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Issued September 2016 P60-257(RV)

By Jessica C. Barnett and Marina S. Vornovitsky

Health Insurance Coverage in the United States: 2015 Current Population Reports

Jessica C. Barnett and Marina S. Vornovitsky, Chief of the Health and Disability Statistics Branch, prepared this report. Jennifer Cheeseman Day, Assistant Division Chief for Employment Characteristics in the Social, Economic, and Housing Statistics Division, provided overall direction.

David L. Watt and Susan S. Gajewski, Demographic Surveys Division, and Tim J. Marshall and Lisa Cheok, Associate Directorate Demographic Programs, processed the Current Population Survey 2016 Annual Social and Economic Supplement file. Kirk E. Davis, Raymond Dowdy, Shawna Evers, Ryan C. Fung, Chandararith R. Phe, and Tiffani Whaley programmed and produced the detailed and publication tables under the direction of Hung X. Pham, Chief of the Tabulation and Applications Branch.

Victoria Velkoff, acting Chief of the American Community Survey Office, and Deborah M. Stempowski, former Chief of the American Community Survey Office, provided overall direction for the implementation of the 2015 American Community Survey. Jennifer W. Reichert, Judy G. Belton, Nicole Butler, Donna M. Daily, and Dameka M. Reese of the American Community Survey Office oversaw the data collection, including content, group quarters, and self- response. Kenneth B. Dawson, Gail M. Denby, and Arumugam Sutha of the Decennial Information Technology Division directed the edit and processing tasks for the 2015 1-Year American Community Survey file.

Jamie Choi, under the supervision of David V. Hornick, both of the Demographic Statistical Methods Division, conducted the statistical review of all Current Population Survey data.

Sirius C. Fuller, under the supervision of Karen E. King, both of the Decennial Statistical Studies Division, conducted the statistical review of all American Community Survey data.

Lisa Clement, Survey Director of the Current Population Survey, provided overall direction for the survey implementation. Lisa Cheok and Aaron Cantu, Associate Directorate Demographic Programs, and Roberto Picha, Agatha Jung, and Johanna Rupp of the Information Technology Directorate prepared and programmed the computer-assisted interviewing instrument used to conduct the Annual Social and Economic Supplement.

Alexandra Cockerham and Linda Orsini prepared the maps under the direction of Kevin Hawley, Chief of the Cartographic Products and Services Branch, Geography Division.

Additional people within the U.S. Census Bureau also made significant contributions to the preparation of this report. Edward Berchick, Kelly Holder, Heide Jackson, Brett O’Hara, Sharon Stern, Amy Steinweg, Danielle Taylor, Susan Walsh, and Monica S. Wiedemann reviewed the contents.

Census Bureau field representatives and telephone interviewers collected the data. Without their dedication, the preparation of this report or any report from the Current Population Survey would be impossible.

Linda Chen, Christine Geter, Donna Gillis, and Anthony Richards of the Public Information Office provided publication management, graphics design and composition, and editorial review for print and electronic media. George E. Williams of the Census Bureau’s Administrative and Customer Services Division provided printing management.

Acknowledgments

U.S. Department of Commerce Penny Pritzker,

Secretary

Bruce H. Andrews, Deputy Secretary

Economics and Statistics Administration Justin Antonipillai,

Counselor, Designated Duties of Under Secretary for Economic Affairs

U.S. CENSUS BUREAU John H. Thompson,

Director

P60-257(RV)

Health Insurance Coverage in the United States: 2015 Issued September 2016

Suggested Citation Barnett, Jessica C. and Marina S. Vornovitsky,

Current Population Reports, P60-257(RV),

Health Insurance Coverage in the United States: 2015,

U.S. Government Printing Office, Washington, DC,

2016.

Economics and Statistics Administration

Justin Antonipillai, Counselor, Designated Duties of Under Secretary for Economic Affairs

U.S. CENSUS BUREAU John H. Thompson, Director

Nancy A. Potok, Deputy Director and Chief Operating Officer

Enrique Lamas, Associate Director for Demographic Programs

David G. Waddington, Acting Chief, Social, Economic, and Housing Statistics Division

ECONOMICS

AND STATISTICS

ADMINISTRATION

U.S. Census Bureau Health Insurance Coverage in the United States: 2015 iii

Contents

TEXT TABLES

Table 1. Coverage Numbers and Rates by Type of Health Insurance: 2013 to 2015 ……………………………………………………………….. 4

Table 2. Percentage of People by Type of Health Insurance Coverage by Age: 2014 and 2015 ………………………………………………….. 7

Table 3. Percentage of People by Type of Health Insurance Coverage for Working-Age Adults 19 to 64 Years Old: 2014 and 2015 ……. 10

Table 4. Percentage of People by Type of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: 2014 and 2015 ……………………………………………………………. 13

Table 5. Percentage of People by Type of Health Insurance Coverage by Selected Demographic Characteristics: 2014 and 2015 ……………………………………………………………. 16

TEXT

Introduction …………………………………………………………………………….. 1 Highlights ……………………………………………………………………………….. 1 What Is Health Insurance Coverage? ……………………………………………. 1 Health Insurance Coverage and the Affordable Care Act …………………. 2 Estimates of the Population Without Health Insurance Coverage ………. 3 Two Measures of Health Insurance Coverage ………………………………… 5 Multiple Coverage Types ……………………………………………………………. 6 Health Insurance Coverage by Selected Characteristics …………………… 6

Age …………………………………………………………………………………… 6 Marital Status ……………………………………………………………………… 9 Disability Status ………………………………………………………………….. 9 Work Experience ………………………………………………………………… 11 Educational Attainment ………………………………………………………. 11 Household Income ……………………………………………………………… 11 Income-to-Poverty Ratios …………………………………………………….. 12 Family Status …………………………………………………………………….. 15 Residence …………………………………………………………………………. 15 Race and Hispanic Origin…………………………………………………….. 15 Nativity ……………………………………………………………………………. 15 Children and Adults Without Health Insurance Coverage ………….. 17

State Estimates of Health Insurance Coverage …………………………….. 18 More Information About Health Insurance Coverage …………………….. 21

Additional Data and Contacts ………………………………………………. 21 State and Local Estimates of Health Insurance Coverage ………….. 21

Comments …………………………………………………………………………….. 21 Sources of Estimates ……………………………………………………………….. 21

Statistical Accuracy…………………………………………………………….. 22

iv Health Insurance Coverage in the United States: 2015 U.S. Census Bureau

APPENDIX TABLES

Table A-1. Population Without Health Insurance Coverage by State: 2013 to 2015 ………………………. 24

Table A-2. Number of People by Type of Health Insurance Coverage by Age: 2014 and 2015 ……….. 26

Table A-3. Number of People by Type of Health Insurance Coverage for Working-Age Adults, Aged 19 to 64: 2014 and 2015 ………………………………………………………………………… 27

Table A-4. Number of People by Type of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: 2014 and 2015 …………………………………………………………… 28

Table A-5. Number of People by Type of Health Insurance Coverage by Selected Demographic Characteristics: 2014 and 2015 ………………………………………… 29

FIGURES

Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2013 to 2015 ………………………………………………………………………………………………2

Figure 2. Uninsured Rate: 2008 to 2015 ………………………………………………………………………………….5

Figure 3. Percentage With One or Multiple Coverage Types: 2015 ……………………………………………….6

Figure 4. Uninsured Rate by Single Year of Age: 2013 to 2015 ……………………………………………………9

Figure 5. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2013 to 2015 ………………………………………………………………14

Figure 6. Children Under Age 19 and Adults Aged 19 to 64 Without Health Insurance Coverage by Selected Characteristics: 2015 ………………………………………………………….17

Figure 7. Uninsured Rate by State: 2015 ………………………………………………………………………………..19

Figure 8. Change in the Uninsured Rate by State: 2013 to 2015 ………………………………………………..20

APPENDIXES

Appendix A. Additional Health Insurance Coverage Tables …………………………………….. 23

Appendix B. Estimates of Health Insurance Coverage ……………………………………………… 31 Quality of Health Insurance Coverage Estimates ……………………………………………………………….. 31

Appendix C. Replicate Weights ……………………………………………………………………………………. 33

Appendix D. Additional Data and Contacts ………………………………………………………………… 35 Customized Tables ……………………………………………………………………………………………………… 35

The CPS Table Creator …………………………………………………………………………………………….. 35 American FactFinder ……………………………………………………………………………………………….. 35 DataFerrett ……………………………………………………………………………………………………………. 35

Public Use Microdata ……………………………………………………………………………………………………. 35 CPS ASEC ………………………………………………………………………………………………………………. 35 ACS ……………………………………………………………………………………………………………………… 35

Topcoding …………………………………………………………………………………………………………………… 35

U.S. Census Bureau Health Insurance Coverage in the United States: 2015 1

Introduction

Health insurance is a means for financing a person’s health care expenses. While the majority of people have private health insurance, primar- ily through an employer, many others obtain coverage through programs offered by the government. Other individuals do not have health insur- ance at all (see the text box “What Is Health Insurance Coverage?”).

Over time, changes in the rate of health insurance coverage and the distribution of coverage types may reflect economic trends, shifts in the demographic composition of the popu- lation, and policy changes that impact access to care. Several such policy changes occurred in 2014, when many provisions of the Patient Protection and Affordable Care Act (ACA) went

into effect (see the text box “Health Insurance Coverage and the Affordable Care Act”).

This report presents statistics on health insurance coverage in the United States in 2015, changes in health insurance coverage rates between 2014 and 2015, as well as changes in health insurance coverage rates between 2013 and 2015. The statistics in this report are based on information collected in two surveys conducted by the Census Bureau, the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS) (see the text box “Two Measures of Health Insurance Coverage”). Throughout the report, unless otherwise noted, estimates come from the CPS ASEC.

Highlights

• The uninsured rate decreased between 2014 and 2015 by 1.3 percentage points as measured by the CPS ASEC. In 2015, the per- centage of people without health insurance coverage for the entire calendar year was 9.1 percent, or 29.0 million, lower than the rate and number of uninsured in 2014 (10.4 percent or 33.0 million) (Figure 1 and Table 1).1, 2

• The percentage of people with health insurance coverage for all or part of 2015 was 90.9 percent, higher than the rate in 2014 (89.6 percent) (Table 1).

• In 2015, private health insurance coverage continued to be more prevalent than public coverage, at 67.2 percent and 37.1 percent, respectively. Of the subtypes of health insurance, employer-based insurance covered 55.7 percent of the population for some or all of the calendar year, followed by Medicaid (19.6 percent), Medicare (16.3 percent), direct-purchase (16.3 percent), and military cover- age (4.7 percent) (Table 1 and Figure 1).3

1 For a brief description of how the Census Bureau collects and reports on health insurance data, see the text box “What is Health Insurance Coverage?” For a discussion of the quality of the CPS ASEC health insurance coverage estimates, see Appendix B.

2 For information on recessions, see Appendix A, P60-256, Income and Poverty in the United States: 2015 at <www.census.gov /content/dam/Census/library/publications /2016/demo/p60-256.pdf>.

3 The percentage of people covered by Medicare in 2015 was not statistically different from the percentage of people covered by direct- purchase health insurance.

Health Insurance Coverage in the United States: 2015

What Is Health Insurance Coverage?

Health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) refers to health insurance that covers basic health care needs. This definition excludes single service plans, such as accident, disability, dental, vision, or prescrip- tion medicine plans. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private insurance or government insurance. The CPS ASEC defines private health insurance as a plan pro- vided through an employer or a union and coverage purchased directly by an individual from an insurance company or through an exchange. Government health insurance includes federal programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), individual state health plans, TRICARE, CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs and the military. In the CPS ASEC, people were considered insured if they were covered by any type of health insur- ance for part or all of the previous calendar year. They were considered uninsured if they were not covered by any type of health insurance for the entire year. Additionally, people were considered uninsured if they only had coverage through the Indian Health Service (IHS). For more informa- tion, see Appendix B, “Estimates of Health Insurance Coverage.”

2 Health Insurance Coverage in the United States: 2015 U.S. Census Bureau

* Military health care includes TRICARE and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs and the military.

Note: Between 2014 and 2015, there was no statistically significant change in the percentage of people covered by employment-based health insurance, Medicaid, or military health care. Between 2013 and 2015, there was not a statistically significant change in the percentage of people covered by employment-based health insurance or military health care. For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see <www2.census.gov/programs-surveys/cps/techdocs/cpsmar16.pdf>.

Source: U.S. Census Bureau, Current Population Survey, 2014 to 2016 Annual Social and Economic Supplements.

Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2013 to 2015

0 20 40 60 80 100

Military health care*

Medicaid

Medicare

Any government plan

Direct-purchase

Employment-based

Any private plan

With health insurance

Uninsured

-6 -4 -2 0 2 4 6

Percent in 2015 Percentage point change:

2014 to 2015

(Population as of March of the following year)

-6 -4 -2 0 2 4 6

Percentage point change: 2013 to 2015

Health Insurance Coverage and the Affordable Care Act

Since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, several provisions of the ACA have gone into effect at different times. For example, in 2010, the Young Adult Provision enab

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