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Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January - March 2009

by Robin A. Cohen, Ph.D. and Michael E. Martinez, M.P.H., M.H.S.A., Division of Health Interview Statistics, National Center for Health Statistics

 

PDF Version (325 KB)

 

Highlights

  • From January to March 2009, 44.9 million persons of all ages (14.9%) were uninsured at the time of interview, 57.7 million (19.2%) had been uninsured for at least part of the year prior to interview, and 32.1 million (10.7%) had been uninsured for more than a year at the time of interview.
  • From January to March 2009, the percentage of children under age 18 years who were uninsured at the time of interview was 8.2%.
  • From January to March 2009, 63.5% of unemployed adults aged 18-64 years and 21.5% of employed adults in this age group had been uninsured for at least part of the past year. Also, 34.8% of unemployed adults aged 18-64 and 13.2% of employed adults in this age group had been uninsured for more than a year.
  • During the first 3 months of 2009, 23.8% of persons under age 65 years with private health insurance were enrolled in a high deductible health plan (HDHP), including 6.6% who were enrolled in a consumer-directed health plan (CDHP). Almost 50% of persons with a private plan obtained by means other than through an employer were in a HDHP. An estimated 20.1% of persons with a private plan were in a family with a flexible spending account (FSA) for medical expenses.

 

Introduction

The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is releasing selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the January-March 2009 National Health Interview Survey (NHIS), along with comparable estimates from the 1997-2008 NHIS. Data analyses for the January-March 2009 NHIS were based on 9,473 persons in the Family Core, which is approximately half the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances, and this should be taken into account when evaluating these finding. Large variances make it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data become available.

Three measures of lack of health insurance coverage are provided: (i) uninsured at the time of interview, (ii) uninsured at least part of the year prior to interview (which also includes persons uninsured for more than a year), and (iii) uninsured for more than a year at the time of interview. Estimates of public and private coverage are also presented.

For individuals with private health insurance, estimates are presented for enrollment in high deductible health plans (HDHPs), enrollment in consumer-directed health plans (CDHPs), and being in a family with a flexible spending account (FSA) for medical expenses. For more information about NHIS and the Early Release (ER) Program, please see the Technical Notes and Additional Early Release Program Products sections of this report.

This report is updated quarterly and is part of the NHIS ER Program, which releases updated selected estimates that are available from the NHIS website.

 

Results

 

Lack of health insurance coverage

From January to March 2009, the percentage of persons uninsured at the time of interview was 14.9% (44.9 million) for persons of all ages, 16.9% (44.4 million) for persons under age 65 years, 20.3% (38.4 million) for persons aged 18-64, and 8.2% (6.0 million) for children under age 18 (Tables 1 and 2).

Based on data from the January-March 2009 NHIS, a total of 57.7 million (19.2%) persons of all ages were uninsured for at least part of the year prior to interview (Tables 1 and 2). Adults aged 18-64 were almost twice as likely to experience this lack of coverage (25.0%) as children (13.3%).

Data from January to March 2009 also revealed that 12.1% (31.8 million) of persons under age 65 (14.8% of adults and 5.3% of children) had been uninsured for more than a year (Tables 1 and 2). Children were less likely than adults aged 18-64 to have been uninsured for more than a year (Figure 1).

 

Public and private coverage

From January to March 2009, 21.1% of persons under age 65 years were covered by public health plans at the time of interview, and 63.7% were covered by private health insurance plans (Table 3). Almost two-thirds (66.8%) of adults aged 18-64 were covered by a private plan, compared with 55.8% of children under age 18 (Figure 1).

More than one-third of children (38.7%) were covered by a public plan, compared with 14.1% of adults aged 18-64 (Figure 1). The percentage of children covered by a public health plan increased from 34.2% in 2008 to 38.7% in the first 3 months of 2009.

 

Insurance coverage, by poverty status

From January to March 2009, 12.7% of poor children and 10.5% of near poor children (see Technical Notes for definition of poverty) did not have health insurance coverage at the time of interview (Table 4). The percentage of near poor children who lacked coverage at the time of interview decreased from 15.6% in 2008 to 10.5% in the first 3 months of 2009.

Based on January to March 2009 data, 80.3% of poor children and 59.8% of near poor children were covered by a public health plan at the time of interview (Table 5). The observed increase in public coverage for near poor children from 53.4% in 2008 to 59.8% in the first 3 months of 2009 was not significant. Based on January to March 2009 data, 39.4% of poor adults aged 18-64 were covered by a public plan (Table 5).

From January to March 2009, 8.6% of poor children and 36.7% of near poor children were covered by private health insurance at the time of interview (Table 6). There was no significant change in private coverage for poor, near poor, and not poor children between 2008 and the first 3 months of 2009. Among poor adults aged 18-64, 19.1% were covered by private health insurance in the first 3 months of 2009.

 

Lack of coverage, by selected demographic characteristics

 

Race/ethnicity

Based on data from the January to March 2009 NHIS, Hispanic persons were considerably more likely than non-Hispanic white persons, non-Hispanic black persons, and non-Hispanic Asian persons to be uninsured at the time of interview, to have been uninsured for at least part of the past 12 months, and to have been uninsured for more than a year (Table 7).

Approximately one-third of Hispanic persons were uninsured at the time of interview or had been uninsured for at least part of the past year, and more than one-fourth of Hispanic persons had been without health insurance coverage for more than a year.

Age and sex

For all persons under age 65 years, the percentage who were uninsured at the time of interview was highest among those aged 18-24 (29.6%) and lowest among those under age 18 (8.2%) (Figure 2). Starting at age 18, younger adults were more likely than older adults to lack health insurance coverage. Among adults in age groups 18-24, 25-34, and 35-44 years, men were more likely than women to lack health insurance coverage at the time of interview.

Other demographic characteristics

Lack of health insurance coverage was greatest in the South and West regions of the United States (Table 7). Among adults who lacked a high school diploma, 35.5% were uninsured at the time of interview, 39.1% had been uninsured for at least part of the past year, and 29.5% had been uninsured for more than a year at the time of interview. These rates are two to more than three times as high as those for persons with more than a high school education. Among currently unemployed adults aged 18-64, 63.5% had been uninsured for at least part of the past year, and 34.8% had been uninsured for more than a year. Among employed adults aged 18-64, 21.5% had been uninsured for at least part of the past year, and 13.2% had been uninsured for more than a year. Married or widowed adults were more likely to have coverage than those who were divorced, separated, living with a partner, or never married.

 

Estimates of enrollment in HDHPs, CDHPs and FSAs

Based on data from the January to March 2009 NHIS, 23.7% of persons under age 65 years with private health insurance were enrolled in a HDHP, including 6.6% who were enrolled in a CDHP and 17.1 % who were enrolled in a HDHP without a health savings account (HSA) (Figure 3). (See Technical Notes for definitions of HDHP, CDHP, and HSA.) Enrollment in HDHPs increased from 17.5% in 2007 to 23.8% in the first 3 months of 2009. There was a significant increase in enrollment in HDHPs without HSAs between 2007 and March 2009. However, the observed increase in CDHP enrollment between 2007 and March 2009 was not significant.

Based on data from the first 3 months of 2009, among persons under age 65 with private health insurance, 21.4% with employer-based coverage were enrolled in a HDHP, compared with almost 50% of those with a private plan that was directly purchased or obtained through means other than an employer (Figure 4). The percentage of persons covered by employer-based private plans that are HDHPs increased from 15.6% in 2007 to 21.4% in the first 3 months of 2009. The percentage of persons covered by directly purchased private health plans that are HDHPs increased from 39.2% in 2007 to 49.6% in the first 3 months of 2009. Approximately 8% of private health plans are obtained through means other than an employer for persons under age 65 (estimates not shown).

During the first 3 months of 2009, among persons under age 65 with private health insurance, 20.1% were in a family that had an FSA for medical expenses (Figure 5). (See Technical Notes for definition of FSA). This is an increase from 2007, when 16.7% of persons under age 65 with private insurance were in a family with a FSA.

 

Long-term trends in coverage

 

Lack of health insurance coverage

The percentage of children uninsured at the time of interview decreased from 13.9% in 1997 to 8.2% in the first 3 months of 2009 (Figure 6). Since 2002, the percentage of adults aged 18-64 who were uninsured at the time of interview has remained relatively stable and has ranged between 18.9% and 20.3% (Table 1).

The percentage of children who were uninsured during at least part of the year prior to interview decreased from 18.1% in 1997 to 13.3% in the first 3 months of 2009 (Figure 6). However, since 2003, the percentage of children uninsured during at least part of the year prior to interview has remained relatively stable and has ranged from 12.6% to 13.7%. Between 1997 and the first 3 months of 2009, the percentage of adults aged 18-64 who lacked coverage for at least part of the year prior to interview fluctuated between 22.2% and 25.0% (Figure 7 and Table 1).

Among adults aged 18-64, the percentage uninsured for more than a year fluctuated between 11.9% and 14.8% between 1997 and the first 3 months of 2009 (Figure 7). By contrast, the percentage of children uninsured for more than a year decreased from 8.4% in 1997 to 5.3% in 2003 (Figure 6). Since 2003, the percentage of children uninsured for more than a year has remained relatively steady, ranging between 5.0% and 5.6%.

Public and private coverage

Public coverage rates among both children and adults aged 18-64 are higher now than in 1997 (Table 3). Conversely, private health care coverage rates among both children and adults aged 18-64 are lower now than in 1997.

Insurance coverage, by poverty status

The percentage of poor children who were uninsured at the time of interview decreased from 1997 through March 2009 (Figure 8). During the same period, the percentage of poor adults who were uninsured remained relatively stable (Figure 9).

Among children, all poverty status groups experienced an increase in public coverage between 1997 and March 2009 (Table 5). However, the largest increase was seen among near poor children, for whom coverage by a public plan more than doubled during the same period.

The rate of private coverage among near poor children was 18.3 percentage points lower in the first 3 months of 2009 than in 1997 (Table 6). As shown in Figure 10, among near poor children the percentage without health insurance and the percentage with private health insurance coverage have declined since 1997, while public coverage increased. Private coverage decreased among near poor adults aged 18-64 from 52.6% in 1997 to 39.1% in the first 3 months of 2009 (Figure 11). Private coverage among not poor adults decreased from 87.1% in 1997 to 82.3% in the first 3 months of 2009.

 

References

  1. U.S. Government Accountability Office (GAO). Consumer-directed health plans: Early enrollee experiences with health savings accounts and eligible health plans. GAO-06-798. Washington, DC: GAO 2006.
  2. Cohen RA, Martinez ME. Impact of Medicare and Medicaid probe questions on health insurance estimates from the National Health Interview Survey, 2004. Health E-stats. Hyattsville, MD: National Center for Health Statistics. 2005.
  3. Lamison-White L. Poverty in the United States, 1996. U.S. Bureau of the Census. Current population reports, series P60-198. Washington, DC: U.S. Government Printing Office. 1997.
  4. Dalaker J, Naifeh M. Poverty in the United States, 1997. U.S. Bureau of the Census. Current population reports, series P60-201. Washington, DC: U.S. Government Printing Office. 1998.
  5. Dalaker J. Poverty in the United States, 1998. U.S. Census Bureau. Current population reports, series P60-207. Washington, DC: U.S. Government Printing Office. 1999.
  6. Dalaker J, Proctor BD. Poverty in the United States, 1999. U.S. Census Bureau. Current population reports, series P60-210. Washington, DC: U.S. Government Printing Office. 2000.
  7. Dalaker J. Poverty in the United States, 2000. U.S. Census Bureau. Current population reports, series P60-214. Washington, DC: U.S. Government Printing Office. 2001.
  8. Proctor BD, Dalaker J. Poverty in the United States, 2001. U.S. Census Bureau. Current population reports, series P60-219. Washington, DC: U.S. Government Printing Office. 2002.
  9. Proctor BD, Dalaker J. Poverty in the United States, 2002. U.S. Census Bureau Current population reports, series P60-222. Washington, DC: U.S. Government Printing Office. 2003.
  10. DeNavas-Walt C, Proctor BD, Mills RJ. Income, poverty, and health insurance coverage in the United States: 2003. U.S. Census Bureau. Current population reports, series P60-226. Washington, DC: U.S. Government Printing Office. 2004.
  11. DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2004. U.S. Census Bureau. Current population reports, series P60-229. Washington, DC: U.S. Government Printing Office. 2005.
  12. DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2005. U.S. Census Bureau. Current population reports, series P60-231. Washington, DC: U.S. Government Printing Office. 2006.
  13. DeNavas-Walt C, Proctor BD, Smith J. Income, poverty, and health insurance coverage in the United States: 2006. U.S. Census Bureau. Current population reports, series P60-233. Washington, DC: U.S. Government Printing Office. 2007.
  14. DeNavas-Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2007. U.S. Census Bureau. Current population reports, series P60-235. Washington, DC: U.S. Government Printing Office. 2008.
  15. U.S. Census Bureau. Preliminary estimates of weighted average poverty thresholds for 2008.
  16. Pleis JR, Dahlhamer JM, Meyer PS. Unfolding the answers? Income nonresponse and income brackets in the National Health Interview Survey. Proceedings of the 2006 Joint Statistical Meetings [CD-ROM]. Alexandria, VA: American Statistical Association, Alexandria, Virginia. 2007. p. 3540-47
  17. Plies JR, Cohen RA. Impact of income bracketing on poverty measures used in the National Health Interview Survey’s Early Release Program: Preliminary data from the 2007 NHIS [PDF - 358 KB]. Hyattsville, MD: National Center for Health Statistics. December 2007.
  18. National Center for Health Statistics. Health, United States, 2008 with Chartbook Hyattsville, MD: National Center for Health Statistics. 2009
  19. Schiller JS, Heyman KM Barnes PM. Early release of selected estimates based on data from the January-March 2009 National Health Interview Survey. Hyattsville, MD: National Center for Health Statistics. September 2009. Available from the NHIS website.
  20. Blumberg SJ, Luke JV. Wireless substitution: Early release of estimates based on data from the National Health Interview Survey, July-December 2008 [PDF - 358 KB]. Hyattsville, MD: National Center for Health Statistics. May 2009.

 

Technical Notes

 

Introduction

The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is releasing selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2009 National Health Interview Survey (NHIS), along with comparable estimates from the 1997-2008 NHIS.

Three measures of lack of health insurance coverage are provided: (i) uninsured at the time of interview, (ii) uninsured at least part of the year prior to interview (which also includes persons uninsured for more than a year), and (iii) uninsured for more than a year at the time of interview. To reflect different policy-relevant perspectives, different time frames are used to measure lack of insurance coverage. The measure of uninsured at the time of interview provides an estimate of persons who at any given time may experience barriers to obtaining needed health care. The estimate of persons who were uninsured at any time in the year prior to interview provides an annual caseload of persons who may experience these barriers. This measure includes persons who have insurance at the time of interview, but who had a period of noncoverage in the year prior to interview, as well as those who are currently uninsured and who may have been uninsured for a long period of time. Finally, the measure of lack of coverage for more than a year provides an estimate of those with a persistent lack of coverage who may be at high risk of not obtaining preventive services as well as care for illness and injury. These three measures of lack of coverage are not mutually exclusive, and a given individual may be counted in more than one of the measures. Estimates of enrollment in public and private coverage are also provided.

This report also includes estimates of three types of consumer-directed private health care. Consumer-directed health care may enable individuals to have more control over when and how they access care, what types of care they use, and how much they spend on health care services. National attention to consumer-directed health care has increased following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173), which established tax-advantaged health savings accounts (1). In 2007, three additional questions were added to the health insurance section of NHIS to monitor enrollment in consumer-directed health care among persons with private health insurance. Estimates for 2009 are provided for enrollment in high deductible health plans (HDHPs); plans with high deductibles coupled with health savings accounts (CDHPs); and being in a family with a flexible spending account (FSA) for medical expenses not otherwise covered. For a more complete description of consumer-directed health care, see “Definitions of selected terms” below.

The 2009 health insurance estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from NHIS. The resulting estimates for persons without health insurance are generally 0.1-0.3 percentage points lower than those based on the editing procedures used for the final data files. Occasionally, due to decisions made for the final data editing and weighting, estimates based on preliminary editing procedures may differ by more than 0.3 percentage points from estimates based on final files.

Due to small sample sizes, estimates based on less than a year of data may have large variances. Caution should therefore be used in comparing estimates with large variances. Patterns described in this report may change as more data become available.

Estimates for 2009 are stratified by age group, sex, race/ethnicity, poverty status, marital status, employment status, region, and educational attainment.

 

Data Source

NHIS is the source of data for this report. NHIS is a multistage probability sample survey of the civilian noninstitutionalized population of the United States. The survey is conducted continuously throughout the year for NCHS by interviewers of the U.S. Census Bureau.

NHIS is a comprehensive health survey that can be used to relate health insurance coverage to health outcomes and health care utilization. It has a low item nonresponse rate (about 1%) for the health insurance questions. Because NHIS is conducted throughout the year, yielding a nationally representative sample each week, data can be analyzed weekly or quarterly to monitor health insurance coverage trends.

The sample for the NHIS is redesigned about every 10 years. A new sample design for the NHIS was implemented in 2006. The fundamental structure of the new 2006 NHIS sample design is very similar to the previous 1995-2005 NHIS sample design. Oversampling of the black and Hispanic populations has been retained, and the new sample design also oversamples the Asian population. In addition, persons 65 aged years and over have a higher probability of being selected as a sample adult. The impact of the new sample design on estimates presented in this report is expected to be minimal. Visit the NHIS website for more information on the design, content, and use of the NHIS.

The data for this report are derived from the Family Core component of the 1997-2009 NHIS, which collects information on all family members in each household. Data analyses for the January-March 2009 NHIS were based on 9,473 persons in the Family Core, which is approximately half the usual quarterly sample.

 

Estimation procedures

NCHS creates survey weights for each calendar quarter of the NHIS sample. The NHIS data weighting procedure [PDF - 300 KB] has been described in more detail elsewhere (view/download PDF). Estimates were calculated by using the NHIS survey weights, which are calibrated to census totals for sex, age, and race/ethnicity of the U.S. civilian noninstitutionalized population. The weights for the 1997-1999 NHIS data were derived from 1990-census-based population estimates. Weights for the 2000-2008 NHIS data were derived from 2000-census-based population estimates.

Point estimates, and estimates of their variances, were calculated using SUDAAN software to account for the complex sample design of NHIS. The Taylor series linearization method was chosen for variance estimation.

Both of the June 2007 Early Release (ER) reports used final in-house design variables for estimating variance for the 2006 estimates. ER reports other than the June 2007 update use ER interim design variables to estimate variance, with the exception of the state-level estimates, which use the final in-house design variables to estimate variance.

Unless otherwise noted, all estimates shown meet the NCHS standard of having less than or equal to 30% relative standard error. Differences between percentages or rates were evaluated using two-sided significance tests at the 0.05 level. Logistic regression was used to evaluate the significance of time trends in the percentage of health insurance coverage. Terms such as “greater than” and “less than” indicate a statistically significant difference. Terms such as “similar” and “no difference” indicate that the estimates being compared were not significantly different. Lack of comments regarding the difference between any two estimates does not necessarily mean that the difference was tested and found to be not significant.

 

Definitions of selected terms

 

Health insurance coverage - The “private health insurance coverage” category excludes plans that pay for only one type of service, such as accidents or dental care. The “public health plan coverage” category includes Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plans, Medicare, and military plans. A small number of persons were covered by both public and private plans and were included in both categories. A person was defined as “uninsured” if he or she did not have any private health insurance, Medicare, Medicaid, CHIP, state-sponsored or other government-sponsored health plan, or military plan at the time of interview. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. The analyses excluded persons with unknown health insurance status (about 1% of respondents each year).

The terms HIKIND, MCAREPRB, and MCAIDPRB refer to questions in NHIS. Data on type of health insurance are collected through the HIKIND question: "What kind of health insurance or health care coverage [fill: do you/does person’s name] have? INCLUDE those that pay for only one type of service (nursing home care, accidents, or dental care). EXCLUDE private plans that only provide extra cash while hospitalized." Respondents can indicate private and public plans or indicate that they or family members are not covered by insurance.

Two additional questions were added to the health insurance section of NHIS beginning with the third quarter of 2004. One question, MCAREPRB, was asked of persons aged 65 years and over who had not indicated that they had Medicare. The MCAREPRB question is: "People covered by Medicare have a card which looks like this. [fill: Are you/Is person’s name] covered by Medicare?" The other question, MCAIDPRB, was asked of persons under age 65 who had not indicated any type of coverage. The MCAIDPRB question is: "There is a program called Medicaid that pays for health care for persons in need. In this State it is also called (* fill State name). [fill: Are you/Is person’s name] covered by Medicaid?"

Respondents who were considered insured at the time of interview were asked about periods of noncoverage in the past year. For persons who did not have health insurance at the time of interview, a question was asked concerning the length of time since the respondent had coverage. Respondents who originally classified themselves as uninsured, but whose classification was changed to Medicare or Medicaid on the basis of a “yes” response to either probe question, subsequently received appropriate follow-up questions concerning periods of noncoverage for insured respondents.

Method 1 estimates are based solely on one question (HIKIND). Method 2 estimates are based on responses to three questions (HIKIND, MCAREPRB, and MCAIDPRB). Prior to 2004, estimates in earlier releases of this report were generated using Method 1. Estimates for 2004 are presented using Method 2 in the figures and both Method 1 and Method 2 in the tables. Estimates using Method 1 for the “uninsured for more than a year” measure excluded persons whose classification was changed from uninsured to either Medicare or Medicaid coverage by either additional probe question. As a result, these respondents did not receive the follow-up question concerning how long had it been since they had coverage. However, they were asked the questions concerning noncoverage in the past 12 months for insured persons. All estimates beginning in 2005 are calculated by using the two additional questions (Method 2).

Of the 892 people (unweighted) who were eligible to receive the MCAREPRB question in the third and fourth quarters of 2004, 55.4% indicated that they were covered by Medicare. Of the 9,146 people (unweighted) who were eligible to receive the MCAIDPRB question in the third and fourth quarters of 2004, 3.0% indicated that they were covered by Medicaid.

From July through December 2004 (the third and fourth quarters combined), the estimates (weighted) for the “uninsured at the time of interview” measure decreased from 10.4% to 9.9% for children under age 18 years, from 19.7% to 19.5% for adults aged 18-64, and from 1.7% to 1.2% for persons aged 65 and over with the use of Method 2 as compared with Method 1. The estimates for public coverage increased from 28.1% to 29.6% for children under age 18, from 11.3% to 11.4% for adults aged 18-64, and from 89.5% to 93.3% for persons aged 65 and over with the use of Method 2 as compared with Method 1. The tabulation of “uninsured for more than a year” using Method 1 excludes respondents whose classification was changed to Medicare or Medicaid by either probe question because these individuals did not receive the question concerning duration of noncoverage for persons who are uninsured. The two additional questions had no impact on the estimates for private coverage. Additional information on the impact of these two probe questions on health insurance estimates can be found in “Impact of Medicare and Medicaid probe questions on health insurance estimates from the National Health Interview Survey, 2004” (2).

For persons with private health insurance, a new question regarding the annual deductible of each private health insurance plan was added beginning in 2007. For plans considered to be high deductible health plans (HDHPs), a follow-up question was asked regarding special accounts or funds used to pay for medical expenses: a health savings account (HSA) or a health reimbursement account (HRA). Lastly, a new question was added about family enrollment in a flexible spending account (FSA) for medical expenses.

Data on health insurance status were edited using an automated system based on logic checks and keyword searches. For comparability, the estimates for all years were created using these same procedures.

High deductible health plan (HDHP) - A HDHP is defined in 2009 as a private health plan with an annual deductible of not less than $1,150 for self-only coverage or $2,300 for family coverage. The deductible is adjusted annually for inflation. For 2007 and 2008, the annual deductible for self-only coverage was $1,100 and for family coverage was $2,200.

Consumer-directed health plan (CDHP) - A CDHP is defined as a HDHP with a special account to pay for medical expenses; unspent funds are carried over to subsequent years. A person is considered to have a CDHP if there was a “yes” response to the following question: "With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts."

Health savings account (HSA) - An HSA is a tax-advantaged account or fund that can be used to pay for medical expenses. It must be coupled with a HDHP. The funds contributed to the account are not subject to federal income tax at the time of deposit. Unlike Flexible Spending Accounts (FSAs), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual. Funds may be used to pay for qualified medical expenses at any time without federal tax liability.

Flexible spending account (FSA) for medical expenses - A person is considered to be in a family with an FSA if there was a "yes" response to the following question: "[fill 1:  Do you/Does anyone in your family] have a Flexible Spending Account for health expenses? These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their out-of-pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee."

The measures of HDHP enrollment, CDHP enrollment, and being in a family with a FSA for medical expenses are not mutually exclusive. Therefore, a person may be counted in more than one measure.

Directly purchased coverage - Private insurance that was originally obtained through direct purchase or through other means not related to employment.

Employer-based coverage - Private insurance that was originally obtained through a present or former employer or union or professional association.

Education - The categories of education are based on the years of school completed or highest degree obtained for persons aged 18 years and over. Only years completed in a school that advances a person toward an elementary or high school diploma, General Educational Development high school equivalency diploma (GED), college, university, or professional degree are included. Education in other schools or home schooling is counted only if the credits are accepted in a regular school system.

Employment - Employment status is assessed at the time of interview and is obtained for persons aged 18 years and over. In this release, it is presented only for persons aged 18-64.

Hispanic or Latino origin and race - Hispanic or Latino origin and race are two separate and distinct categories. Persons of Hispanic or Latino origin may be of any race. Hispanic or Latino origin includes persons of Mexican, Puerto Rican, Cuban, Central and South American, or Spanish origins. Race is based on the family respondent’s description of his or her own race background as well as the race background of other family members. For conciseness, the text, tables, and figures in this report use shorter versions of the 1997 Office of Management and Budget (OMB) race and Hispanic or Latino origin terms. For example, the category "not Hispanic or Latino, black or African American, single race" is referred to as "non-Hispanic black, single race" in the text, tables, and figures. Estimates for non-Hispanic persons of races other than white only, black only, Asian only, or of multiple races are combined into the "other races or multiple race" category.

Poverty status - Poverty categories are based on the ratio of the family’s income in the previous calendar year to the appropriate poverty threshold (given the family’s size and number of children) defined by the U.S. Census Bureau for that year (3-15). Persons categorized as "poor" had a ratio less than 1.0 (i.e., their family income was below the poverty threshold), "near poor" persons have incomes of 100% to less than 200% of the poverty threshold, and "not poor" persons have incomes that are 200% of the poverty threshold or greater. The remaining group of respondents is coded as "unknown" with respect to poverty status. The percentage of respondents with unknown poverty status (19.1% in 1997, 23.6% in 1998, 26.4% in 1999, 27.0% in 2000, 27.1% in 2001, 28.1% in 2002, 31.5% in 2003, 29.6% in 2004, 28.9% in 2005, 30.7% in 2006, 18.0% in 2007, 15.8% in 2008, and 11.6% in the first quarter of 2009) is disaggregated by insurance status and age in Tables 4, 5, and 6.

In 2004, the NHIS instrument recorded a much larger than expected proportion of respondents with a family income for the previous calendar year of "$2."  The ER updates from March 2005 through December 2005 used these preliminary data. Following extensive review, the "$2" responses were coded to "not ascertained" for the final 2004 NHIS microdata files. The 2004 estimates of coverage by poverty status were recalculated using the final microdata. The revised estimates were released in the March 2006 ER update, and continue to be used in subsequent ER updates. The problem with the "$2" income reports was fixed in the 2005 NHIS.

See the NHIS Survey Description Documents for 1997-2007 (available from the NHIS website) for more information on the unknown income and unknown poverty status categories.

Prior to 2007, the "Income and Assets" section in the Family Core of the NHIS instrument allowed respondents to report their family income in several ways. Respondents were first asked to provide their combined family income before taxes from all sources for the previous calendar year in a dollar amount (from $0 to $999,995). Respondents who did not know or refused to state an amount were then asked if their combined family income in the previous calendar year was $20,000 or more, or less than $20,000. If they again refused to answer or said that they did not know, they were not asked any more questions about their family income. Respondents who did reply to the "above-below $20,000" question were then handed a list (flash card) of detailed income categories (top-coded at $75,000 or more) and asked to pick the interval containing their best estimate of their combined family income. Thus, NHIS respondents fell into one of four categories with respect to combined family income information: (i) those willing to supply a dollar amount, (ii) those who indicated their combined family income from a fairly detailed set of intervals, (iii) those who said that their combined family income was either $20,000 or more, or less than $20,000, and (iv) those unwilling to provide any information whatsoever. However, the flash card approach had a very low item response rate (15%-18%), and this led to income variables such as poverty ratio having relatively high levels of missing data (approximately 30% item nonresponse rate).

In the 2007 NHIS, the family income section of the questionnaire was redesigned to improve the collection of income information and to reduce the amount of income nonresponse. Questions used to collect income data from respondents who initially would not indicate the amount of their family’s income in the last calendar year were changed from using a flash card approach to using a set of unfolding brackets. The unfolding bracket method asks a series of closed-ended income range questions (e.g., "is it less than $50,000?") if the respondent did not provide an answer to an exact income amount question. These questions utilize a series of income intervals, and respondents answering the complete path of questions would answer either two or three questions. The first follow-up income question asks a respondent if the family’s income is less than $50,000. With this as a starting point, for respondents who answered "yes" to this question, additional questions are asked to determine if the family’s income is below $35,000 and if the family’s income is below the poverty threshold. Alternately, for respondents who answered "no" to the less than $50,000 question, additional questions are asked to determine if the family income is below $100,000 and below $75,000. The pilot test used to develop these new questions is described elsewhere (16).

Based on preliminary data from the first quarter of 2007, 56% of the respondents eligible for the modified income follow-up questions answered all the questions in the applicable path. Initial evaluations of the distribution of poverty among selected demographic variables in the first quarter of 2007 suggest that poverty estimates are generally comparable to years 2006 and earlier (17). As a result of the changes in questions, the 2007 and 2008 poverty ratio variable has fewer missing values compared with prior years. This reflects improved income item response rates.

NCHS imputes income for approximately 30% of NHIS records. Beginning with survey year 2007, the imputation procedure was modified to take into account the changes made to the income section. The imputed income files are released a few months after the annual release of NHIS microdata and are not available for the ER updates. Therefore, ER health insurance estimates stratified by poverty status are based only on the reported income and may differ from similar estimates produced later (e.g., in Health, United States (18)) that are based on both reported and imputed income.

Region - In the geographic classification of the U.S. population, states are grouped into the following four regions used by the U.S. Census Bureau:

 

Region States Included
Northeast

Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania

Midwest

Ohio, Illinois, Indiana, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Kansas, and Nebraska

South

Delaware, Maryland, District of Columbia, West Virginia, Virginia, Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Oklahoma, Arkansas, and Texas

West

Washington, Oregon, California, Nevada, New Mexico, Arizona, Idaho, Utah, Colorado, Montana, Wyoming, Alaska, and Hawaii

 

Additional Early Release Program Products

 Two additional reports are published via the ER Program. Early Release of Selected Estimates Based on Data from the National Health Interview Survey (19) is published quarterly and provides estimates of 15 selected measures of health, including insurance coverage. Other measures of health include estimates of usual place to go for medical care, obtaining needed medical care, influenza vaccination, pneumococcal vaccination, obesity, leisure-time physical activity, current smoking, alcohol consumption, HIV testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Wireless Substitution: Early Release of Estimates from the National Health Interview Survey (20) is published in May and December and provides selected estimates of telephone coverage in the United States.

New measures may be added as work continues and in response to changing data needs. Feedback on these releases is welcome (nhislist@cdc.gov).

Announcements about Early Releases, other new data releases, publications, or corrections related to the NHIS will be sent to members of the HISUSERS Listserv. To join, visit the CDC website.

 

Suggested Citation

Cohen RA, Martinez ME. Health insurance coverage: Early release of estimates from the National Health Interview Survey, January-March 2009. Hyattsville, MD: National Center for Health Statistics. September 2009. Available from: /nchs/nhis.htm.

 

Figures

 

Figure 1. Percentage of persons without health insurance, by three measurements and age group, and percentage of persons with health insurance at the time of interview, by coverage type and age group: United States, January-March 2009

Figure 1 is a bar chart showing lack of health insurance, and private and public coverage, for children under age 18 and adults aged 18 to 64, for January through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 2. Percentage of persons under age 65 years without health insurance coverage at the time of interview, by age group and sex: United States, January-March 2009

Figure 2 is a bar chart showing lack of health insurance among persons under age 65, by age and sex, for January through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 3. Percentage of persons under age 65 years who are enrolled in a high deductible health plan without a health savings account or in a consumer-directed health plan, among those with private health insurance: United States, 2007-March 2009

Figure 3 is a bar chart showing enrollment in high deductible health plans with and without a health savings account among persons under age 65 with private coverage, from 1997 through March 2009.

NOTES: HDHP no HSA is high deductible health plan without a health savings account. CDHP is consumer-directed health plan, which is a HDHP with a HSA. The individual components of HDHPs may not add to up to the total, due to rounding.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 2007-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 4. Percentage of persons under age 65 years with private health insurance who are enrolled in a high deductible health plan, by source of coverage: United States, 2007-March 2009

Figure 4 is a bar chart showing enrollment in high deductible health plans for persons under age 65 with private coverage, by source of coverage, for 2007 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 2007-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 5. Percentage of persons under age 65 years with private health insurance who are in a family with a flexible spending account for medical expenses: United States, 2007-March 2009

Figure 5 is a bar chart showing persons under age 65 with private health insurance who are in a family with a flexible spending account for medical expenses, for 2007 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 2007-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 6. Percentage of children under age 18 years who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year: United States, 1997-March 2009

Figure 6 is a line graph showing lack of health insurance, by three measurements, among children under age 18, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 7. Percentage of adults aged 18-64 years who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year: United States, 1997-March 2009

Figure 7 is a line graph showing lack of health insurance, by three measurements, among adults aged 18 to 64, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 8 is a line graph showing lack of health insurance at the time of interview, by poverty status, for children under age 18, from 1997 through March 2009.

Figure 8 is a line graph showing lack of health insurance at the time of interview, by poverty status, for children under age 18, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 9. Percentage uninsured at the time of interview, by poverty status, for adults aged 18-64 years: United States, 1997-March 2009

Figure 9 is a line graph showing lack of health insurance at the time of interview, by poverty status, for adults aged 18 to 64, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 10. Percentage with health insurance, by coverage type, and percentage uninsured at the time of interview, for near poor children under age 18 years: United States, 1997-March 2009

Figure 10 is a line graph showing lack of health insurance at the time of interview, and private and public coverage, for near poor children under age 18, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Figure 11. Percentage with health insurance, by coverage type, and percentage uninsured at the time of interview, for near poor adults aged 18-64 years: United States, 1997-March 2009

Figure 11 is a line graph showing lack of health insurance at the time of interview, and private and public coverage, for near poor adults aged 18-64, from 1997 through March 2009.

DATA SOURCE: CDC/NCHS, National Health Interview Survey 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

 

Tables

 

Table 1

 

Table 1a. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, all ages: United States, 1997-March 2009

 

All ages Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
1997 15.4 (0.21) 19.5 (0.24) 10.4 (0.18)
1998 14.6 (0.23) 18.6 (0.26) 9.8 (0.19)
1999 14.2 (0.22) 18.2 (0.25) 9.3 (0.19)
2000 14.9 (0.22) 18.7 (0.24) 9.6 (0.18)
2001 14.3 (0.23) 18.0 (0.26) 9.3 (0.18)
2002 14.7 (0.22) 18.3 (0.24) 9.3 (0.17)
2003 15.2 (0.24) 18.6 (0.26) 10.0 (0.19)
2004 (Method 1)3 14.7 (0.21) 18.0 (0.23) 10.1 (0.17)
2004 (Method 2)3 14.6 (0.20) 17.9 (0.23) 10.1 (0.17)
2005 3 14.2 (0.21) 17.6 (0.23) 10.0 (0.18)
2006 3,4 14.8 (0.26) 18.6 (0.29) 10.5 (0.22)
2007 3 14.5 (0.29) 18.2 (0.34) 10.3 (0.24)
2008 3 14.7 (0.32) 18.7 (0.33) 10.6 (0.26)
2009 3 (January-March) 14.9 (0.79) 19.2 (0.84) 10.7 (0.66)

See footnotes at end of table 1d.

 

Table 1b. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, under 65 years: United States, 1997-March 2009

 

Under 65 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
1997 17.4 (0.24) 21.9 (0.28) 11.8 (0.21)
1998 16.5 (0.26) 20.9 (0.29) 11.0 (0.21)
1999 16.0 (0.25) 20.4 (0.28) 10.5 (0.21)
2000 16.8 (0.24) 21.0 (0.26) 10.8 (0.20)
2001 16.2 (0.26) 20.3 (0.29) 10.5 (0.21)
2002 16.5 (0.24) 20.6 (0.27) 10.4 (0.19)
2003 17.2 (0.27) 20.9 (0.28) 11.2 (0.21)
2004 (Method 1)3 16.6 (0.23) 20.2 (0.26) 11.4 (0.19)
2004 (Method 2)3 16.4 (0.23) 20.1 (0.26) 11.4 (0.19)
2005 3 16.0 (0.24) 19.9 (0.26) 11.3 (0.21)
2006 3,4 16.8 (0.29) 20.9 (0.32) 11.8 (0.25)
2007 3 16.4 (0.33) 20.5 (0.38) 11.7 (0.27)
2008 3 16.7 (0.36) 21.2 (0.37) 12.0 (0.29)
2009 3 (January-March) 16.9 (0.89) 21.7 (0.94) 12.1 (0.74)

See footnotes at end of table 1d.

 

Table 1c. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, 18-64 years: United States, 1997-March 2009

 

18-64 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
1997 18.9 (0.23) 23.6 (0.26) 13.3 (0.21)
1998 18.2 (0.27) 22.5 (0.30) 12.5 (0.23)
1999 17.8 (0.26) 22.2 (0.29) 11.9 (0.23)
2000 18.7 (0.27) 22.9 (0.29) 12.4 (0.23)
2001 18.3 (0.27) 22.4 (0.29) 12.3 (0.22)
2002 19.1 (0.26) 23.1 (0.29) 12.5 (0.21)
2003 20.1 (0.29) 23.8 (0.31) 13.7 (0.25)
2004 (Method 1)3 19.4 (0.26) 23.2 (0.29) 13.8 (0.21)
2004 (Method 2)3 19.3 (0.26) 23.1 (0.29) 13.8 (0.21)
2005 3 18.9 (0.26) 22.8 (0.28) 13.8 (0.23)
2006 3,4 19.8 (0.33) 24.1 (0.36) 14.5 (0.29)
2007 3 19.4 (0.36) 23.7 (0.40) 14.3 (0.32)
2008 3 19.7 (0.40) 24.3 (0.40) 14.6 (0.34)
2009 3 (January-March) 20.3 (0.97) 25.0 (1.01) 14.8 (0.84)

See footnotes at end of table 1d.

 

Table 1d. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, under 18 years: United States, 1997-March 2009

 

Under 18 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
1997 13.9 (0.36) 18.1 (0.41) 8.4 (0.29)
1998 12.7 (0.34) 17.1 (0.40) 7.6 (0.27)
1999 11.8 (0.32) 16.3 (0.39) 7.2 (0.26)
2000 12.3 (0.32) 16.7 (0.35) 7.0 (0.23)
2001 11.0 (0.34) 15.2 (0.41) 6.3 (0.25)
2002 10.5 (0.32) 14.6 (0.37) 5.6 (0.24)
2003 10.1 (0.34) 13.7 (0.37) 5.3 (0.25)
2004 (Method 1)3 9.6 (0.29) 12.9 (0.33) 5.4 (0.25)
2004 (Method 2)3 9.4 (0.29) 12.7 (0.33) 5.4 (0.25)
2005 3 8.9 (0.29) 12.6 (0.33) 5.3 (0.24)
2006 3,4 9.3 (0.34) 13.0 (0.40) 5.2 (0.26)
2007 3 8.9 (0.40) 12.6 (0.48) 5.0 (0.28)
2008 3 8.9 (0.43) 13.3 (0.49) 5.6 (0.35)
2009 3 (January-March) 8.2 (1.14) 13.3 (1.23) 5.3 (0.91)

1 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care.

2 A year is defined as the 12 months prior to interview.

3 Beginning in the third quarter of 2004, two additional questions were added to the National Health Interview Survey (NHIS) insurance section to reduce potential errors in reporting Medicare and Medicaid status. Persons aged 65 years and over not reporting Medicare coverage were asked explicitly about Medicare coverage, and persons under age 65 with no reported coverage were asked explicitly about Medicaid coverage. Estimates of uninsurance for 2004 were calculated without using the additional information from these questions (noted as Method 1) and with the responses to these questions (noted as Method 2). Respondents who were reclassified as “covered” by the additional questions received the appropriate follow-up questions concerning periods of noncoverage for insured respondents. These reclassified respondents were excluded in the tabulation of “uninsured for more than a year” using Method 1 in 2004. Beginning in 2005, all estimates were calculated using Method 2. See “Technical Notes” for additional information.

4 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 2

 

Table 2a. Number of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, all ages: United States, 1997-March 2009

 

All ages Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Number in millions
1997 41.0 51.9 27.7
1998 39.3 49.9 26.3
1999 38.7 49.4 25.3
2000 41.3 51.8 26.6
2001 40.2 50.4 26.1
2002 41.5 51.7 26.2
2003 43.6 53.1 28.5
2004 (Method 1)3 42.5 52.0 29.2
2004 (Method 2)3 42.1 51.6 29.2
2005 3 41.2 51.3 29.2
2006 3,4 43.6 54.5 30.7
2007 3 43.1 53.9 30.6
2008 3 43.8 55.9 31.7
2009 3 (January-March) 44.9 57.7 32.1

See footnotes at end of table 2d.

 

Table 2b. Number of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, under 65 years: United States, 1997-March 2009

 

Under 65 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Number in millions
1997 40.7 51.4 27.6
1998 39.0 49.5 26.2
1999 38.3 48.9 25.1
2000 40.8 51.3 26.4
2001 39.8 49.9 25.9
2002 41.1 51.2 25.9
2003 43.2 52.5 28.3
2004 (Method 1)3 42.0 51.3 28.9
2004 (Method 2)3 41.7 51.0 28.9
2005 3 41.0 50.9 29.0
2006 3,4 43.3 54.0 30.5
2007 3 42.8 53.5 30.4
2008 3 43.6 55.5 31.6
2009 3 (January-March) 44.4 57.0 31.8

See footnotes at end of table 2d.

 

Table 2c. Number of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, 18-64 years: United States, 1997-March 2009

 

18-64 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Number in millions
1997 30.8 38.5 21.7
1998 30.0 37.2 20.7
1999 29.8 37.1 19.9
2000 32.0 39.2 21.3
2001 31.9 38.9 21.4
2002 33.5 40.6 21.9
2003 35.9 42.5 24.5
2004 (Method 1)3 35.0 41.9 25.0
2004 (Method 2)3 34.9 41.8 25.0
2005 3 34.5 41.7 25.2
2006 3,4 36.5 44.5 26.8
2007 3 36.3 44.2 26.8
2008 3 37.1 45.6 27.5
2009 3 (January-March) 38.4 47.1 27.9

See footnotes at end of table 2d.

 

Table 2d. Number of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, under 18 years: United States, 1997-March 2009

 

Under 18 years Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Number in millions
1997 9.9 12.9 6.0
1998 9.1 12.3 5.5
1999 8.5 11.8 5.2
2000 8.9 12.0 5.1
2001 7.9 11.0 4.5
2002 7.6 10.6 4.1
2003 7.3 10.0 3.9
2004 (Method 1)3 7.0 9.4 4.0
2004 (Method 2)3 6.8 9.3 3.9
2005 3 6.5 9.3 3.9
2006 3,4 6.8 9.5 3.8
2007 3 6.5 9.3 3.7
2008 3 6.6 9.9 4.1
2009 3 (January-March) 6.0 9.8 3.9

1 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care.

2 A year is defined as the 12 months prior to interview.

3 Beginning in the third quarter of 2004, two additional questions were added to the National Health Interview Survey (NHIS) insurance section to reduce potential errors in reporting Medicare and Medicaid status. Persons aged 65 years and over not reporting Medicare coverage were asked explicitly about Medicare coverage, and persons under age 65 with no reported coverage were asked explicitly about Medicaid coverage. Estimates of uninsurance for 2004 were calculated without using the additional information from these questions (noted as Method 1) and with the responses to these questions (noted as Method 2). Respondents who were reclassified as “covered” by the additional questions received the appropriate follow-up questions concerning periods of noncoverage for insured respondents. These reclassified respondents were excluded in the tabulation of “uninsured for more than a year” using Method 1 in 2004. Beginning in 2005, all estimates were calculated using Method 2. See “Technical Notes” for additional information.

4 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 3

 

Table 3a. Percentage of persons under 65 years of age with public health plan coverage at the time of interview, by age group: United States, 1997-March 2009

 

Public health plan coverage1 Under 65 years Under 18 years 18-64 years
  Percent (standard error)
1997 13.6 (0.25) 21.4 (0.48) 10.2 (0.20)
1998 12.7 (0.26) 20.0 (0.49)  9.5 (0.21)
1999 12.4 (0.24) 20.4 (0.46)  9.0 (0.19)
2000 12.9 (0.26) 22.0 (0.50)  9.1 (0.19)
2001 13.6 (0.26) 23.6 (0.50)  9.4 (0.21)
2002 15.2 (0.29) 27.1 (0.54) 10.3 (0.23)
2003 16.0 (0.31) 28.6 (0.58) 10.9 (0.24)
2004 (Method 1)3 16.1 (0.29) 28.5 (0.54) 11.1 (0.22)
2004 (Method 2)3 16.2 (0.29) 28.7 (0.54) 11.1 (0.23)
2005 3 16.8 (0.29) 29.9 (0.56) 11.5 (0.22)
2006 3,4 18.1 (0.35) 32.3 (0.69) 12.4 (0.26)
2007 3 18.1 (0.40) 32.7 (0.77) 12.3 (0.31)
2008 3 19.3 (0.42) 34.2 (0.79) 13.4 (0.33)
2009 3 (January-March) 21.1 (0.96) 38.7 (2.11) 14.1 (0.69)

See footnotes at end of table 3b.

 

Table 3b. Percentage of persons under 65 years of age with private health insurance coverage at the time of interview, by age group: United States, 1997-March 2009

 

Private health insurance coverage2 Under 65 years Under 18 years 18-64 years
  Percent (standard error)
1997 70.8 (0.35) 66.2 (0.57) 72.8 (0.30)
1998 72.0 (0.36) 68.5 (0.55) 73.5 (0.32)
1999 73.1 (0.36) 69.1 (0.55) 74.7 (0.33)
2000 71.8 (0.34) 67.1 (0.53) 73.8 (0.32)
2001 71.6 (0.37) 66.7 (0.57) 73.7 (0.33)
2002 69.8 (0.39) 63.9 (0.61) 72.3 (0.35)
2003 68.2 (0.40) 62.6 (0.60) 70.6 (0.36)
2004 3 68.6 (0.39) 63.1 (0.59) 70.9 (0.36)
2005 3 68.4 (0.39) 62.4 (0.60) 70.9 (0.36)
2006 3,4 66.5 (0.48) 59.7 (0.72) 69.2 (0.43)
2007 3 66.8 (0.53) 59.9 (0.82) 69.6 (0.47)
2008 3 65.4 (0.57) 58.3 (0.84) 68.1 (0.54)
2009 3 (January-March) 63.7 (1.39) 55.8 (2.33) 66.8 (1.17)

1 "Public health plan coverage" includes Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, Medicare (disability), and military plans.

2 "Private health insurance coverage" excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories.

3Beginning in the third quarter of 2004, two additional questions were added to the National Health Interview Survey (NHIS) insurance section to reduce potential errors in reporting Medicare and Medicaid status. Persons aged 65 years and over not reporting Medicare coverage were asked explicitly about Medicare coverage, and persons under age 65 with no reported coverage were asked explicitly about Medicaid coverage. Estimates of uninsurance for 2004 were calculated without using the additional information from these questions (noted as Method 1) and with the responses to these questions (noted as Method 2). Respondents who were reclassified as “covered” by the additional questions received the appropriate follow-up questions concerning periods of noncoverage for insured respondents. The two additional questions added beginning in the third quarter of 2004 did not affect the estimates of private coverage. Beginning in 2005, all estimates were calculated using Method 2. See “Technical Notes” for additional information.

4 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 4

 

Table 4a. Percentage uninsured at the time of interview for persons under the age of 65 years, by poverty status: United States, 1997-March 2009

 

Under 65 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent uninsured2 (standard error)
1997 17.4 (0.24) 32.7 (0.80) 30.4 (0.70) 8.9 (0.22) 21.6 (0.59)
1998 16.5 (0.26) 32.7 (0.84) 30.8 (0.79) 8.0 (0.22) 20.7 (0.59)
1999 16.0 (0.25) 32.1 (0.93) 30.7 (0.73) 7.8 (0.20) 20.1 (0.48)
2000 16.8 (0.24) 32.7 (0.89) 31.3 (0.69) 8.7 (0.22) 19.7 (0.51)
2001 16.2 (0.26) 31.0 (0.99) 28.6 (0.69) 8.4 (0.21) 20.3 (0.53)
2002 16.5 (0.24) 28.6 (0.80) 28.3 (0.70) 9.5 (0.24) 20.7 (0.55)
2003 17.2 (0.27) 29.4 (0.91) 30.2 (0.70) 9.1 (0.25) 21.3 (0.52)
2004 (Method 1)3,4 16.6 (0.23) 30.5 (0.93) 29.1 (0.67) 9.4 (0.23) 18.7 (0.48)
2004 (Method 2)3,4 16.4 (0.23) 30.1 (0.91) 28.9 (0.67) 9.4 (0.23) 18.6 (0.48)
2005 3 16.0 (0.24) 28.4 (0.78) 28.6 (0.63) 9.1 (0.22) 18.5 (0.48)
2006 3,5 16.8 (0.29) 29.2 (0.98) 30.8 (0.80) 9.7 (0.29) 17.5 (0.49)
2007 6 16.4 (0.33) 28.0 (1.04) 30.2 (0.91) 9.8 (0.27) 20.8 (0.74)
2008 3 16.7 (0.36) 27.9 (1.08) 30.6 (0.82) 10.2 (0.27) 21.0 (0.73)
2009 3 (January-March) 16.9 (0.89) 30.5 (2.43) 27.4 (1.93) 10.1 (0.83) 22.1 (2.26)

See footnotes at end of table 4c.

 

Table 4b. Percentage uninsured at the time of interview for persons under the age of 18 years, by poverty status: United States, 1997-March 2009

 

Under 18 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent uninsured2 (standard error)
1997 13.9 (0.36) 22.4 (0.99) 22.8 (0.96) 6.1 (0.33) 18.3 (0.90)
1998 12.7 (0.34) 21.6 (1.02) 22.5 (0.97) 4.9 (0.29) 16.5 (0.75)
1999 11.8 (0.32) 21.4 (1.13) 21.6 (0.92) 4.4 (0.29) 14.9 (0.69)
2000 12.3 (0.32) 20.6 (1.04) 21.4 (0.93) 5.3 (0.30) 15.0 (0.72)
2001 11.0 (0.34) 18.8 (1.24) 17.0 (0.85) 4.4 (0.26) 15.5 (0.84)
2002 10.5 (0.32) 15.9 (0.97) 15.7 (0.84) 5.3 (0.36) 14.1 (0.76)
2003 10.1 (0.34) 15.4 (1.06) 14.7 (0.88) 4.8 (0.33) 13.5 (0.67)
2004 (Method 1)3,4 9.6 (0.29) 16.2 (1.23) 15.5 (0.81) 5.0 (0.30) 10.5 (0.56)
2004 (Method 2)3,4 9.4 (0.29) 15.3 (1.17) 15.1 (0.81) 5.0 (0.30) 10.3 (0.56)
2005 3 8.9 (0.29) 13.0 (0.92) 14.7 (0.79) 4.6 (0.30) 11.0 (0.66)
2006 3,5 9.3 (0.34) 12.7 (1.06) 16.5 (1.05) 4.8 (0.39) 10.0 (0.63)
2007 6 8.9 (0.40) 11.4 (1.08) 15.5 (1.10) 4.9 (0.34) 11.8 (1.01)
2008 3 8.9 (0.43) 12.4 (1.13) 15.6 (1.07) 4.8 (0.39) 11.0 (0.97)
2009 3 (January-March) 8.2 (1.14) 12.7 (2.41) 10.5 (2.12) 5.1 (1.30) 10.2 (2.86)

See footnotes at end of table 4c.

 

Table 4c. Percentage uninsured at the time of interview for persons 18-64 years of age, by poverty status: United States, 1997-March 2009

 

18-64 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent uninsured2 (standard error)
1997 18.9 (0.23) 40.2 (0.88) 34.9 (0.71) 9.9 (0.22) 22.9 (0.58)
1998 18.2 (0.27) 40.8 (1.02) 36.0 (0.83) 9.2 (0.23) 22.2 (0.60)
1999 17.8 (0.26) 39.9 (1.11) 36.3 (0.81) 9.0 (0.20) 22.2 (0.50)
2000 18.7 (0.27) 41.1 (1.05) 37.4 (0.77) 10.0 (0.24) 21.5 (0.53)
2001 18.3 (0.27) 39.5 (1.19) 35.6 (0.78) 9.9 (0.22) 22.1 (0.52)
2002 19.1 (0.26) 37.0 (1.09) 36.2 (0.77) 11.0 (0.25) 23.2 (0.56)
2003 20.1 (0.29) 38.2 (1.19) 39.5 (0.81) 10.6 (0.27) 24.2 (0.56)
2004 (Method 1)3,4 19.4 (0.26) 40.1 (1.10) 36.9 (0.72) 11.0 (0.26) 21.7 (0.54)
2004 (Method 2)3,4 19.3 (0.26) 39.9 (1.09) 36.8 (0.73) 11.0 (0.26) 21.6 (0.54)
2005 3 18.9 (0.26) 38.5 (0.95) 36.6 (0.73) 10.7 (0.24) 21.2 (0.52)
2006 3,5 19.8 (0.33) 40.0 (1.33) 38.6 (0.89) 11.4 (0.31) 20.3 (0.54)
2007 6 19.4 (0.36) 38.6 (1.47) 39.3 (1.01) 11.4 (0.29) 23.8 (0.79)
2008 3 19.7 (0.40) 37.7 (1.49) 39.9 (0.94) 11.9 (0.28) 24.4 (0.83)
2009 3 (January-March) 20.3 (0.97) 42.5 (3.52) 37.4 (2.12) 11.7 (0.81) 26.0 (2.44)

1 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold, “near poor” persons have incomes of 100% to less than 200% of the poverty threshold, and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 19.1% in 1997, 23.6% in 1998, 26.4% in 1999, 27.0% in 2000, 27.1% in 2001, 28.1% in 2002, 31.5% in 2003, 29.6% in 2004, 28.9% in 2005, 30.7% in 2006, 18.0% in 2007, 15.8% in 2008 and 11.6% in the first quarter of 2009. For more information on the unknown income and poverty status categories, see the National Health Interview Survey (NHIS) Survey Description Document for years 1997-2005, available from the NHIS website. Estimates may differ from estimates based on both reported and imputed income. See “Technical Notes” for a discussion of the use of imputed income in the stratification of health insurance coverage by poverty status.

2 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan at the time of the interview. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.

3 Beginning in the third quarter of 2004, two additional questions were added to the NHIS insurance section to reduce potential errors in reporting Medicare and Medicaid status. Persons aged 65 years and over not reporting Medicare coverage were asked explicitly about Medicare coverage, and persons under age 65 with no reported coverage were asked explicitly about Medicaid coverage. Estimates of uninsurance for 2004 were calculated without using the additional information from these questions (noted as Method 1) and with the responses to these questions (noted as Method 2). Respondents who were reclassified as “covered” by the additional questions received the appropriate follow-up questions concerning periods of noncoverage for insured respondents. Beginning in 2005, all estimates were calculated using Method 2. See “Technical Notes” for additional information.

4 In 2004, a much larger than expected proportion of respondents reported a family income of “$2.” Based on extensive review, these “$2” responses were coded to “not ascertained” for the final 2004 NHIS data files. Effective with the March 2006 Early Release report, the 2004 estimates were recalculated to reflect this editing decision. For a complete discussion, see the NHIS Survey Description Document for 2004, available from the NHIS website. The problem with the “$2” income reports was fixed in the 2005 NHIS.

5 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

6 In 2007, the income section of the NHIS was redesigned, and estimates by poverty status may not be directly comparable with earlier years. See “Technical Notes” for further information on the income question changes.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 5

 

Table 5a. Percentage of persons under the age of 65 years with public health plan coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

Under 65 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with public health plan coverage2 (standard error)
1997 13.6 (0.25) 46.1 (1.01) 18.2 (0.56) 5.3 (0.19) 13.2 (0.49)
1998 12.7 (0.26) 44.7 (1.05) 17.5 (0.57) 5.1 (0.23) 13.4 (0.45)
1999 12.4 (0.24) 43.4 (1.04) 20.5 (0.63) 4.8 (0.18) 13.2 (0.43)
2000 12.9 (0.26) 43.7 (1.11) 21.7 (0.62) 5.3 (0.21) 12.8 (0.42)
2001 13.6 (0.26) 45.0 (1.14) 25.0 (0.39) 5.7 (0.21) 13.1 (0.42)
2002 15.2 (0.29) 47.0 (1.07) 27.5 (0.72) 6.1 (0.24) 16.6 (0.45)
2003 16.0 (0.31) 48.8 (1.16) 29.3 (0.75) 6.6 (0.27) 15.8 (0.48)
2004 (Method 1)3,4 16.1 (0.29) 50.7 (1.02) 27.6 (0.69) 6.9 (0.23) 16.0 (0.47)
2004 (Method 2)3,4 16.2 (0.29) 51.1 (1.01) 27.8 (0.68) 6.9 (0.23) 16.1 (0.47)
2005 3 16.8 (0.29) 50.6 (0.98) 30.0 (0.72) 7.4 (0.22) 16.4 (0.48)
2006 3,5 18.1 (0.35) 51.5 (1.17) 30.5 (0.78) 7.5 (0.28) 17.9 (0.64)
2007 6 18.1 (0.40) 53.3 (1.34) 33.9 (0.91) 7.6 (0.30) 18.6 (0.77)
2008 3 19.3 (0.42) 55.5 (1.22) 34.7 (0.92) 8.5 (0.30) 19.4 (0.90)
2009 3 (January-March) 21.1 (0.96) 55.8 (2.99) 37.6 (2.18) 8.8 (0.63) 19.3 (2.55)

See footnotes at end of table 5c.

 

Table 5b. Percentage of persons under the age of 18 years with public health plan coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

Under 18 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with public health plan coverage2 (standard error)
1997 21.4 (0.48) 62.1 (1.31) 24.3 (0.93) 6.3 (0.32) 21.4 (0.97)
1998 20.0 (0.49) 61.1 (1.34) 22.9 (0.95) 6.0 (0.39) 22.1 (0.95)
1999 20.4 (0.46) 60.7 (1.37) 28.7 (1.15) 6.0 (0.32) 22.2 (0.88)
2000 22.0 (0.50) 61.8 (1.48) 32.4 (1.13) 7.4 (0.39) 22.1 (0.85)
2001 23.6 (0.50) 65.2 (1.47) 37.0 (1.23) 8.1 (0.39) 23.1 (0.94)
2002 27.1 (0.54) 69.0 (1.33) 42.2 (1.18) 8.9 (0.45) 30.7 (0.99)
2003 28.6 (0.58) 72.3 (1.32) 47.2 (1.27) 9.8 (0.48) 28.5 (1.00)
2004 (Method 1)3,4 28.5 (0.54) 72.5 (1.36) 43.4 (1.20) 9.7 (0.45) 30.4 (1.01)
2004 (Method 2)3,4 28.7 (0.54) 73.4 (1.34) 43.8 (1.20) 9.7 (0.45) 30.6 (1.01)
2005 3 29.9 (0.56) 73.3 (1.32) 47.3 (1.21) 10.7 (0.47) 30.8 (1.05)
2006 3,5 32.3 (0.69) 75.8 (1.32) 49.0 (1.45) 10.4 (0.53) 33.1 (1.25)
2007 6 32.7 (0.77) 78.7 (1.38) 53.5 (1.44) 11.0 (0.60) 34.0 (1.54)
2008 3 34.2 (0.79) 79.4 (1.37) 53.4 (1.58) 13.1 (0.62) 35.1 (1.72)
2009 3 (January-March) 38.7 (2.11) 80.3 (3.01) 59.8 (3.81) 13.5 (1.72) 37.1 (6.16)

See footnotes at end of table 5c.

 

Table 5c. Percentage of persons 18-64 years with public health plan coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

18-64 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with public health plan coverage2 (standard error)
1997 10.2 (0.20) 34.3 (0.93) 14.6 (0.51) 5.0 (0.18) 10.1 (0.41)
1998 9.5 (0.21) 32.9 (1.08) 14.1 (0.53) 4.8 (0.21) 10.0 (0.34)
1999 9.0 (0.19) 30.8 (0.98) 15.4 (0.52) 4.4 (0.17) 9.6 (0.33)
2000 9.1 (0.19) 31.1 (1.00) 15.2 (0.54) 4.5 (0.19) 9.1 (0.33)
2001 9.4 (0.21) 30.8 (1.10) 17.8 (0.62) 4.8 (0.20) 9.4 (0.33)
2002 10.3 (0.23) 32.5 (1.10) 18.3 (0.66) 5.1 (0.22) 11.2 (0.35)
2003 10.9 (0.24) 34.0 (1.19) 18.6 (0.68) 5.5 (0.24) 11.1 (0.37)
2004 (Method 1)3,4 11.1 (0.22) 36.1 (1.03) 18.5 (0.61) 5.9 (0.21) 10.8 (0.35)
2004 (Method 2)3,4 11.1 (0.23) 36.3 (1.03) 18.6 (0.60) 5.9 (0.21) 10.9 (0.35)
2005 3 11.5 (0.22) 35.6 (0.98) 20.0 (0.61) 6.2 (0.20) 11.3 (0.36)
2006 3,5 12.4 (0.26) 35.6 (1.25) 20.3 (0.68) 6.5 (0.25) 12.3 (0.48)
2007 6 12.3 (0.31) 37.0 (1.41) 21.7 (0.85) 6.5 (0.27) 13.4 (0.61)
2008 3 13.4 (0.33) 40.4 (1.34) 23.1 (0.80) 7.0 (0.28) 14.1 (0.77)
2009 3 (January-March) 14.1 (0.69) 39.4 (3.41) 24.5 (1.98) 7.4 (0.53) 13.4 (1.75)

1 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold, “near poor” persons have incomes of 100% to less than 200% of the poverty threshold, and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 19.1% in 1997, 23.6% in 1998, 26.4% in 1999, 27.0% in 2000, 27.1% in 2001, 28.1% in 2002, 31.5% in 2003, 29.6% in 2004, 28.9% in 2005, 30.7% in 2006, 18.0% in 2007, 15.8% in 2008 and 11.6% in the first quarter of 2009. For more information on the unknown income and poverty status categories, see the National Health Interview Survey (NHIS) Survey Description Document for years 1997-2005, available from the NHIS website. Estimates may differ from estimates based on both reported and imputed income. See “Technical Notes” for a discussion of the use of imputed income in the stratification of health insurance coverage by poverty status.

2 The category “public health plan coverage” includes Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plans, Medicare (disability), and military plans. A small number of persons were covered by both public and private plans and were included in both categories. See Table 6 for persons covered by private plans.

3 Beginning in the third quarter of 2004, two additional questions were added to the NHIS insurance section to reduce potential errors in reporting Medicare and Medicaid status. Persons aged 65 years and over not reporting Medicare coverage were asked explicitly about Medicare coverage, and persons under age 65 with no reported coverage were asked explicitly about Medicaid coverage. Estimates of uninsurance for 2004 were calculated without using the additional information from these questions (noted as Method 1) and with the responses to these questions (noted as Method 2). Respondents who were reclassified as “covered” by the additional questions received the appropriate follow-up questions concerning periods of noncoverage for insured respondents. Beginning in 2005, all estimates were calculated using Method 2. See “Technical Notes” for additional information.

4 In 2004, a much larger than expected proportion of respondents reported a family income of “$2.” Based on extensive review, these “$2” responses were coded to “not ascertained” for the final 2004 NHIS data files. Effective with the March 2006 Early Release report, the 2004 estimates were recalculated to reflect this editing decision. For a complete discussion, see the NHIS Survey Description Document for 2004, available from: NHIS website. The problem with the “$2” income reports was fixed in the 2005 NHIS.

5 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

6 In 2007, the income section of the NHIS was redesigned, and estimates by poverty status may not be directly comparable with earlier years. See “Technical Notes” for further information on the income question changes.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 6

 

Table 6a. Percentage of persons under the age of 65 years with private health insurance coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

Under 65 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with private health insurance coverage2 (standard error)
1997 70.8 (0.35) 22.9 (0.93) 53.5 (0.80) 87.6 (0.27) 66.7 (0.71)
1998 72.0 (0.36) 23.1 (1.02) 53.0 (0.92) 88.1 (0.29) 67.1 (0.71)
1999 73.1 (0.36) 26.1 (1.12) 50.9 (0.86) 88.9 (0.24) 68.0 (0.65)
2000 71.8 (0.34) 25.2 (1.00) 49.1 (0.87) 87.4 (0.28) 68.8 (0.63)
2001 71.6 (0.37) 25.5 (1.13) 48.4 (0.85) 87.2 (0.27) 67.8 (0.69)
2002 69.8 (0.39) 26.0 (1.14) 46.5 (0.89) 86.0 (0.33) 63.9 (0.71)
2003 68.2 (0.40) 23.4 (1.21) 42.3 (0.90) 85.8 (0.34) 64.1 (0.68)
2004 3 68.6 (0.39) 20.0 (1.11) 44.9 (0.85) 85.0 (0.32) 66.3 (0.70)
2005 68.4 (0.39) 22.1 (0.89) 43.2 (0.89) 84.7 (0.30) 66.2 (0.68)
2006 4 66.5 (0.48) 20.6 (1.29) 40.6 (0.91) 84.1 (0.41) 65.7 (0.79)
2007 5 66.8 (0.53) 20.1 (1.41) 37.9 (1.00) 83.8 (0.40) 61.7 (1.04)
2008 3 65.4 (0.58) 17.9 (1.21) 36.3 (1.00) 82.5 (0.38) 60.7 (1.16)
2009 3 (January-March) 63.7 (1.39) 14.9 (2.67) 38.2 (2.55) 82.4 (1.11) 59.8 (3.21)

See footnotes at end of table 6c.

 

Table 6b. Percentage of persons under the age of 18 years with private health insurance coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

Under 18 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with private health insurance coverage2 (standard error)
1997 66.2 (0.57) 17.5 (1.09) 55.0 (1.15) 88.9 (0.43) 61.7 (1.18)
1998 68.5 (0.55) 19.3 (1.17) 56.3 (1.22) 89.9 (0.48) 62.1 (1.13)
1999 69.1 (0.55) 20.2 (1.16) 52.1 (1.23) 90.6 (0.39) 63.8 (1.02)
2000 67.1 (0.53) 19.5 (1.21) 48.8 (1.23) 88.4 (0.47) 64.2 (0.99)
2001 66.7 (0.57) 18.1 (1.12) 48.4 (1.23) 88.4 (0.40) 62.2 (1.16)
2002 63.9 (0.61) 17.2 (1.08) 44.9 (1.29) 86.9 (0.54) 56.3 (1.19)
2003 62.6 (0.60) 14.4 (1.06) 39.9 (1.28) 86.5 (0.56) 58.8 (1.07)
2004 3 63.1 (0.59) 12.6 (0.97) 43.0 (1.29) 86.4 (0.52) 60.0 (1.11)
2005 62.4 (0.60) 15.0 (1.10) 40.0 (1.31) 85.6 (0.52) 59.3 (1.16)
2006 4 59.7 (0.72) 13.1 (1.10) 36.9 (1.37) 85.9 (0.63) 57.8 (1.28)
2007 5 59.9 (0.82) 11.9 (1.08) 34.0 (1.46) 85.1 (0.63) 54.8 (1.82)
2008 3 58.3 (0.84) 10.4 (0.95) 32.9 (1.46) 83.1 (0.67) 54.8 (1.78)
2009 3 (January-March) 55.8 (2.33) 8.6 (2.43) 36.7 (4.16) 82.6 (2.13) 55.0 (6.22)

See footnotes at end of table 6c.

 

Table 6c. Percentage of persons 18-64 years with private health insurance coverage at the time of interview, by poverty status: United States, 1997-March 2009

 

18-64 years Poverty status1
  Total Poor Near poor Not poor Unknown
  Percent of persons with private health insurance coverage2 (standard error)
1997 72.8 (0.30) 26.8 (1.09) 52.6 (0.76) 87.1 (0.26) 68.6 (0.65)
1998 73.5 (0.32) 25.8 (1.17) 50.9 (0.90) 87.4 (0.27) 69.1 (0.66)
1999 74.7 (0.33) 30.4 (1.39) 50.2 (0.85) 88.2 (0.24) 69.7 (0.60)
2000 73.8 (0.32) 29.2 (1.16) 49.3 (0.83) 87.1 (0.27) 70.6 (0.61)
2001 73.7 (0.33) 31.7 (1.41) 48.4 (0.82) 86.8 (0.28) 69.9 (0.61)
2002 72.3 (0.35) 31.8 (1.50) 47.5 (0.85) 85.7 (0.30) 66.9 (0.62)
2003 70.6 (0.36) 29.0 (1.60) 43.7 (0.88) 85.5 (0.33) 66.0 (0.62)
2004 3 70.9 (0.36) 24.9 (1.39) 46.0 (0.79) 84.6 (0.31) 68.6 (0.65)
2005 70.9 (0.36) 26.8 (1.03) 45.0 (0.85) 84.4 (0.29) 68.7 (0.61)
2006 4 69.2 (0.43) 25.5 (1.72) 42.6 (0.92) 83.6 (0.40) 68.6 (0.71)
2007 5 69.6 (0.47) 25.4 (1.92) 40.4 (1.01) 83.4 (0.38) 64.0 (0.92)
2008 3 68.1 (0.54) 22.7 (1.65) 38.3 (1.01) 82.4 (0.37) 62.7 (1.13)
2009 3 (January-March) 66.8 (1.17) 19.1 (3.53) 39.1 (2.00) 82.3 (0.99) 61.4 (2.85)

1 Poverty status is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold, “near poor” persons have incomes of 100% to less than 200% of the poverty threshold, and “not poor” persons have incomes of 200% of the poverty threshold or greater. The percentage of respondents with unknown poverty status was 19.1% in 1997, 23.6% in 1998, 26.4% in 1999, 27.0% in 2000, 27.1% in 2001, 28.1% in 2002, 31.5% in 2003, 29.6% in 2004, 28.9% in 2005, 30.7% in 2006, 18.0% in 2007, 15.8% in 2008 and 11.6% in the first quarter of 2009. For more information on the unknown income and poverty status categories, see the National Health Interview Survey (NHIS) Survey Description Document for years 1997-2005, available from the NHIS website. Estimates may differ from estimates based on both reported and imputed income. See “Technical Notes” for a discussion of the use of imputed income in the stratification of health insurance coverage by poverty status.

2 The category “private health insurance” excludes plans that paid for only one type of service such as accidents or dental care. A small number of persons were covered by both public and private plans and thus were included in both categories. See Table 5 for persons covered by public plans.

3 In 2004, a much larger than expected proportion of respondents reported a family income of “$2.” Based on extensive review, these “$2” responses were coded to “not ascertained” for the final 2004 NHIS data files. Effective with the March 2006 Early Release report the 2004 estimates were recalculated to reflect this editing decision. For a complete discussion, see the NHIS Survey Description Document for 2004, available from the NHIS website. The problem with the “$2” income reports was fixed in the 2005 NHIS.

4 In 2006, NHIS underwent a sample redesign. The impact of the new sample design on estimates presented in this report is expected to be minimal.

5 In 2007, the income section of the NHIS was redesigned, and estimates by poverty status may not be directly comparable with earlier years. See “Technical Notes” for further information on the income question changes.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997-2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

Table 7

 

Table 7a. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by age: United States, January-March 2009

 

Age Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
All ages 14.9 (0.79) 19.2 (0.84) 10.7 (0.66)
Under 65 years 16.9 (0.89) 21.7 (0.94) 12.1 (0.74)
Under 18 years 8.2 (1.14) 13.3 (1.23) 5.3 (0.91)
18-64 years 20.3 (0.97) 25.0 (1.01) 14.8 (0.84)
65 years and over *1.3 (0.39) 1.9 (0.40) *0.9 (0.34)

See footnotes at end of table 7g.

 

Table 7b. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by sex: United States, January-March 2009

 

Sex Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Male 17.0 (0.93) 20.9 (0.99) 12.4 (0.83)
Female 13.0 (0.78) 17.5 (0.83) 9.0 (0.62)

See footnotes at end of table 7g.

 

Table 7c. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by race/ethnicity: United States, January-March 2009

 

Race/ethnicity Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Hispanic or Latino 32.3 (1.86) 35.9 (1.71) 25.7 (1.83)
Non-Hispanic
White, single race
10.4 (0.86) 14.5 (1.00) 7.0 (0.65)
Non-Hispanic
Black, single race
17.0 (1.05) 22.8 (1.30) 11.3 (1.08)
Non-Hispanic
Asian, single race
13.0 (2.45) 17.1 (2.93) 8.8 (1.78)
Non-Hispanic
Other races and multiple races
19.1 (3.58) 24.3 (4.01) 13.3 (2.73)

See footnotes at end of table 7g.

 

Table 7d. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by region: United States, January-March 2009

 

Region Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Northeast 10.8 (1.82) 14.1 (1.79) 7.9 (1.76)
Midwest 12.6 (1.57) 16.5 (1.62) 7.5 (0.85)
South 18.4 (1.42) 22.9 (1.49) 13.6 (1.25)
West 14.6 (1.44) 19.3 (1.74) 11.2 (1.15)

See footnotes at end of table 7g.

 

Table 7e. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by education: United States, January-March 2009

 

Education3 Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Less than high school 35.5 (1.97) 39.1 (2.07) 29.5 (1.91)
High school diploma or GED4 20.6 (1.27) 24.3 (1.40) 15.4 (1.11)
More than high school 10.8 (0.62) 15.1 (0.75) 6.8 (0.48)

See footnotes at end of table 7g.

 

Table 7f. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by employment status: United States, January-March 2009

 

Employment status5 Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Employed 17.1 (0.96) 21.5 (1.02) 13.2 (0.87)
Unemployed 55.3 (3.13) 63.5 (3.13) 34.8 (2.87)
Not in workforce 19.5 (1.65) 24.2 (1.78) 13.7 (1.30)

See footnotes at end of table 7g.

 

Table 7g. Percentage of persons who lacked health insurance coverage at the time of interview, for at least part of the past year, or for more than a year, by marital status: United States, January-March 2009

 

Marital status3 Uninsured1 at the time of interview Uninsured1 for at least part of the past year2 Uninsured1 for more than a year2
  Percent (standard error)
Married 12.0 (0.97) 15.0 (1.03) 9.3 (0.86)
Widowed 4.9 (1.34) 5.8 (1.42) 4.4 (1.24)
Divorced or separated 21.8 (1.64) 27.4 (1.69) 16.0 (1.44)
Living with partner 29.9 (2.60) 36.4 (2.51) 18.9 (2.24)
Never married 27.0 (1.47) 32.9 (1.61) 18.9 (1.32)

* Estimate has a relative standard error greater than 30% and less than or equal to 50% and should be used with caution as it does not meet the standard of reliability or precision.

1 A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), state-sponsored or other government-sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care.

2 A year is defined as the 12 months prior to interview.

3 Education and marital status are shown only for persons aged 18 years and over.

4 GED is General Educational Development high school equivalency diploma.

5 Employment status is shown only for persons aged 18-64 years.

NOTE: Estimates are based on approximately half of the usual quarterly sample. Estimates based on this smaller sample size for the first quarter have larger variances making it more difficult to detect significant differences between estimates. Observed changes between the last two data points should be reevaluated when the next quarter of data becomes available.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2009, Family Core component. The estimates for 2009 are based on data collected from January through March. Data are based on household interviews of a sample of the civilian noninstitutionalized population.

 

 
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