage redesign of CPS ASEC health insurance information is part of a longer history of improvement spanning decades. Historical Comparisons Researchers should use caution when comparing results over time. Due to the differences in measurement, health insurance estimates for calendar year 2013 through 2017 are not directly comparable to previous years. Estimates for calendar year 2018 should only be compared with 2017 estimates from the 2018 CPS ASEC Bridge File or 2016 estimates from the 2017 CPS ASEC Research File. It is not appropriate to compare 2018 estimates with earlier years processed with the legacy system.8 Two data files can be used to provide estimates of health insurance coverage in 2017, namely the 2018 CPS ASEC and the 2018 CPS ASEC Bridge File. The 2018 CPS ASEC is 8 Data users may also compare 2019 CPS ASEC and 2018 CPS ASEC Bridge File estimates with 2017 CPS ASEC Research File estimates. However, due to a number of differences described on the Census Bureau Web site, users should use caution in making these comparisons. Figure A1. Measuring Health Insurance Coverage With the Current Population Survey Annual Social and Economic Supplement (CPS ASEC): A History of Improvement 18 16 Percent without insurance 1 3 14 12 2 4 10 8 5 6 4 2 0 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017 Changes in processing steps 1. People with no coverage other than access to Indian Health Service now considered uninsured. Overall estimates of health insurance coverage change only negligibly; however, the increase in the number of people covered by Medicaid may be partially due to this change. 3. These estimates from the 2005 CPS ASEC were revised based on improvements to the algorithm that assigned coverage to dependents, and there was an adjustment to the weights. 5. Updated processing system implemented to take full advantage of the 2014 CPS ASEC instrument redesign. Change to survey instrument 2. Follow-up verification question added. 4. Health insurance questions were redesigned to address underreport of coverage. Estimates of overall coverage and coverage types are not comparable with later years. Note: CPS measures prior-year coverage, e.g., 1997 statistics come from the 1998 CPS. For more information on the history of improvement to CPS ASEC health insurance content, see . Source: U.S. Census Bureau, 2017 CPS ASEC Research File, 2018 CPS ASEC Bridge File, 2019 CPS ASEC, Table HI-1. Health Insurance Coverage Status and Type of Coverage by Sex, Race, and Hispanic Origin: 1987 to 2005, . Health Insurance Historical Tables—HIB Series, . 28 Health Insurance Coverage in the United States: 2018 U.S. Census Bureau List of Coverage Years Available and Source File Coverage years Files 1987–2012 1988 CPS ASEC–2013 CPS ASEC 2013–2017 2014 CPS ASEC–2018 CPS ASEC 2017–current 2018 CPS ASEC Bridge File; 2019+ CPS ASEC used to compare coverage estimates in 2013 through 2017 (using the 2014 through 2018 CPS ASEC). The 2018 CPS ASEC Bridge File is used to compare estimates from 2017 and later years (using the 2019 CPS ASEC forward). Estimates for health coverage in 2017 in this report come from the 2018 CPS ASEC Bridge File, while estimates in the previous report, Health Insurance Coverage in the United States: 2017, come from the 2018 CPS ASEC. U.S. Census Bureau Comparison of Estimates of Health Insurance Coverage in 2017, Traditional Processing System and Updated Processing System Data files produced with the two processing systems differ with respect to the population that the health insurance estimates describe; the imputation process for households with incomplete and missing data; and the availability of additional measures to capture more detailed information about coverage. Microdata files also include different types of coverage in their definitions of public, private, and military coverage. The updated processing system allows the report of TRICARE separate from VA and CHAMPVA coverage. In the 2018 CPS ASEC, private health insurance includes coverage provided through an employer or union, coverage purchased directly by an individual from an insurance company, or coverage through someone outside the household. In the 2018 CPS ASEC Bridge File, private health insurance also includes TRICARE. In the 2018 CPS ASEC, this type of coverage cannot be separated from other types of military coverage and is included with government coverage. Because of these improvements, coverage estimates are higher in the 2018 CPS ASEC Bridge File than in the 2018 CPS ASEC.9 Coverage rates significantly differ between the two files for all types of coverage. 9 For a comparison of estimates, see . Health Insurance Coverage in the United States: 2018 29 APPENDIX B. REPLICATE WEIGHTS Beginning in the 2011 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) report, the variance of CPS ASEC estimates used to calculate the standard errors and confidence intervals displayed in the text tables were calculated using the Successive Difference Replication (SDR) method.1 This method involves the computation of a set of replicate weights that account for the complex survey design of the CPS. The SDR method has been used to estimate variances in the American Community Survey since its inception. Before 2011, the standard errors of CPS ASEC estimates were calculated using a Generalized Variance Function (GVF) approach. Under this approach, generalized variance parameters were used in formulas provided in the 1 R. E. Fay and G. F. Train, “Aspects of Survey and Model-Based Postcensal Estimation of Income and Poverty Characteristics for States and Counties,” Proceedings of the Section on Government Statistics, American Statistical Association, Alexandria, VA, 1995, pp. 154–159. U.S. Census Bureau source and accuracy statement to estimate standard errors. One study found that the CPS ASEC GVF standard errors performed poorly against more precise Survey Design-Based (SDB) estimates.2 In most cases, results indicated that the published GVF parameters significantly underestimated standard errors in the CPS ASEC. This and other critiques prompted the U.S. Census Bureau to transition from using the GVF method of estimating standard errors to using the SDR method of estimating standard errors for the CPS ASEC. In 2009, the Census Bureau released replicate weights for the 2005 through 2009 CPS ASEC collection years and has released replicate weights for 2010 to 2019 with the release of the CPS ASEC public-use data, including for the 2017 Research File and 2018 Bridge File. 2 M. Davern, A. Jones, J. Lepkowski, G. Davidson, and L. A. Blewett, “Unstable Inferences? An Examination of Complex Survey Sample Design Adjustments Using the Current Population Survey for Health Services Research,” Inquiry, Vol. 43, No. 3, 2006, pp. 283–297. Following the 2009 release of CPS ASEC replicate weights, another study compared replicate weight standard error estimates with SDB estimates.3 Replicate weight estimates performed markedly better against SDB standard errors than those calculated using the published GVF parameters. Since the published GVF parameters generally underestimated standard errors, standard errors produced using SDR may be higher than in previous reports. For most CPS ASEC estimates, the increase in standard errors from GVF to SDR will not alter the findings. However, marginally significant differences using the GVF may not be significant using replicate weights. The Census Bureau will continue to provide the GVF parameters in the source and accuracy statement. 3 M. Boudreaux, M. Davern, and P. Graven, “Alternative Variance Estimates in the Current Population Survey and the American Community Survey,” presented at the 2011 Annual Meeting of the Population Association of America. Available at . Health Insurance Coverage in the United States: 2018 31 APPENDIX C. ADDITIONAL DATA AND CONTACTS Press releases, briefings, and data access are available on the U.S. Census Bureau’s Health Insurance Web site. The Web site may be accessed through the Census Bureau’s home page at or directly at . For assistance with health insurance data, contact the Census Bureau Customer Services Center at 1-800-923-8282 (tollfree), or search your topic of interest using the Census Bureau’s “Question and Answer Center” found at . Additional Tables The Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) along with the American Community Survey (ACS) are used to produce additional health insurance coverage tables. These tables are available on the Census Bureau’s Health Insurance Web site. The Web site may be accessed through the Census Bureau’s home page at or directly at . Customized Tables DATA.CENSUS.GOV Data.census.gov is the new platform to access data and digital content from the Census Bureau. It is the official source of data for the Census Bureau’s most popular surveys and programs such as the CPS, ACS, Decennial Census, Economic Census, and more. Through the centralized experience on data.census.gov, data users of all skill levels can search premade tables or create custom statistics from Public Use Microdata files. 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, upcoming improvements, and the retirement of older tools, such as American FactFinder, CPS Table Creator, and DataFerrett, check out the release U.S. Census Bureau notes and FAQs at . Public-Use Microdata CPS ASEC Microdata for the CPS ASEC is available online at . Data for the 2018 CPS ASEC Bridge File is available at . Technical methods have been applied to CPS microdata to avoid disclosing the identities of individuals from whom data were collected. ACS The ACS Public Use Microdata Sample files (PUMS) are a sample of the actual responses to the ACS and include most population and housing characteristics. These files provide users with the flexibility to prepare customized tabulations and can be used for detailed research and analysis. Files have been edited to protect the confidentiality of all individuals and of all individual households. The smallest geographic unit that is identified within the PUMS is the Public Use Microdata Area (PUMA). These data are available online at . Because the PUMS file is a sample of the ACS, estimates of health insurance coverage will differ slightly. Topcoding In the Census Bureau’s long history of releasing public-use microdata files based on the CPS ASEC, the Census Bureau has censored the release of “high dollar” amounts, such as medical out-of-pocket expenses (MOOP) and income, in order to meet the requirements of Title 13. This process is called topcoding. During the period prior to the March 1996 survey, topcoding was applied by limiting the values for dollar amounts to be no greater than a specified maximum value (the topcode). Values above the maximum were replaced by the maximum value. Beginning with the 1996 survey, the censorship method was modified so that mean values were substituted for all amounts above the topcode. Using the mean value for all amounts above the topcode made it impossible to examine the distributions above the topcode. In an effort to alleviate this problem and improve the overall usefulness of the CPS ASEC, the Census Bureau sponsored research on methods that both met Title 13 requirements and preserved the distributions above the topcode. This research led to the implementation in the 2011 CPS ASEC of rank proximity swapping methods that switch dollar amounts above the topcode for respondents that are of similar rank. Swapped amounts are rounded following the swapping process to provide additional disclosure avoidance. Health Insurance Coverage in the United States: 2018 33 U.S. CENSUS BUREAU Washington, DC 20233 Penalty for Private Use $300 Health Insurance Coverage in the United States: 2018 OFFICIAL BUSINESS FIRST-CLASS MAIL POSTAGE & FEES PAID U.S. Census Bureau Permit No. G-58 P60-267 U.S. Department of Commerce Current Population Reports U.S. Census Bureau