Health Insurance Coverage

Household Pulse Survey

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To rapidly monitor recent changes in mental health, the National Center for Health Statistics (NCHS) partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. Data collection began on April 23, 2020.

NCHS included questions to obtain information on health insurance coverage. These questions are similar to, but not exactly the same as, questions included on the National Health Interview Survey (NHIS). The NHIS, conducted by NCHS, is the source for high-quality data to monitor health insurance coverage in the U.S. Estimates of health insurance coverage based on the 2019 NHIS may be useful benchmarks for comparison with estimates from the Household Pulse Survey. In 2019, 14.5% of adults aged 18–64 were uninsured at the time of interview, 20.4% had public coverage, and 67.5% had private health insurance coverage.

Estimates on this page are derived from the Household Pulse Survey and show the percentage of adults aged 18-64 years who were uninsured at the time of the interview or had public or private health insurance coverage.

Pulse Survey Topics

Use the drop-down menus to show data for selected indicators or categories. Select the buttons at the bottom of the dashboard to view national and state estimates. The data table may be scrolled horizontally and vertically to view additional estimates.

Access Dataset on Data.CDC.gov (Export to CSV, JSON, XLS, XML)[?]

Technical Notes

 

Survey Questions

Respondents were asked, “Are you currently covered by any of the following types of health insurance or health coverage plans?”  They were then provided with a list of 8 possible sources of health care coverage and asked to mark yes or no to each.  The list consisted of:

  • Insurance through a current or former employer or union (through yourself or another family member)
  • Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member)
  • Medicare, for people 65 and older, or people with certain disabilities
  • Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
  • TRICARE or other military health care
  • VA (including those who have ever used or enrolled for VA health care)
  • Indian Health Service
  • Other

 

Definitions

Health insurance coverage is categorized into three categories: private, public, and uninsured.  The private and public categories are not mutually exclusive.  Adults can be enrolled in both.

Private health insurance coverage includes adults with a) insurance through a current or former employer or union; b) insurance purchased directly from an insurance company, including marketplace coverage; or c) TRICARE or other military health care.

Public health plan coverage includes adults with a) Medicare; b) Medicaid; or c) VA health care.

Adults were classified as uninsured if they did not report any private health insurance coverage or public health plan coverage at the time of interview.  Adults were also classified as uninsured if they had only Indian Health Service coverage.

 

Estimation

Estimates on this page are based on responses from adults aged 18-64 years. Information about adults of all ages are available from the Census Bureau website: https://www.census.gov/householdpulsedata.

Adults with missing responses to all eight questions are not shown separately in the tables and are not included in the calculation of percentages. Adults with missing responses to some, but not all, of the questions were included in the calculation of percentages; if the response was missing, the adult was classified as not having that source of health care coverage.

 

Data Source

The U.S. Census Bureau, in collaboration with five federal agencies, launched the Household Pulse Survey to produce data on the social and economic impacts of Covid-19 on American households.  The Household Pulse Survey was designed to gauge the impact of the pandemic on employment status, consumer spending, food security, housing, education disruptions, and dimensions of physical and mental wellness.

The survey was designed to meet the goal of accurate and timely weekly estimates. It was conducted by an internet questionnaire, with invitations to participate sent by email and text message. The sample frame is the Census Bureau Master Address File Data. Housing units linked to one or more email addresses or cell phone numbers were randomly selected to participate, and one respondent from each housing unit was selected to respond for him or herself. Estimates are weighted to adjust for nonresponse and to match Census Bureau estimates of the population by age, sex, race and ethnicity, and educational attainment. All estimates shown meet the NCHS Data Presentation Standards for Proportions.

Response Rate and Sample Size

Limitations

The Household Pulse Survey is different from other surveys. NCHS, the Census Bureau, and other federal statistical agencies are considered the preeminent source of the nation’s most important benchmark surveys.  Many of these surveys have been in production for decades and provide valuable insight on health, social, and economic trends. However, the production of benchmark data requires a relatively long lead time, and personal interviews (face-to-face or telephone) require additional time.  While efforts are underway to introduce COVID-19 questions into these surveys, that process can take months, sometimes years, before data are made available.

The Household Pulse Survey is different:  It was designed to go into the field quickly, to be administered via the web, and to disseminate data in near real-time, providing data users with information they can use now to help ease the burden on American households and expedite post-pandemic recovery.  The Census Bureau is fielding the Household Pulse Survey as a demonstration project, with data released as part of its Experimental Statistical Products Series.

Confidence intervals included in the tables on this page only reflect the potential for sampling error.  Nonsampling errors can also occur and are more likely for surveys that are implemented quickly, achieve low response rates, and rely on online response.  Nonsampling errors for the Household Pulse Survey may include:

  • Measurement error: The respondent provides incorrect information, or an unclear survey question is misunderstood by the respondent. The Household Pulse Survey schedule offered only limited time for testing questions.
  • Coverage error: Individuals who otherwise would have been included in the survey frame were missed. The Household Pulse Survey only recruited households for which an email address or cell phone number could be identified.
  • Nonresponse error: Responses are not collected from all those in the sample or the respondent is unwilling to provide information. The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.
  • Processing error: Forms may be lost, data may be incorrectly keyed, coded, or recoded. The real-time dissemination of the Household Pulse Survey provided limited time to identify and fix processing errors.

For more information on nonresponse bias for the 2020 Household Pulse Survey, please visit https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_NR_Bias_Report-final.pdf.

 

For more information on the Household Pulse Survey, please visit https://www.census.gov/householdpulsedata.

Suggested Citation

National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2020–2024. Health Insurance Coverage. Generated interactively: from https://www.cdc.gov/nchs/covid19/pulse/health-insurance-coverage.htm