Health Insurance Coverage in the United States: 2016

Health Insurance Coverage in the United States: 2016

Current Population Reports

By Jessica C. Barnett and Edward R. Berchick Issued September 2017 P60-260

Acknowledgments Jessica C. Barnett and Edward R. Berchick prepared this report under the direc- tion of Marina Vornovitsky, Chief of the Health and Disability Statistics Branch. Jennifer Cheeseman Day, Assistant Division Chief for Employment Characteristics of the Social, Economic, and Housing Statistics Division, provided overall direction. Susan S. Gajewski and Nancy Hunter, Demographic Surveys Division, and Lisa P. Cheok, Associate Directorate Demographic Programs, processed the Current Population Survey 2017 Annual Social and Economic Supplement file. Kirk E. Davis, Raymond Dowdy, Shawna Evers, Ryan C. Fung, Lan N. Huynh, and Chandararith R. Phe programmed and produced the historical, detailed, and publication tables under the direction of Hung X. Pham, Chief of the Tabulation and Applications Branch. Victoria Velkoff, Chief of the American Community Survey Office, provided overall direction for the implementation of the 2016 American Community Survey. Jennifer W. Reichert, Nicole Butler, Dameka M. Reese, and Michelle Wiland, all 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 2016 1-Year American Community Survey file. Rebecca Hoop, under the supervision of KeTrena Farnham, both of the Demographic Statistical Methods Division, conducted the statistical review of all Current Population Survey data. Karen E. King, Chief of the American Community Survey Variance Estimation and Statistical Support Branch, Decennial Statistical Studies Division, conducted the statistical review of all American Community Survey data. Tim J. Marshall, Assistant Survey Director of the Current Population Survey, pro- vided overall direction for the survey implementation. Lisa Cheok and Aaron Cantu, Associate Directorate Demographic Programs, and Charlie Carter, 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. Amanda Moritz 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. Kelly Holder, Heide Jackson, Brett O’Hara, Sharon Stern, Amy Steinweg, Danielle Taylor, Susan Walsh, and Monica 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. Faye Brock, Linda Chen, Christine Geter, and Anthony Richards of the Public Information Office provided publication management, graphics design and compo- sition, and editorial review for print and electronic media. George E. Williams of the Census Bureau’s Administrative and Customer Services Division provided print- ing management. Health Insurance Coverage in

the United States: 2016 Issued September 2017

P60-260

U.S. Department of Commerce Wilbur Ross, Secretary

Ellen Herbst, Acting Deputy Secretary

Economics and Statistics Administration Karen Dunn Kelley, Under Secretary for Economic Affairs

U.S. CENSUS BUREAU Ron S. Jarmin, Performing the Nonexclusive Functions and Duties of the Director Suggested Citation Barnett, Jessica C. and Edward R. Berchick, Current Population Reports, P60-260, Health Insurance Coverage in the United States: 2016, U.S. Government Printing Office, Washington, DC, 2017. ECONOMICS AND STATISTICS ADMINISTRATION

Economics and Statistics Administration Karen Dunn Kelley, Under Secretary for Economic Affairs

U.S. CENSUS BUREAU Ron S. Jarmin, Performing the Nonexclusive Functions and Duties of the Director Enrique Lamas, Performing the Nonexclusive Functions and Duties of the Deputy Director and Chief Operating Officer Eloise Parker, Acting Associate Director for Demographic Programs David G. Waddington, Chief, Social, Economic, and Housing Statistics Division Contents

TEXT Introduction ����������������������������������������������������������������������������������������� 1 Highlights �������������������������������������������������������������������������������������������� 1 What Is Health Insurance Coverage? ���������������������������������������������������� 1 Estimates of Health Insurance Coverage ���������������������������������������������� 3 Health Insurance Coverage and the Affordable Care Act ���������������������� 3 Two Measures of Health Insurance Coverage ��������������������������������������� 5 Multiple Coverage Types ���������������������������������������������������������������������� 6 Health Insurance Coverage by Selected Characteristics ������������������������ 6 Age ������������������������������������������������������������������������������������������������ 6 Marital Status ��������������������������������������������������������������������������������� 8 Disability Status ����������������������������������������������������������������������������� 9 Work Experience ����������������������������������������������������������������������������� 9 Educational Attainment ���������������������������������������������������������������� 11 Household Income ������������������������������������������������������������������������ 11 Income-to-Poverty Ratio ��������������������������������������������������������������� 12 Family Status �������������������������������������������������������������������������������� 12 Residence ������������������������������������������������������������������������������������� 15 Race and Hispanic Origin ������������������������������������������������������������� 15 Nativity ���������������������������������������������������������������������������������������� 15 Children and Adults Without Health Insurance Coverage �������������� 15 State Estimates of Health Insurance Coverage ����������������������������������� 18 More Information About Health Insurance Coverage �������������������������� 22 Additional Data and Contacts ������������������������������������������������������� 22 State and Local Estimates of Health Insurance Coverage �������������� 22 Comments ����������������������������������������������������������������������������������������� 22 Sources of Estimates �������������������������������������������������������������������������� 22 Statistical Accuracy ���������������������������������������������������������������������� 23

TEXT TABLES Table 1. Coverage Numbers and Rates by Type of Health Insurance: 2013 to 2016 �������������������������������������������������������������������������� 4 Table 2. Percentage of People by Type of Health Insurance Coverage by Age: 2015 and 2016 ����������������������������������������������������������� 7 Table 3. Percentage of People by Type of Health Insurance Coverage for Working-Age Adults Aged 19 to 64: 2015 and 2016 �������� 10 Table 4. Percentage of People by Type of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: 2015 and 2016 ���������������������������������������������������������������������� 13 Table 5. Percentage of People by Type of Health Insurance Coverage by Selected Demographic Characteristics: 2015 and 2016 ����� 16 Table 6. Percentage of People Without Health Insurance Coverage by State: 2013 to 2016 ���������������������������������������������������������� 19

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 iii FIGURES Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2013 to 2016 ������������������������������������������������������������������������������������������������������������2 Figure 2. Uninsured Rate: 2008 to 2016 ����������������������������������������������������������������������������������������������5 Figure 3. Percentage With One or Multiple Coverage Types: 2016 �������������������������������������������������������6 Figure 4. Uninsured Rate by Single Year of Age: 2013 to 2016 ������������������������������������������������������������9 Figure 5. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2013 to 2016 ����������������������������������������������������������������������������������������������������14 Figure 6. Percentage of Children Under Age 19 and Adults Aged 19 to 64 Without Health Insurance Coverage by Selected Characteristics: 2016 ������������������������������������������������������17 Figure 7. Uninsured Rate by State: 2016 ��������������������������������������������������������������������������������������������20 Figure 8. Change in the Uninsured Rate by State: 2008 to 2016 ��������������������������������������������������������21

APPENDIXES

Appendix A. Additional Health Insurance Coverage Tables ���������������������������������������������������������������� 25 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

APPENDIX TABLES Table A-1. Number of People by Type of Health Insurance Coverage by Age: 2015 and 2016 ����������� 26 Table A-2. Number of People by Type of Health Insurance Coverage for Working-Age Adults Aged 19 to 64: 2015 and 2016 �������������������������������������������������������������������������������������� 27 Table A-3. Number of People by Type of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: 2015 and 2016 ����������������������������������������������������������������� 28 Table A-4. Number of People by Type of Health Insurance Coverage by Selected Demographic Characteristics: 2015 and 2016 �������������������������������������������������������������������������������������� 29 Table A-5. Number of People Without Health Insurance Coverage by State: 2013 to 2016 ����������������� 30

iv Health Insurance Coverage in the United States: 2016 U.S. Census Bureau Health Insurance Coverage in the United States: 2016

Introduction went into effect (see the text box Highlights “Health Insurance Coverage and the Health insurance is a means for financ- • The uninsured rate decreased Affordable Care Act”). ing a person’s health care expenses. between 2015 and 2016 by 0.3 While the majority of people have This report presents statistics on percentage points as measured by private health insurance, primarily health insurance coverage in the the CPS ASEC. In 2016, the per- through an employer, many others United States in 2016, changes in centage of people without health obtain coverage through programs health insurance coverage rates insurance coverage for the entire offered by the government. Other indi- between 2015 and 2016, as well as calendar year was 8.8 percent, viduals do not have health insurance changes in health insurance coverage or 28.1 million, lower than the at all (see the text box “What Is Health rates between 2013 and 2016. The rate and number of uninsured in Insurance Coverage?”). statistics in this report are based on 2015 (9.1 percent or 29.0 million) information collected in two surveys (Figure 1 and Table 1).1 Over time, changes in the rate of conducted by the U.S. Census Bureau, health insurance coverage and the • The percentage of people with the Current Population Survey Annual distribution of coverage types may health insurance coverage for all Social and Economic Supplement (CPS reflect economic trends, shifts in or part of 2016 was 91.2 percent, ASEC) and the American Community the demographic composition of the higher than the rate in 2015 (90.9 Survey (ACS) (see the text box population, and policy changes that percent) (Table 1). “Two Measures of Health Insurance affect access to care. Several such Coverage”). Throughout the report, • In 2016, private health insur- policy changes occurred in 2014, unless otherwise noted, estimates ance coverage continued to be when many provisions of the Patient come from the CPS ASEC. more prevalent than govern- Protection and Affordable Care Act ment coverage, at 67.5 percent and 37.3 percent, respectively.2 What Is Health Insurance Coverage? Of the subtypes of health insur- Health insurance coverage in the Current Population Survey Annual Social ance coverage, employer-based and Economic Supplement (CPS ASEC) refers to comprehensive cover- insurance covered 55.7 percent age during the calendar year.* For reporting purposes, the U.S. Census of the population for some or all Bureau broadly classifies health insurance coverage as private insurance of the calendar year, followed by or government insurance. The CPS ASEC defines private health insurance Medicaid (19.4 percent), Medicare as a plan provided through an employer or a union and coverage pur- (16.7 percent), direct-purchase chased directly by an individual from an insurance company or through (16.2 percent), and military cover- an exchange. Government coverage includes federal programs, such as age (4.6 percent) (Table 1 and Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), indi- Figure 1). vidual state health plans, TRICARE, CHAMPVA (Civilian Health and Medical • Between 2015 and 2016, the rate Program of the Department of Veterans Affairs), as well as care provided of Medicare coverage increased by the Department of Veterans Affairs and the military. In the CPS ASEC, by 0.4 percentage points to cover people were considered “insured” if they were covered by any type of 16.7 percent of people for part or health insurance for part or all of the previous calendar year. They were all of 2016 (up from 16.3 percent considered uninsured if, for the entire year, they were not covered by any type of health insurance. Additionally, people were considered uninsured if they only had coverage through the Indian Health Service (IHS). For more 1 For a discussion of the quality of the CPS information, see Appendix A, “Estimates of Health Insurance Coverage.” ASEC health insurance coverage estimates, see Appendix B. 2 Some people may have more than one cov- * Comprehensive health insurance covers basic healthcare needs. This definition excludes erage type during the calendar year. single service plans, such as accident, disability, dental, vision, or prescription medicine plans.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 1 Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2013 to 2016 (Population as of March of the following year) Percentage-point change: Percentage-point change: Percent in 2016 2015 to 2016 2013 to 2016 0 20 40 60 80 100 –6 –4 –2 0 2 4 6 –6 –4 –2 0 2 4 6 Uninsured With health insurance

Any private plan Employment-based Direct-purchase

Any government plan Medicare Medicaid Military health care*

Changes between the estimates are not statistically different from zero at the 90 percent confidence level.

* 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: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2014 to 2017 Annual Social and Economic Supplements.

in 2015) (Table 1 and Figure 1).3 did not significantly change had the highest uninsured rate, at There was no statistically signifi- between 2015 and 2016 (Table 2). 16.0 percent (Table 5).6 cant difference between 2015 and • In 2016, the uninsured rate for 2016 for any other subtype of 6 Federal surveys give respondents the option children under age 19 in poverty, of reporting more than one race. Therefore, two health insurance. 7.0 percent, was higher than the basic ways of defining a race group are pos- sible. A group such as Asian may be defined as • Between 2015 and 2016, the uninsured rate for children not in those who reported Asian and no other race (the percentage of people without poverty, 5.0 percent (Figure 6). race-alone or single-race concept) or as those who reported Asian regardless of whether they health insurance coverage also reported another race (the race-alone-or-in- • In 2016, non-Hispanic Whites had dropped for most ages under 65, combination concept). The body of this report the lowest uninsured rate among (text, figures, and tables) shows data using the with generally larger decreases first approach (race alone). Use of the single-race race and Hispanic origin groups, for working-age adults (aged 19 population does not imply that it is the preferred method of presenting or analyzing data. The 4, 5 at 6.3 percent. The uninsured to 64) (Figure 4). Census Bureau uses a variety of approaches. rates for Blacks and Asians were In this report, the term “non-Hispanic White” • The percentage of uninsured chil- higher than for non-Hispanic refers to people who are not Hispanic and who reported White and no other race. The Census dren under age 19, 5.4 percent, Whites, at 10.5 percent and 7.6 Bureau uses non-Hispanic Whites as the compari- percent, respectively. Hispanics son group for other race groups and Hispanics. Since Hispanics may be any race, data in this 3 This increase was likely due to growth in report for Hispanics overlap with data for race the number of people aged 65 and over. The groups. Being Hispanic was reported by 15.1 population 65 years and older did not have a percent of White householders who reported only statistically significant change in the Medicare one race, 4.8 percent of Black householders who coverage rate between 2015 and 2016. However, reported only one race, and 2.3 percent of Asian the percentage of the U.S. population 65 years householders who reported only one race. and older increased between 2015 and 2016. Data users should exercise caution when 4 Estimates are from the 2015 and 2016 interpreting aggregate results for the Hispanic 1-Year American Community Surveys. population or for race groups because these 5 The change in the uninsured rate between populations consist of many distinct groups that 2015 and 2016 was not statistically significant differ in socioeconomic characteristics, culture, for infants and for people aged 1, 3, 4, 6, 9, 37, and recent immigration status. For further infor- 56, 57, 60, 61, and 63. mation, see .

2 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau • Between 2015 and 2016, the per- Estimates of Health Insurance endar year. For more information, see centage of people without health Coverage the text box “What Is Health Insurance insurance at any time during the In 2016, 8.8 percent of people (or Coverage?” year fell 0.4 percentage points for 28.1 million) were uninsured for the In 2016, most people (91.2 percent) non-Hispanic Whites, down to 6.3 entire calendar year (Table 1 and had health insurance coverage at percent. There was no statistical Figure 1). This was a decrease of 0.3 some point during the calendar year, change in the uninsured rate for percentage points from 2015, when with more people having private Blacks, Asians, or Hispanics dur- 9.1 percent (or 29.0 million) were health insurance (67.5 percent) than ing this period (Table 5).7 uninsured for the entire calendar year. government coverage (37.3 percent). • Between 2015 and 2016, the This report classifies health insur- Employer-based insurance was the percentage of people without ance coverage into three different most common subtype of health health insurance coverage at the groups: private coverage, government insurance (55.7 percent of the civil- time of interview decreased in coverage, and the uninsured. Private ian, noninstitutionalized population), 8 39 states (Figure 8 and Table 6). coverage includes health insurance followed by Medicaid (19.4 percent), Eleven states and the District of provided through an employer or Medicare (16.7 percent), direct- Columbia did not have a statisti- union and coverage purchased directly purchase (16.2 percent), and military cally significant change in their by an individual from an insurance health care (4.6 percent) (Table 1). 9 uninsured rate. 10 company or through an exchange. The percentage of people covered Government coverage includes federal by any type of health insurance programs, such as Medicare, Medicaid, increased by 0.3 percentage points 7 The small sample size of the Asian popula- the Children’s Health Insurance to 91.2 percent in 2016, up from tion and the fact that the CPS does not use sepa- Program (CHIP), individual state health rate population controls for weighting the Asian 90.9 percent in 2015. Neither private sample to national totals contribute to the large plans, TRICARE, CHAMPVA, as well coverage nor government coverage variances surrounding estimates for this group. as care provided by the Health and As a result, we are unable to detect statistically had a statistically significant increase significant differences between some estimates Medical Program of the Department of during this period. for the Asian population. The ACS, based on a Veterans Affairs and the military (VA much larger sample size of the population, is Medicare was the only subtype of a better source for estimating and identifying Care). Individuals are considered to be changes for small subgroups of the population. uninsured if they do not have health health insurance that experienced 8 Estimates are from the 2015 and 2016 a statistically significant change 1-Year American Community Surveys. insurance coverage for the entire cal- 9 Alaska, Delaware, Hawaii, Kansas, Maine, between 2015 and 2016. The rate of Nebraska, New Hampshire, North Dakota, 10 Exchanges include coverage purchased Medicare coverage increased by 0.4 Oklahoma, Vermont, and Wyoming did not through the federal Health Insurance Marketplace, have a statistically significant change in their as well as other state-based marketplaces, and percentage points, from 16.3 percent uninsured rates. include both subsidized and unsubsidized plans.

Health Insurance Coverage and the Affordable Care Act Since the passage of the Patient Protection and Affordable Care Act in 2010, several of its provisions have gone into effect at different times. For example, in 2010, the Young Adult Provision enabled adults under age 26 to remain as dependents on their parents’ health insurance plans. Many more of the main provisions went into effect on January 1, 2014, including the expansion of Medicaid eligibility and the establishment of health insurance marketplaces (e.g., healthcare.gov).

In 2014, people under age 65, particularly adults aged 19 to 64, may have become eligible for coverage options under the Affordable Care Act. Based on family income, some people may have qualified for subsidies or tax credits to help pay for premiums associated with health insurance plans. In addition, the population with lower income may have become eligible for Medicaid coverage if they resided in one of the 30 states (or the District of Columbia) that expanded Medicaid eligibility on or before January 1, 2016. Twenty-four states and the District of Columbia expanded Medicaid eligibility by January 1, 2014. Between then and January 1, 2015, three additional states—Michigan, New Hampshire, and Pennsylvania—expanded Medicaid eligibility. By January 1, 2016, three more states—Alaska, Indiana, and Montana—expanded Medicaid eligibility.*

* For a list of the states and their Medicaid expansion status as of January 1, 2016, see Table 6: Percentage of People Without Health Insurance Coverage by State: 2013 to 2016.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 3 Z X 0.1 less *4 . 6 *3.3 *4.8 *2.7 *1.0 *1.9 2016 2013 *–4 . 6 Z X 0.3 0.1 less *0 . 3 *0.4 –0.1 –0.1 –0.1 2016 2015 *–0 . 3 Change in rate >.

X 622 less 2016 2013 *4,037 *4,351 *7,384 *20,714 *15,165 *16,206 *11,073 *–13,743 X 915 –96 966 –81 less 2016 2015 –211 *–914 *2,417 *1,965 *1,507 Change in number

1 X of (±) 0 . 2 0.4 0.4 0.3 0.3 0.1 0.3 0.2 0 . 2 error Margin X 4.6 8 . 91 . 2 67.5 55.7 16.2 37.3 16.7 19.4 Rate

1 of 2016 96 (±) 541 874 396 931 575 519 error 1,145 1,130 1,018 Margin www2.census.gov/library/publications/2017/demo/p60-260sa.pdf 51,961 53,372 62,303 14,638 28,052 Number 320,372 292,320 216,203 178,455 119,361

1 X of (±) 0 . 2 0.4 0.4 0.3 0.3 0.1 0.3 0.2 0 . 2 error Margin X 4.7 9 . 1 90 . 9 67.2 55.7 16.3 37.1 16.3 19.6 Rate

1 of 95 2015 (±) 650 916 308 917 626 634 error 1,118 1,229 1,067 Margin 52,057 51,865 62,384 14,849 28,966 Number 318,868 289,903 214,238 177,540 118,395

1 X of (±) 0 . 2 0.4 0.4 0.3 0.3 0.1 0.3 0.2 0 . 2 error Margin X 4.5 89 . 6 66.0 55.4 14.6 36.5 16.0 19.5 10 . 4 Rate

1 of 2014 92 (±) 568 798 339 931 568 561 error 1,221 1,188 1,035 Margin 46,165 50,546 61,650 14,143 32,968 Number 316,168 283,200 208,600 175,027 115,470

1 X of (±) 0 . 2 0.4 0.4 0.2 0.4 0.1 0.3 0.2 0 . 2 error Margin ) X 4.5 86 . 7 64.1 55.7 11.4 34.6 15.6 17.5 13 . 3 Rate

1 of 2013 (±) 109 636 615 377 969 595 614 error 1,140 1,160 1,115 Margin 35,755 49,020 54,919 14,016 41,795 Number 313,401 271,606 201,038 174,418 108,287 . . . 2 2, 5 2, 4 . . 2 2, 3 . . . 2 2 . . 6 Coverage type Coverage Total Military health care The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government and the military. Affairs Veterans the Department by as care provided of as well TRICARE and CHAMPVA, Military health care includes the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they A margin of error is a measure of an estimate’s variability. The larger the margin of error in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s 2 3 4 5 6 Social and Economic Supplements. 2014 to 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. at the 90 percent confidence level. from zero the estimates are statistically different * Changes between X Not applicable. Z Represents or rounds to zero. 1 Any private plan private Any plan government Any Table 1. Table of Health Insurance: 2013 to 2016 Coverage Numbers and Rates by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in thousands or percentage points as appropriate. (Numbers in thousands, www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf health plan Any Employment-based Direct-purchase Medicare Medicaid Uninsured at < Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval.

4 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau Two Measures of Health Insurance Coverage This report includes two types of uninsured rates measure different CPS and 8.6 percent as measured health insurance coverage mea- concepts. The CPS ASEC uninsured by the ACS. sures: health insurance coverage rate represents the percentage of Over a longer period, as mea- during the entire calendar year and people who had no health insur- sured by the ACS, uninsured rates health insurance coverage at the ance coverage at any time during remained relatively stable between time of the interview. the previous calendar year. The 2008 and 2013, but decreased ACS uninsured rate is a measure The first measure, health insurance sharply by 2.8 percentage of the percentage of people who coverage at any time during the points between 2013 and 2014. were uninsured at the time of the calendar year, is collected with the Uninsured rates then decreased interview. Current Population Survey Annual by 2.3 percentage points between Social and Economic Supplement The two measures of health 2014 and 2015 and by 0.8 per- (CPS ASEC). The CPS is the longest- insurance coverage both point centage points between 2015 running survey conducted by the to a decrease in uninsured rates and 2016. Overall, the uninsured U.S. Census Bureau. The key pur- between 2015 and 2016 (Figure 2). rate decreased by 5.9 percentage pose of the CPS ASEC is to provide For 2016, the uninsured rate was points between 2013 and 2016. timely and detailed estimates of 8.8 percent as measured by the economic well-being, of which health insurance coverage is an important part. The Census Bureau Figure 2. conducts the CPS ASEC annually Uninsured Rate: 2008 to 2016 between February and April, and Percent the resulting measure of health 16 insurance coverage reflects an individual’s coverage status during Uninsured at the time of the interview the entire previous calendar year. (American Community Survey) 12 The second measure, health insurance coverage at the time Uninsured for the entire calendar year (Current Population Survey) of the interview, is collected with 8 the American Community Survey (ACS). The ACS is an ongoing survey that collects comprehensive 4 information on social, economic, and housing topics. Due to its large sample size, the ACS pro- 0 vides estimates at many levels of 2008 2009 2010 2011 2012 2013 2014 2015 2016 geography and for smaller popula- Note: For the American Community Survey, estimates are for the civilian noninstitutionalized population. For thetion Current groups. Population The Survey, Census Bureau Note: Estimates are for the civilian noninstitutionalized population. For the Current estimates reflect the population as of March of the following year. For information on confidentiality protection, sampling error, nonsampling Population Survey, estimates reflect the population as of March of the following year. error, and definitions in the Current Population Survey, see .conducts the ForACS information throughout the For information on confidentiality protection, sampling error, nonsampling error, and on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey,year, see and . -surveys/cps/techdocs/cpsmar17.pdf>. For the American Community Survey, health coverage reflects an annual Source: U.S. Census Bureau, Current Population Survey, 2014, 2015, and 2016 Annual Social and Economic Supplements and 2008 to 2015 estimates reflect the population as of July of the calendar year. For information on 1-Year American Community Surveys. average of current health insur- confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2014 to 2017 Annual Social As a result of the difference in and Economic Supplements and 2008 to 2016 1-Year American Community Surveys. the collection of health insurance coverage status, the resulting

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 5 in 2015 to 16.7 percent in 2016. This coverage were more likely to be held Health Insurance Coverage by increase was likely due to growth in in combination with another type of Selected Characteristics the number of people aged 65 and insurance at some point during the over and not to changes in Medicare year. Among people with employer- Age coverage rates within any particular based health insurance coverage or Age is strongly associated with the age group. Medicaid coverage, most had only one likelihood that a person has health plan type during 2016 (78.5 percent insurance and the type of health Multiple Coverage Types and 66.4 percent, respectively). insurance a person has. In 2016, adults aged 65 or over and children While most people have a single type People covered by direct-purchase under 19 were more likely to have of insurance, some people may have insurance, Medicare, or military health had health insurance coverage (98.8 more than one type of coverage dur- care were more likely to have had percent and 94.6 percent, respec- ing the calendar year. They may have more than one coverage type during tively) compared with working-age multiple types of coverage at one time the year. In 2016, 57.9 percent of adults aged 19 to 64 (87.9 percent) to supplement their primary insurance people with direct-purchase health (Table 2). type, or they may switch coverage insurance, 60.7 percent of people types over the course of the year. Of with military health care, and 61.8 Adults aged 65 and over had the high- the population with health insurance percent of people with Medicare had est rate of health insurance coverage coverage in 2016, 78.5 percent had some other type of health insurance.11 (98.8 percent) with 93.6 percent cov- one coverage type during the year ered by a government plan (primarily and 21.5 percent had multiple cover- Medicare) and 52.8 percent covered by age types over the course of the year a private plan, which may have supple- (Figure 3). mented their government coverage. Some types of health insurance were 11 The percentage of people with Medicare coverage and another type of health insurance The rates of (overall) health insur- more likely to be held alone, while was not statistically different from the percent- ance coverage, private coverage, other types of health insurance age of people with military health care and another type of health insurance. and government coverage did not

Figure 3. Percentage With One or Multiple Coverage Types: 2016 (Population as of March of the following year) Percent within coverage type

0 10 20 30 40 50 60 70 80 90 100

One coverage type Multiple coverage types

Any health plan

Any private plan Employment-based Direct-purchase

Any government plan Medicare Medicaid Military health care*

* 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: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2017 Annual Social and Economic Supplement.

6 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau * 1, >. 0.1 0.1 0.2 less –0.6 –0.6 –0.2 *–0 . 3 *–0.4 *–0.5 *–0.5 *–1.4 (2016 2015) Change

2 of (±) 0 . 2 0.2 0.3 0.2 0.3 0.2 0.6 0.6 0.5 0.3 0.1 error 5 Margin - 2016 8 . 5.3 5.4 9.4 1.2 Per cent 10.1 11.9 12.1 13.1 15.7 13.1

Uninsured 2 of (±) 0 . 2 0.2 0.3 0.3 0.3 0.3 0.6 0.6 0.5 0.3 0.1 error Margin - 2015

9 . 1 5.2 5.3 9.6 1.1 Per cent 10.5 12.5 12.6 14.5 16.3 13.7 * 1, Z 0 . 1 0.2 0.2 0.1 0.3 0.3 less –0.2 –0.2 *–1.1 *–1.1 (2016 4 2015) Change

2 of (±) 0 . 3 0.4 0.6 0.3 0.6 0.3 0.8 0.6 0.6 0.5 0.3 www2.census.gov/library/publications/2017/demo/p60-260sa.pdf error Margin - 2016 Per cent 37 . 3 27.0 41.9 21.4 41.5 21.1 23.1 20.4 19.3 21.7 93.6

2 nonsampling error, and definitions, see and definitions, nonsampling error, of (±) 0 . 3 0.4 0.7 0.3 0.6 0.3 0.7 0.7 0.6 0.5 0.3 error Margin - Government health insurance Government 2015 Per cent 37 . 1 27.2 43.0 21.3 42.6 21.0 23.0 20.1 19.3 21.4 93.8 * 1, 0 . 3 0.3 0.4 0.3 0.3 0.3 0.1 0.6 0.7 less *1.4 –0.1 (2016 2015) Change 3

2 of Total (±) 0 . 4 0.4 0.6 0.4 0.6 0.4 0.8 0.7 0.7 0.5 0.8 error Margin - 2016 Per cent 67 . 5 70.2 62.7 73.0 62.9 73.1 71.3 69.7 73.3 75.2 52.8

2 of (±) 0 . 4 0.4 0.6 0.4 0.6 0.4 0.9 0.7 0.6 0.4 0.8 Any health insurance Any error Margin Private health insurance Private - 2015 Per cent 67 . 2 69.8 62.3 72.7 62.6 72.7 69.9 69.6 72.7 75.3 52.1 * 1, 0.6 0.6 0.2 less *0 . 3 *0.4 *0.5 *0.5 *1.4 –0.1 –0.1 –0.2 (2016 2015) Change

2 of (±) 0 . 2 0.2 0.3 0.2 0.3 0.2 0.6 0.6 0.5 0.3 0.1 error Margin - 2016 Per cent 91 . 2 89.9 94.7 88.1 94.6 87.9 86.9 84.3 86.9 90.6 98.8

2 of ) (±) 0 . 2 0.2 0.3 0.3 0.3 0.3 0.6 0.6 0.5 0.3 0.1 error Margin - 2015 Per cent 90 . 9 89.5 94.8 87.5 94.7 87.4 85.5 83.7 86.3 90.4 98.9 mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; mutually not 2016 74,047 78,150 29,815 39,736 40,046 83,351 49,274 Number 271,098 197,051 192,948 320,372 2015 74,062 78,182 30,475 38,960 40,005 83,701 47,547 Number 318,868 271,322 197,260 193,140

. . 7 ...... 6 . . Total Details may not sum to totals because of rounding. Details may the 90 percent forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they Medicaid/CHIP. for Children under the age of 19 are eligible plan. health insurance to be a dependent on parent’s be eligible Individuals aged 19 to 25 may provision. dependent coverage Care Act’s is of special interest because the Affordable This age group * Changes between the estimates are statistically different from zero at the 90 percent confidence level. from zero the estimates are statistically different * Changes between Z Represents or rounds to zero. 1 2 3 4 5 6 7 are type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: Characteristic Aged 19 to 25 Aged 26 to 34 Aged 35 to 44 Aged 45 to 64 Under age 18 Aged 18 to 64 Under age 19 Aged 19 to 64 Table 2. Table of Health Insurance Coverage by Age: 2015 and 2016 Percentage of People by Type ­ on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in percentage points. (Numbers in thousands, www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf Age Under age 65 Aged 65 and older at < Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown confidence interval.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 7 demonstrate statistically significant of coverage through the government, 18- and 19-year-olds, between 25- and change between 2015 and 2016 for at 21.1 percent.13 26-year-olds, and between 64- and adults aged 65 or over. 65-year-olds. In 2016, the uninsured Between 2015 and 2016, the per- rate was about one-and-a-half times Children under age 19 were covered centage of adults aged 19 to 64 with greater for 19-year-olds compared by health insurance at a higher rate health insurance rose by 0.5 percent- with 18-year-olds, almost one-and-a- than working-age adults in 2016. One age points, driven by an increase quarter times greater for 26-year-olds reason for this difference could be in coverage for people aged 19 to compared with 25-year-olds, and that children from lower income fami- 25. For this group of young adults, the uninsured rate for 65-year-olds lies may be eligible for programs such both the overall rate of health insur- was about one-quarter of the rate of as Medicaid or the Children’s Health ance coverage and the rate of private 64-year-olds.18 Adults aged 26 contin- Insurance Program (CHIP).12 In 2016, coverage increased by 1.4 percentage ued to have the highest uninsured rate 62.9 percent of children under age 19 points in 2016, to 86.9 percent and in 2016 (at 17.5 percent) (Figure 4). had private health insurance and 41.5 71.3 percent, respectively.14, 15 percent had government coverage. Even within the broad age groups Between 2015 and 2016, the per- Some children were covered by both of children and working-age adults, centage of people without health private and government coverage dur- uninsured rates for single years of insurance coverage dropped for ing the calendar year. age differed. In 2016, for children most ages under 65, with generally under age 19, uninsured rates gener- Between 2015 and 2016, neither larger decreases for working-age ally increased with age, with rates of the overall rate of health insurance adults (aged 19 to 64) (Figure 4).16, 17 3.2 percent for children under 1 year coverage, nor the rate of private Younger adults tended to experience of age and 8.2 percent for 18-year- coverage, exhibited statistically a larger decline than older adults. olds. Among young adults between significant change for children under For example, the uninsured rate the ages of 19 and 25, the uninsured 19. Children’s rate of government decreased by 2.0 percentage points rate was 12.5 percent for 19-year-olds coverage decreased by 1.1 percentage for 26-year-olds and 0.6 percent- and 14.7 percent for 25-year-olds. For points to 41.5 percent in 2016, down age points for 64-year-olds. These adults between the ages 26 and 64, from 42.6 percent in 2015. declines in the uninsured rate fol- the uninsured rate declined gener- lowed 2 years of decreases for all Working-age adults (people aged ally across all ages from 17.5 percent ages under 65. 19 to 64) had a lower rate of health for 26-year-olds to 6.3 percent for insurance coverage in 2016 (87.9 The uneven downward shift in 64-year-olds. Among adults 65 years percent) than both children and older uninsured rates reduced some of and over, the uninsured rate varied adults. Among working-age adults, the age-specific rate disparities. little by age. the population aged 26 to 34 was the However, three notable sharp dif- Between 2013 and 2016, uninsured least likely to be insured, with a cov- ferences remained between single- rates fell for all single-year ages under erage rate of 84.3 percent. For adults year ages, specifically between age 65, with the largest declines of aged 19 to 25, the health insurance about 11.5 or more percentage points coverage rate of 86.9 percent was 13 In 2016, the health insurance coverage rate for each age between 21 and 28. higher than that for adults aged 26 to for people aged 19 to 25 was not statistically different from the coverage rate for people aged 34. For age groups between 26 and 35 to 44. Marital Status 64, the rate of health insurance cover- 14 The percentage-point difference in the overall health insurance coverage rate between age increased as age increased. 2015 and 2016 for people aged 19 to 25 was not Many adults obtain health insurance statistically different from the percentage-point coverage through their spouse. In Working-age adults were more likely difference in the private coverage rate for this 2016, married adults aged 19 to 64 age group. than other age groups to be covered 15 Between 2015 and 2016, there was no had the highest coverage rate, at 91.2 by private health insurance, which statistical difference in the government coverage percent (Table 3).19 The coverage rate rate for people aged 19 to 25. provided coverage to 73.1 percent 16 These estimates and estimates in the of the population aged 19 to 64 in remainder of this section come from the 2013 18 2016. They also had the lowest rate through 2016 1-Year American Community In 2016, the uninsured rate was 1.53 Surveys (ACS). In the ACS, health insurance times greater for 19-year-olds compared with coverage status corresponds to coverage at the 18-year-olds and 1.19 times greater for 26-year- time of the interview (see the text box “Two olds compared with 25-year-olds. The uninsured 12 The Children’s Health Insurance Program Measures of Health Insurance Coverage”). rate for 65-year-olds was 0.25 times the rate of is a government program that provides health 17 The change in the uninsured rate between 64-year-olds. insurance to children in families with income too 2015 and 2016 was not statistically significant 19 These estimates and estimates in the high to qualify for Medicaid but who are unable for infants and for people aged 1, 3, 4, 6, 9, 37, remainder of this section are for the population to afford private health insurance. 56, 57, 60, 61, and 63. aged 19 to 64.

8 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau Figure 4. Uninsured Rate by Single Year of Age: 2013 to 2016 2013 (Civilian noninstitutionalized population) 2014 2015 Percent 2016 35

30

25

20

15

10

5

0

1050 15 20 25 30 35 40 45 50 55 60 65 70 75+ Age Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2013 to 2016 1-Year American Community Surveys.

was lowest for people who were sepa- Disability Status Between 2015 and 2016, both the rated (80.8 percent). Among people population with a disability and the Adults aged 19 to 64 with a disability who were never married, 84.0 percent population with no disability had had a higher rate of health insurance were covered by health insurance. statistically significant increases in coverage (91.2 percent) compared The coverage rates for people who their coverage rates. Coverage rates with adults with no disability (87.6 were widowed or divorced were both increased by 1.1 percentage points to percent) in 2016 (Table 3).22 86.1 percent.20 91.2 percent in 2016 for adults with Adults with a disability were less a disability and by 0.5 percentage Between 2015 and 2016, the cover- likely to have private health insur- points to 87.6 percent in 2016 for age rate for the divorced population ance coverage and more likely to have adults with no disability.23 increased by 1.0 percentage point, government coverage compared with and the rate for people who were adults with no disability. In 2016, 43.5 Work Experience never married rose 0.8 percentage percent of adults with a disability had points.21 People who were married, For many adults, health insurance cov- private coverage compared with 75.9 separated, or widowed did not have a erage and type of coverage is related percent of adults with no disability, a statistically significant change in their to work status, such as working full- 32.4 percentage-point difference. At coverage rates. time, year-round; working less than the same time, 58.6 percent of adults with a disability and 17.5 percent with no disability had government 20 In 2016, the coverage rate of people who coverage, a 41.1 percentage-point were widowed was not statistically different from difference. the coverage rate of people who were divorced. 21 The percentage-point change in the health 23 The percentage-point change in the health insurance coverage rate between 2015 and 2016 insurance coverage rate between 2015 and for people who were divorced was not statisti- 22 These estimates and estimates in the 2016 for individuals with a disability was not cally different from the change for people who remainder of this section are for the population statistically different from the change for people were never married. aged 19 to 64. without a disability.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 9 * 3 Z . 1, –0.2 –0.2 –0.2 –0.3 –0.2 –1.4 –0.4 –0.5 –0.3 –0.1 *–0 *–1.1 *–0.5 *–1.0 *–0.8 *–0.5 *–0.4 *–1.0 *–0.8 2015) Change (2016 less

2 2 of . (±) 0 0.7 0.3 0.4 0.3 0.6 0.2 1.6 0.6 0.5 0.2 0.3 0.5 0.5 1.1 0.4 1.5 0.2 0.5 0.5 5 error Margin - 8 . 2016 8 8.8 9.8 4.8 8.8 9.3 6.8 Per cent 12.1 13.9 13.9 16.0 12.4 11.2 14.8 15.0 27.3 19.2 11.9 15.2 11.6 Uninsured

2 2 of . (±) 0 0.7 0.3 0.5 0.3 0.3 1.6 0.7 0.5 0.3 0.3 0.5 0.5 1.1 0.6 1.6 0.3 0.5 0.6 0.4 error Margin - 1 . 2015 9 9.9 9.9 4.8 9.0 9.5 7.0 Per cent 12.6 14.2 14.9 16.8 12.9 11.6 15.8 15.8 27.6 20.6 12.2 15.6 11.9 * 1 Z . 1, 0 0.9 0.4 0.3 0.2 0.2 0.7 0.7 1.6 0.2 0.4 0.1 0.2 *1.3 *2.3 –0.1 –0.1 –0.1 –0.9 4 2015) Change (2016 less

2 3 of . (±) 0 0.3 0.9 0.6 1.1 0.3 0.3 0.3 0.6 0.7 1.1 0.6 0.4 2.2 1.8 0.3 0.6 0.7 0.8 0.4 error Margin - 3 . 2016 9.8 Per cent 37 21.1 26.8 23.2 58.6 17.5 13.9 10.4 23.1 45.6 37.7 17.9 33.5 31.0 20.8 26.3 23.8 19.5 11.6

2 3 of . (±) 0 0.3 0.3 0.6 0.9 0.5 1.2 0.3 0.3 0.8 1.1 0.6 0.4 2.1 1.9 0.4 0.7 0.7 0.7 0.5 error Margin Government health insurance Government - 1 . 2015 9.1 Per cent 37 21.0 10.5 21.7 26.0 22.8 58.3 17.4 13.8 44.9 35.4 18.0 33.6 29.4 20.6 26.0 23.7 20.3 11.6 * 3 Z Z . 1, 0 0.4 0.5 0.1 0.4 0.1 0.5 0.1 1.4 0.1 0.1 0.3 0.6 0.3 –0.2 –0.5 –0.2 *–2.2 2015) Change 3 (2016 less

Total 2 4 . of (±) 0 0.4 1.0 0.7 1.2 0.4 0.3 0.3 0.6 0.8 0.6 0.5 2.0 1.9 0.4 1.1 0.7 0.8 0.9 0.5 error Margin - 5 . 2016 Per cent 67 73.1 64.3 66.5 43.5 75.9 80.1 84.5 69.0 49.1 90.0 80.1 58.7 55.9 73.4 40.9 65.0 71.8 77.9 86.8

2 4 of . (±) 0 0.4 0.9 0.6 1.2 0.4 0.3 0.4 0.7 0.8 0.6 0.5 2.2 1.9 0.4 1.2 0.7 0.8 0.8 0.5 Any health insurance Any error Private health insurance Private Margin - 2 . 2015 Per cent 67 72.7 63.9 66.0 43.4 75.5 80.0 84.5 69.0 48.6 90.2 80.0 59.1 54.4 73.3 43.1 65.2 71.7 77.6 86.2 * 3 Z . 1, 0.2 0.2 1.4 0.4 0.3 0.5 0.3 0.2 0.2 0.1 *0 *0.5 *1.0 *0.8 *1.1 *0.5 *0.4 *1.0 *0.8 2015) Change (2016 less

2 2 of . (±) 0 0.2 0.3 1.6 0.6 1.5 0.5 0.7 0.2 0.3 0.3 0.5 0.5 0.2 1.1 0.5 0.5 0.6 0.4 0.4 error Margin - 2 2016 . Per cent 91 87.9 91.2 86.1 86.1 80.8 84.0 91.2 87.6 88.8 90.2 85.2 85.0 88.1 72.7 84.8 88.4 90.7 93.2 95.2

2 2 . of (±) 0 0.3 0.3 1.6 0.7 1.6 0.5 0.7 0.3 0.3 0.3 0.5 0.5 0.3 1.1 0.5 0.6 0.6 0.4 0.5 error Margin - 2015 9 . Per cent 90 87.4 91.0 85.8 85.1 79.4 83.2 90.1 87.1 88.4 90.1 84.2 84.2 87.8 72.4 84.4 88.1 90.5 93.0 95.2 3,633 4,495 2016 19,460 63,537 15,248 41,528 43,843 15,389 45,401 26,594 17,739 36,528 21,482 Number 320,372 192,948 101,822 176,842 149,105 107,577 163,133 3,451 4,698 2015 19,817 63,896 15,128 42,970 44,637 16,079 44,925 27,246 17,471 35,870 21,075 Number 318,868 193,140 101,277 177,102 148,503 105,533 162,665 .

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ree .

ree . , no . ­

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...... 6 Characteristic Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they “married, spouse absent.” and “married, spouse present,” armed forces “married, civilian spouse present,” includes three individual categories: The combined category“married” forces. for individuals in the armed The sum of those with and without a disability does not equal the total because status is defined Total mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: y year-round diploma degree professional degree at the 90 percent confidence level. from zero the estimates are statistically different * Changes between Z Represents or rounds to zero. 1 2 3 4 5 6 7 graduate (includes graduate equivalency) y No high school High school Some college Associate deg Bachelor's deg Gr W ears old ear-round one week old years >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. Table 3. Table Adults Aged 19 to 64: 2015 and 2016 of Health Insurance Coverage for Working-Age Percentage of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in percentage points. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf 19 to 64 Total, With a disability full-time, orked aduate or With no disability Less than full-time, Widowed Marital Status Married Divorced Separated Disability Status Experience Work All workers Did not work at least Educational Attainment 26 to 64 Total, Never married Never

10 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau full-time, year-round; or not working population who did not work.27 The $25,000 had health insurance cover- at all during the calendar year.24, 25 health insurance coverage rate in 2016 age, compared with 92.4 percent of was not statistically different from the people with household income of Among all workers, 88.8 percent had rate in 2015 for the population who $75,000 to $99,999 and 95.8 percent health insurance coverage in 2016. worked full-time, year-round. of people with household income of Full-time, year-round workers were $125,000 or more (Table 4).29 more likely to be covered by health Educational Attainment insurance (90.2 percent) than the People with lower household income population who worked less than People with higher levels of educa- also had lower rates of private cover- full-time, year-round (85.2 percent) or tional attainment were more likely to age than people with higher income. nonworkers (85.0 percent) (Table 3).26 have health insurance coverage than These differences varied more for people with lower levels of education. lower income groups than for higher Workers were more likely to be covered In 2016, 95.2 percent of the popula- income groups. In 2016, the pri- by private health insurance coverage, tion aged 26 to 64 with a graduate or vate health insurance coverage rate compared with nonworkers. In 2016, professional degree had health insur- for people with household income 84.5 percent of full-time, year-round ance coverage, compared with 93.2 between $25,000 and $49,999 (52.7 workers had private insurance cover- percent of the population with a bach- percent) was 22.3 percentage points age, compared with 69.0 percent of elor’s degree, 84.8 percent of high higher than the rate for people with people who worked less than full- school graduates, and 72.7 percent household income below $25,000 time, year-round and 49.1 percent of of the population with no high school (30.4 percent). At the same time, the nonworkers. 28 diploma (Table 3). private health insurance coverage rate In 2016, nonworkers were more Between 2015 and 2016, no educa- for people with household income than three times as likely to have tional attainment group saw a statisti- at or above $125,000 (88.5 percent) government coverage (45.6 percent) cally significant change in its overall was 4.8 percentage points higher than workers (13.9 percent). Among rate of coverage. than the rate for people with house- workers, 10.4 percent of people who hold income between $100,000 and worked full-time, year-round and 23.1 People with no high school diploma $124,999 (83.8 percent). percent of people who worked less were the only educational attainment Conversely, government coverage than full-time, year-round had govern- group to have a statistically significant rates decreased as income increased, ment coverage in 2016. change for private coverage and gov- ernment coverage. Their private cover- but as with private coverage, rates Between 2015 and 2016, the health age rate decreased by 2.2 percent- varied more at lower incomes than at insurance coverage rate increased by age points to 40.9 percent in 2016, higher incomes. In 2016, the gov- 0.4 percentage points for people who while their government coverage rate ernment coverage rate for people worked at some point during the year. increased by 2.3 percentage points to with household income of less than The coverage rate increased 1.0 per- 37.7 percent in 2016. $25,000 (68.0 percent) was 16.0 centage point for the population who percentage points higher than the rate worked less than full-time, year-round Household Income for people with household income and 0.8 percentage points for the between $25,000 and $49,999 (52.0 In 2016, people with lower house- percent). For the two highest income hold income had lower overall health groups, the difference was smaller. insurance coverage rates than people The government coverage rate for with higher income. During this people with household income time, 86.3 percent of people with an between $100,000 and $124,999 annual household income of less than (21.8 percent) was 3.0 percentage 24 For this report, a full-time, year-round points higher than the rate for people worker is a person who worked 35 or more 27 The change between 2015 and 2016 in hours per week (full-time) and 50 or more weeks the health insurance coverage rate for people with household income at or above during the previous calendar year (year-round). who worked at some point during the year was $125,000 (18.8 percent). For school personnel, summer vacation is not statistically different from the change in the counted as weeks worked if they are scheduled coverage rate for nonworkers. to return to their job in the fall. The change between 2015 and 2016 in the Only one income group saw a statisti- 25 These estimates and estimates in the health insurance coverage rate for people who cally significant change in its health remainder of this section are for the population worked less than full-time, year-round was not aged 19 to 64. statistically different from the change in the insurance coverage rate between 26 In 2016, the health insurance coverage coverage rate for nonworkers. rate for people who worked less than full-time, 28 These estimates and estimates in the year-round was not statistically different from the remainder of this section are for the population 29 The 2015 income estimates are inflation- coverage rate for nonworkers. aged 26 to 64. adjusted and presented in 2016 dollars.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 11 2015 and 2016. The coverage rate In 2016, the population living below Act”). For adults aged 19 to 64, the increased by 1.1 percentage points to 100 percent of poverty had the lowest relationship between poverty status 86.3 percent for people with house- health insurance coverage rate, at and change in the uninsured rate hold income of less than $25,000. 83.7 percent, while people living at or between 2015 and 2016 may be above 400 percent of poverty had the related to the state of residence and Between 2015 and 2016, people with highest coverage rate, at 95.6 percent whether or not that state expanded household income between $50,000 (Table 4). The population with income Medicaid eligibility (Figure 5).33, 34 In and $74,999 were the only income between 100 percent and 399 percent states that expanded Medicaid eligi- group to have a statistically signifi- of the poverty ratio had coverage bility on or before January 1, 2016, cant change in the rate of private cov- rates that ranged from 87.4 percent (“expansion states”) and states that erage. Their rate of private coverage for people with income between did not expand Medicaid eligibility decreased by 1.7 percentage points to 100 and 199 percent of poverty to (“non-expansion states”), the unin- 68.6 percent in 2016. 92.5 percent for the population with sured rate decreased as the income- Most of the income groups showed income between 300 and 399 percent to-poverty ratio increased for adults a statistically significant change in of poverty. aged 19 to 64. However, in 2014, their government coverage rates 2015, and 2016, the uninsured rate Government coverage continued to between 2015 and 2016. The rate of was higher in non-expansion states be most prevalent for the population government coverage increased for than in expansion states regardless in poverty (63.6 percent) and least three income groups: people with of individuals’ poverty status group. prevalent for the population with household income less than $25,000 While the uninsured rate decreased income-to-poverty ratios at or above (1.4 percentage-point increase), for each income-to-poverty group 400 percent of poverty (22.8 percent) people with household income between 2015 and 2016 (except for in 2016. between $50,000 and $74,999 (2.2 people living at or above 400 percent percentage-point increase), and Between 2015 and 2016, the health of poverty in non-expansion states), people with household income at or insurance coverage rate increased the overall decrease in the uninsured above $125,000 (0.8 percentage- 1.1 percentage points for people rate was greater in expansion states point increase).30 The government with income below 100 percent of than in non-expansion states for all coverage rate decreased by 1.4 poverty (to 83.7 percent) and 0.9 poverty status groups. percentage points for people with percentage points for people with household income between $75,000 income between 100 and 199 per- Family Status 32 and $99,999, down to 26.2 percent cent of poverty (to 87.4 percent). Many people obtain health insurance in 2016. The coverage rate decreased 1.0 per- coverage through a family member’s centage point for people with income plan. The Census Bureau classifies Income-to-Poverty Ratio between 200 and 299 percent of living arrangements into three types: People and families are classified as poverty (89.2 percent). families, unrelated subfamilies, and being in poverty if their income is less In 2014, policy changes associated 31 than their poverty threshold. with the Affordable Care Act pro- vided the option for states to expand 30 The percentage-point difference in the Medicaid eligibility to people whose government coverage rate between 2015 and income-to-poverty ratio fell under a 2016 for people with household income below $25,000 was not statistically different from the particular threshold (for more infor- percentage-point differences for people with mation, see the text box “Health household income between $50,000 and $74,999 and household income at or above $125,000. Insurance and the Affordable Care 33 Estimates from Figure 5 are from the 2013 31 The Office of Management and Budget to 2016 1-Year American Community Surveys. determined the official definition of poverty in 34 Thirty states and the District of Columbia Statistical Policy Directive 14. Appendix B of the 32 The percentage-point difference in the expanded Medicaid eligibility on or before report Income and Poverty in the United States: health insurance coverage rate between 2015 January 1, 2016. For a list of the states and 2016 provides a more detailed description of and 2016 for people below 100 percent of their Medicaid expansion status as of January 1, how the Census Bureau calculates poverty; see poverty was not statistically different from the 2016, see Table 6: Percentage of People Without . 100 and 199 percent of poverty. 2016.

12 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau * 3 Z . 1, 0.2 0.5 0.1 0.2 *1.0 –0.6 –0.1 *–0 *–1.1 *–1.1 *–1.0 *–0.9 Change 2015) (2016 less

2 2 . (±) 0 0.4 0.5 0.3 0.2 0.5 0.6 0.4 0.6 0.4 0.5 0.5 0.5 5

Mar - error gin of - 8 . 2016 8 7.6 5.8 4.2 4.4 9.8 7.5 Per cent 13.7 11.9 16.3 15.3 12.6 10.8 Uninsured

2 2 . (±) 0 0.4 0.5 0.3 0.2 0.5 0.5 0.4 0.7 0.5 0.6 0.4 0.5 Mar - error gin of - 1 . 2015 9 7.4 5.3 4.1 4.5 9.7 9.8 7.3 Per cent 14.8 12.5 17.4 16.4 13.6 * 1 . 1, 0 1.0 0.1 0.2 *0.8 *1.4 *2.2 *1.5 *1.7 *2.0 *1.4 –0.8 *–1.4 4 Change 2015) (2016 less

2 3 . (±) 0 0.7 0.8 0.8 0.6 0.4 0.8 0.7 0.8 0.6 0.8 0.8 0.8 Mar - error gin of - 3 . 2016 Per cent 37 52.0 26.2 21.8 18.8 22.8 68.0 36.9 63.6 63.1 55.9 38.0 31.1

2 3 . (±) 0 0.8 0.8 0.8 0.6 0.4 0.8 0.8 0.9 0.7 0.8 0.8 0.7 Mar - error gin of Government health insurance Government - 1 . 2015 Per cent 37 51.0 27.7 21.7 18.0 22.6 34.7 66.6 62.1 61.4 53.8 38.8 29.8 * 3 . Z 1, 0 0.2 0.2 –0.1 –0.9 –0.1 –0.3 –0.9 –1.1 –0.8 *–1.7 *–1.9 Change 2015) 3 (2016 less Total

2 4 . (±) 0 0.8 0.8 0.7 0.7 0.5 0.3 0.8 0.9 0.7 0.9 0.8 0.8 Mar - error gin of - 5 . 2016 Per cent 67 52.7 68.6 79.4 83.8 88.5 86.6 30.4 28.6 31.1 45.4 66.2 76.4

2 4 . (±) 0 0.8 0.8 0.7 0.8 0.5 0.4 0.8 0.9 0.7 0.9 0.8 0.7 Any health insurance Any Mar - Private health insurance Private error gin of - 2 . 2015 Per cent 67 52.9 70.3 79.2 84.7 88.6 86.4 30.7 28.6 32.1 46.5 66.9 78.3 * 3 Z . 1, 0.6 0.1 *1.1 *1.1 *1.0 *0.9 *0 –0.1 –0.2 –0.5 –0.2 *–1.0 Change 2015) (2016 less

2 2 . (±) 0 0.6 0.4 0.5 0.4 0.5 0.3 0.6 0.5 0.5 0.5 0.4 0.2 Mar - error gin of - 2 2016 . Per cent 91 86.3 88.1 90.2 92.4 94.2 95.8 83.7 84.7 87.4 89.2 92.5 95.6

2 2 . (±) 0 0.5 0.5 0.4 0.4 0.5 0.3 0.7 0.5 0.6 0.4 0.5 0.2 Mar - error gin of - 9 2015 . Per cent 85.2 87.5 90.3 92.6 94.7 95.9 82.6 83.6 86.4 90.2 92.7 95.5 90 48,346 63,644 54,829 44,225 32,954 76,374 40,616 61,039 54,629 51,705 42,562 2016 Number 320,372 130,398 51,526 64,874 54,791 42,794 32,654 72,229 43,123 64,711 57,770 49,668 41,691 2015 Number 318,868 126,202 ...... T Characteristic Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. from zero the estimates are statistically different * Changes between Z Represents or rounds to zero. 1 2 3 4 5 Ratio poverty poverty percent of poverty percent of poverty of poverty percent of poverty >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. 2015 and 2016 Table 4. Table of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: Percentage of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in percentage points. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf otal Household Income Less than $25,000 Below 100 percent of Below $100,000 to 124,999 $125,000 or more Income-to-Poverty $25,000 to $49,999 $75,000 to $99,999 138 percent of Below $50,000 to $74,999 100 and 199 Between 200 and 299 Between 400 percent At or above Between 300 and 399 Between

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 13 Figure 5. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2013 to 2016 (Civilian noninstitutionalized population)

Percent 50 Expansion states* Non-expansion states* 45 2013 2014 2015 2016 2013 2014 2015 2016

40

35

30

25

20

15

10

5

0 Below Between At or above Below Between At or above 100% 100% and 399% 400% 100% 100% and 399% 400% of poverty of poverty of poverty of poverty of poverty of poverty

Percentage-point change in uninsured rate between 2015 and 2016 0

–5 –10

–15

–20 Percentage-point change in uninsured rate between 2013 and 2016 0

–5 –10

–15

–20

* Medicaid expansion status as of January 1, 2016. For a list of expansion and non-expansion states, see Table 6: Percentage of People Without Health Insurance Coverage by State: 2013 to 2016. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2013 to 2016 1-Year American Community Surveys.

14 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau unrelated individuals.35 Families are living inside principal cities, at 90.3 through the government, at 27.1 the largest of these categories (81.1 percent (Table 5).37, 38 percent in 2016. percent of the population in 2016), Between 2015 and 2016, the health Between 2015 and 2016, health insur- followed by unrelated individuals insurance coverage rate increased by ance coverage rates increased 0.4 (18.5 percent), and unrelated subfami- 0.8 percentage points for people liv- percentage points for non-Hispanic lies (0.4 percent). ing inside principal cities. There were Whites. There were no statistically In 2016, people living in families had no statistically significant changes significant changes in the health a higher health insurance coverage between 2015 and 2016 for people insurance coverage rates for Blacks, rate (91.8 percent) than unrelated living outside principal cities within Asians, or Hispanics between 2015 individuals (88.7 percent) and people metropolitan statistical areas and and 2016. living in unrelated subfamilies (86.5 people living outside metropolitan percent) (Table 5).36 statistical areas. Nativity

Between 2015 and 2016, the cover- In 2016, the overall health insurance Race and Hispanic Origin age rate increased by 1.0 percentage coverage rate for the native-born point for unrelated individuals to In 2016, 93.7 percent of non-Hispanic population (92.7 percent) was larger 88.7 percent in 2016. There was no Whites had health insurance coverage. than that of naturalized citizens (91.5 statistically significant change in cov- This rate was higher than the cover- percent) and noncitizens (73.8 per- erage rates between 2015 and 2016 age rate for Blacks (89.5 percent), cent) (Table 5). for people with other types of living Asians (92.4 percent), and Hispanics Between 2015 and 2016, the health arrangements. (84.0 percent) (Table 5). insurance coverage rate increased by Non-Hispanic Whites and Asians were 0.4 percentage points for the native- Residence among the most likely to have private born population to 92.7 percent. The In 2016, the health insurance cover- health insurance in 2016, at 73.9 per- foreign-born population did not have age rate was the highest for people cent and 74.2 percent, respectively.39 a statistically significant change in living outside principal cities within Hispanics, who had the lowest rate of their health insurance coverage rate metropolitan statistical areas, at any health insurance coverage, also during this period. 92.0 percent, and lowest for people had the lowest rate of private cover- age, at 52.4 percent. In 2016, 56.5 Children and Adults Without Health percent of Blacks had private health Insurance Coverage insurance coverage. In 2016, for all selected character- Rates of government health cover- istics, the uninsured rate for adults age followed a different pattern than (aged 19 to 64) was significantly private health insurance coverage. In larger than for children (under 19 2016, the government coverage rate years of age) (Figure 6). Additionally, was the highest for Blacks, at 43.7 differences in the uninsured rates 35 Families are defined as a group of two or more related people where one of them is the percent, followed by Hispanics (40.1 between demographic and socio- householder. Family members must be related by percent) and non-Hispanic Whites economic groups were generally birth, marriage, or adoption and reside together. Unrelated subfamilies are family units that (35.9 percent). Asians had the low- larger among adults than among 40 reside with, but are not related to, the primary est rate of health insurance coverage children. householder. For example, unrelated subfamilies could include a married couple with or without children, or a single parent with one or more 37 The Census Bureau categorizes residency never-married children under 18 years old living into two broad groups; individuals can either live 40 In 2016, the percentage-point difference in in a household. An unrelated subfamily may also inside a metropolitan statistical area or outside the uninsured rate between children with house- include people such as partners, roommates, of one. People living inside metropolitan statisti- hold income between $100,000 and $124,999 or resident employees and their spouses and/ cal areas include individuals living both inside and children with household income at or above or children. The number of unrelated subfam- and outside principal cities. $125,000 was not statistically different from ily members is included in the total number of 38 In 2016, the health insurance coverage rate the difference between adults with household household members, but is not included in the for people living inside principal cities within income between $100,000 and $124,999 and count of family members. The remainder of the metropolitan statistical areas was not statistically adults with household income at or above population is classified as unrelated individuals. different from the coverage rate for people living $125,000. In 2016, the percentage-point dif- 36 In 2016, the health insurance coverage rate outside metropolitan statistical areas. ference in the uninsured rate between native- of unrelated individuals was not statistically dif- 39 In 2016, the private coverage rate for non- born children and naturalized children was not ferent from the coverage rate of people living in Hispanic Whites was not statistically different statistically different from the difference between unrelated subfamilies. from the private coverage rate for Asians. native-born adults and naturalized adults.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 15 * 3 . 1, 0.1 1.4 0.2 –0.3 –0.3 –0.2 –0.3 –0.2 –0.2 –0.1 –0.2 –0.6 –0.2 *–0 *–0.3 *–0.4 *–0.3 *–0.8 *–0.4 *–1.0 Change 2015) (2016 less

2 2 . (±) 0 0.3 0.3 0.2 0.7 0.2 0.6 0.2 0.4 0.2 0.3 0.3 0.6 0.2 2.9 0.3 0.5 0.5 0.6 1.0 5 Mar - error gin of - 8 . 2016 8 8.4 5.2 8.4 7.6 7.3 8.5 8.2 5.8 8.7 9.7 8.0 9.4 6.3 Per cent 13.5 11.3 10.5 16.0 18.0 26.2 Uninsured

2 2 . (±) 0 0.3 0.3 0.2 0.6 0.2 0.5 0.2 0.5 2.7 0.4 0.2 0.4 0.3 0.6 0.2 0.5 0.5 0.6 1.0 Mar - error gin of - 1 . 2015 9 8.7 5.2 8.7 7.5 7.7 8.7 8.3 6.1 9.0 8.1 9.6 6.7 Per cent 12.1 12.2 10.5 11.1 16.2 18.1 26.4 * 1 Z . Z 1, 0 0.2 0.3 0.1 1.5 0.2 0.2 0.1 *1.2 *1.3 *0.6 –0.2 –0.1 –0.7 –0.1 –0.4 *–1.2 *–1.1 4 Change 2015) (2016 less

2 3 . (±) 0 0.4 0.4 0.7 1.0 4.9 0.5 0.4 0.7 0.4 1.1 0.3 0.4 0.9 1.2 0.7 0.3 0.7 1.0 1.0 Mar - error gin of - 3 . 2016 Per cent 37 36.4 36.3 41.5 45.1 48.6 40.6 35.9 37.8 34.8 45.7 36.6 35.9 43.7 27.1 40.1 38.1 31.7 37.2 27.0

2 3 . (±) 0 4.5 0.6 0.4 1.0 1.1 0.4 0.4 0.7 1.1 0.6 0.4 0.4 0.4 0.9 0.8 0.3 0.8 1.0 1.0 Mar - error gin of Government health insurance Government - 1 . 2015 Per cent 37 47.1 37.6 34.9 44.4 27.1 36.6 36.2 42.7 45.8 39.4 35.9 36.5 35.3 44.1 41.2 38.0 31.8 36.9 27.3 * 3 . 1, 0 0.3 0.3 0.4 0.1 0.4 0.3 0.5 0.7 0.3 0.4 0.7 0.2 0.6 0.4 *0.6 *0.5 –3.5 –1.3 –1.0 Change 2015) 3 (2016 less Total

2 4 . (±) 0 0.4 0.4 0.6 1.0 5.3 0.6 0.4 0.6 0.5 1.1 0.4 0.4 1.0 1.2 0.8 0.4 0.7 1.0 1.1 Mar - error gin of - 5 . 2016 Per cent 67 68.7 71.2 63.0 58.9 48.5 62.8 68.5 64.1 71.1 61.1 69.4 73.9 56.5 74.2 52.4 68.7 59.9 67.3 53.5

2 4 . (±) 0 0.6 0.5 1.1 1.0 1.1 1.0 0.4 0.5 1.0 5.0 0.6 0.4 0.7 0.4 0.4 0.3 0.9 1.0 1.3 Any health insurance Any Mar - Private health insurance Private error gin of - 2 . 2015 Per cent 67 62.7 70.7 62.1 55.9 75.5 51.6 68.3 70.5 58.4 52.0 62.7 68.0 63.6 69.0 73.6 68.4 59.4 66.5 53.2 * 3 . 1, 0.2 0.3 0.3 0.2 0.3 0.2 0.1 0.2 0.6 0.2 *0 *1.0 *0.3 *0.8 *0.3 *0.4 *0.4 –0.1 –1.4 –0.2 Change 2015) (2016 less

2 2 . (±) 0.2 0.3 0.3 0.4 0.3 0.2 0.3 0.3 0.6 0.2 0.2 0.5 0.7 0.5 0.2 0.6 0.6 1.0 2.9 0 Mar - error gin of - 2 2016 . Per cent 91 91.8 91.6 94.8 94.2 88.7 91.3 90.3 92.0 90.6 91.6 93.7 89.5 92.4 84.0 92.7 82.0 91.5 73.8 86.5

2 2 . (±) 0 0.2 0.3 0.3 0.5 0.4 0.2 0.4 0.3 0.6 0.2 0.2 0.5 0.6 0.5 0.2 0.6 0.5 1.0 2.7 Mar - error gin of - 9 2015 . Per cent 91.7 91.3 94.8 93.9 87.8 91.0 89.5 91.9 90.4 91.3 93.3 88.9 92.5 83.8 92.3 81.9 91.3 73.6 87.9 90 1,208 82,854 72,674 23,531 59,301 43,556 42,040 18,897 57,670 43,854 20,409 23,445 2016 Number 320,372 259,863 276,816 104,295 172,521 246,310 195,453 276,518 1,344 82,199 72,558 23,459 59,403 44,477 41,703 18,249 56,873 43,070 20,086 22,984 2015 Number 318,868 258,121 274,392 103,740 170,652 245,805 195,646 275,798 . .

.

. . .

. . .

. 6 . . Census Bureau, Current Population Survey, 2016 and 2017 Annual Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population . incipal en ...... under age 6 age under Related children Related under age 18 and Hispanic . Characteristic . . T 7 Related children Related Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs) Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they see < www.census.gov/programs-surveys/metro-micro/about more information, For category includes both micropolitan statistical areas and territory“Outside metropolitan statistical areas” The outside of metropolitan and micropolitan statistical areas. be defined as those who reported (the race-alone such as Asian may Asian and no other race A group are possible. group of defining a race basic ways two Therefore, respondents the option of reporting give more than one race. now surveys Federal Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: U.S. Source: cities cities at the 90 percent confidence level. from zero the estimates are statistically different * Changes b etween Z Represents or rounds to zero. 1 2 3 4 5 6 7 Householder Inside pr Outside pr Natur Not a citiz White

Origin statistical areas statistical areas White >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. >. /glossary.html population does The use of the single-race alone). data using the first approach (race shows This table concept) or as those who reportedor single-race also reported concept). Asian regardless of whether they (the race-alone-or-in-combination another race or or Asian and Black White and American Indian and Alaska Native on people who reported Information such as more than one race, of approaches. The Census Bureau uses a variety method of presenting or analyzing data. not imply that it is the preferred Islanders, and Other Pacific Hawaiians Native American Indians and Alaska Natives, Data for About 2.9 percent of people reported in the 2010 Census. more than one race from the 2010 Census through American FactFinder. African American, is available and those reporting separately. are not shown or more races two Status Family otal In families incipal , not Hispanic citizen alized Table 5. Table 2015 and 2016 of Health Insurance Coverage by Selected Demographic Characteristics: Percentage of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of errors in percentage points. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf Outside metropolitan Race race) Hispanic (any born Foreign In unrelated subfamilies Unrelated individuals Black Asian Nativity born Native Residence Inside metropolitan

16 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau For both age groups, in 2016, unin- times higher than it was for adults uninsured rate for adults in poverty sured rates were higher for people with household income of $125,000 (24.7 percent) was over twice that for with household income below or greater. adults not in poverty (10.4 percent). $25,000, compared with people The overall percentage of children In 2016, non-Hispanic White children with household income of $125,000 under the age of 19 without health had an uninsured rate of 4.1 percent. or more. Children with household insurance was 5.4 percent in 2016. Asian children had an uninsured rate income below $25,000 had an Children in poverty were more likely of 5.0 percent, and Black children had uninsured rate of 6.6 percent, while to be uninsured (7.0 percent) than an uninsured rate of 5.5 percent.41 children with a household income at children not in poverty (5.0 percent). Hispanic children had the highest or above $125,000 had an uninsured rate of 2.9 percent. The uninsured The difference in the uninsured rate 41 In 2016, the uninsured rate for Asian rate for adults with household income by poverty status was larger among children was not statistically different from the of less than $25,000 was over four uninsured rate for non-Hispanic White children or adults than among children. The Black children.

Figure 6. Percentage of Children Under Age 19 and Adults Aged 19 to 64 Without Health Insurance Coverage by Selected Characteristics: 2016 (Population as of March of the following year) Children under age 19 Adults aged 19 to 64

Total

Household income Less than $25,000

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $124,999

$125,000 or more

Poverty status Not in poverty

In poverty

Race1 and Hispanic origin White, not Hispanic

Black

Asian

Hispanic (any race)

Nativity Native-born citizen

Naturalized citizen

Noncitizen

0 5 10 15 20 25 30 Percent

1 Federal surveys give respondents the option of reporting more than one race. This figure shows data using the race-alone concept. For example, Asian refers to people who reported Asian and no other race. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the Current Population Survey, see . Source: U.S. Census Bureau, Current Population Survey, 2017 Annual Social and Economic Supplement.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 17 uninsured rate, at 7.9 percent. For all Between 2015 and 2016, the percent- In general, in 2016, the uninsured race and Hispanic origin groups, the age of people without health insur- rate in states that expanded Medicaid uninsured rate for adults was signifi- ance coverage decreased in 39 states eligibility on or before January 1, cantly larger than the uninsured rate (Figure 8 and Table 6). The decrease 2016, was lower than in states that for children. ranged from 0.3 percentage points did not expand eligibility (Figure 7). (Massachusetts) to 3.5 percentage In states that expanded Medicaid The uninsured rate for noncitizen points (Montana).44 Eleven states and eligibility (“expansion states”), the children in 2016 was 17.9 percent, the District of Columbia did not have uninsured rate in 2016 was 6.5 per- over three-times greater than the a statistically significant change in cent, compared with 11.7 percent in uninsured rate for native-born citizen their uninsured rates.45 states that did not expand Medicaid children (5.0 percent). eligibility (“non-expansion states”). In 2014, many provisions of the For adults in 2016, 28.6 percent of Many Medicaid expansion states have Patient Protection and Affordable Care noncitizen adults were uninsured, uninsured rates near or lower than Act went into effect. Since 2013, unin- which was over two-and-a-half times the national average, while many sured rates dropped in all 50 states greater than the uninsured rate for non-expansion states have uninsured and in the District of Columbia (Figure native-born adults (10.2 percent). rates near or above the national aver- 8). However, the year-to-year changes age (Figure 8). The uninsured rates in uninsured rates varied across State Estimates of Health by state ranged from 2.5 percent states, as did uninsured rates in 2016. Insurance Coverage (Massachusetts) to 14.0 percent During 2016, the state with the low- Variation in both the uninsured rate (Alaska) in expansion states, and from est percentage of people without in 2016 and change in the uninsured 5.3 percent (Wisconsin) to 16.6 per- health insurance was Massachusetts rate by state between 2013 and 2016 cent (Texas) in non-expansion states. may be related to whether the state (2.5 percent), while the state with the Between 2015 and 2016, the overall expanded Medicaid eligibility as part highest percentage was Texas (16.6 decrease in the uninsured rate was 42 of the Affordable Care Act. Thirty percent) (Figure 7 and Table 6). 0.9 percentage points in expansion states and the District of Columbia Twenty-five states and the District states, compared with 0.7 percent- expanded Medicaid eligibility on or of Columbia had an uninsured rate age points in non-expansion states. before January 1, 2016 (see the text of 8.0 percent or less, and seven In general, decreases in the unin- box “Health Insurance Coverage and states (Connecticut, Hawaii, Iowa, sured rate were greater in expansion the Affordable Care Act”).46 Massachusetts, Minnesota, Rhode states than in non-expansion states. Island, and Vermont) and the District Statistically significant decreases in of Columbia had an uninsured rate the uninsured rate ranged from 3.5 43 of 5.0 percent or less. Two states, percentage points to 0.3 percentage 44 Alaska and Texas, had an uninsured The change in the uninsured rate between points in expansion states, and from rate of 14.0 percent or more. 2015 and 2016 in Massachusetts was not signifi- cantly different from the change in the uninsured 1.7 percentage points to 0.4 percent- rate in Arkansas, Colorado, Delaware, Hawaii, age points in non-expansion states.47 42 These estimates and estimates in the Idaho, Kansas, Maine, Maryland, Minnesota, remainder of this section come from the ACS, Mississippi, Nebraska, Nevada, New Hampshire, which measures insurance coverage at the time North Dakota, Oklahoma, Texas, Vermont, of survey. The ACS, which has a much larger Virginia, West Virginia, Wisconsin, Wyoming, and sample size than the CPS, is also a useful source the District of Columbia. for estimating and identifying changes in the 45 The states that did not have a significant uninsured population at the state level. Estimates change in the uninsured rate between 2015 and for Figure 7 come from the 2016 1-Year American 2016 were Alaska, Delaware, Hawaii, Kansas, Community Survey, and estimates for Figure 8 Maine, Nebraska, New Hampshire, North Dakota, come from the 2008 to 2016 1-Year Oklahoma, Vermont, and Wyoming. 47 The lower bound of the change in the American Community Surveys. 46 For a list of the states and their Medicaid uninsured rate between 2015 and 2016 for 43 Consistent with Figure 7, classification expansion status as of January 1, 2016, see expansion states (0.3 percentage points) was not into these categories is based on unrounded Table 6: Percentage of People Without Health significantly different from the lower bound for uninsured rates. Insurance Coverage by State: 2013 to 2016. non-expansion states (0.4 percentage points).

18 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau Table 6. Percentage of People Without Health Insurance Coverage by State: 2013 to 2016 (Numbers in thousands. Civilian noninstitutionalized population. For information on confidentiality protection, sampling error, nonsampling error, and definitions, see www2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2016.pdf) Medicaid Difference in uninsured expansion 2013 uninsured 2014 uninsured 2015 uninsured 2016 uninsured 2016 less 2015 2016 less 2013 State state? Yes (Y) Margin of Margin of Margin of Margin of Margin of Margin of or No (N)1 Percent error2 (±) Percent error2 (±) Percent error2 (±) Percent error2 (±) Percent error2 (±) Percent error2 (±) United States . . . . . X 14 .5 0 .1 11 .7 0 .1 9 .4 0 .1 8 .6 0 .1 *–0 8. 0 .1 *–5 .9 0 .1

Alabama ...... N 13.6 0.4 12.1 0.4 10.1 0.3 9.1 0.3 *–1.0 0.4 *–4.5 0.5 Alaska...... +Y 18.5 1.0 17.2 0.9 14.9 0.7 14.0 0.9 –0.9 1.1 *–4.5 1.3 Arizona ...... Y 17.1 0.4 13.6 0.3 10.8 0.3 10.0 0.3 *–0.9 0.4 *–7.2 0.5 Arkansas...... Y 16.0 0.5 11.8 0.4 9.5 0.4 7.9 0.4 *–1.6 0.6 *–8.1 0.6 California...... Y 17.2 0.2 12.4 0.1 8.6 0.1 7.3 0.1 *–1.2 0.1 *–9.8 0.2 Colorado...... Y 14.1 0.3 10.3 0.3 8.1 0.3 7.5 0.3 *–0.5 0.4 *–6.6 0.4 Connecticut...... Y 9.4 0.4 6.9 0.3 6.0 0.4 4.9 0.3 *–1.1 0.5 *–4.5 0.5 Delaware...... Y 9.1 0.7 7.8 0.7 5.9 0.6 5.7 0.5 –0.2 0.8 *–3.5 0.8 District of Columbia. . . Y 6.7 0.6 5.3 0.7 3.8 0.6 3.9 0.6 0.1 0.9 *–2.7 0.9 Florida...... N 20.0 0.2 16.6 0.2 13.3 0.2 12.5 0.2 *–0.8 0.3 *–7.5 0.3

Georgia...... N 18.8 0.3 15.8 0.3 13.9 0.3 12.9 0.3 *–0.9 0.4 *–5.9 0.4 Hawaii...... Y 6.7 0.4 5.3 0.4 4.0 0.3 3.5 0.4 –0.4 0.5 *–3.2 0.6 Idaho...... N 16.2 0.8 13.6 0.7 11.0 0.6 10.1 0.5 *–0.9 0.8 *–6.1 0.9 Illinois...... Y 12.7 0.2 9.7 0.2 7.1 0.2 6.5 0.2 *–0.6 0.2 *–6.3 0.3 Indiana...... +Y 14.0 0.3 11.9 0.3 9.6 0.3 8.1 0.3 *–1.5 0.4 *–5.8 0.4 Iowa...... Y 8.1 0.3 6.2 0.3 5.0 0.3 4.3 0.2 *–0.8 0.4 *–3.9 0.4 Kansas...... N 12.3 0.4 10.2 0.4 9.1 0.4 8.7 0.3 –0.4 0.5 *–3.5 0.5 Kentucky...... Y 14.3 0.3 8.5 0.3 6.0 0.2 5.1 0.2 *–0.9 0.3 *–9.2 0.4 Louisiana...... N 16.6 0.4 14.8 0.3 11.9 0.4 10.3 0.4 *–1.7 0.5 *–6.3 0.5 Maine...... N 11.2 0.5 10.1 0.6 8.4 0.5 8.0 0.5 –0.4 0.7 *–3.1 0.7

Maryland...... Y 10.2 0.3 7.9 0.3 6.6 0.2 6.1 0.3 *–0.5 0.3 *–4.0 0.4 Massachusetts. . . . . Y 3.7 0.2 3.3 0.1 2.8 0.1 2.5 0.2 *–0.3 0.2 *–1.2 0.2 Michigan ...... ^Y 11.0 0.2 8.5 0.2 6.1 0.1 5.4 0.1 *–0.7 0.2 *–5.6 0.2 Minnesota...... Y 8.2 0.3 5.9 0.2 4.5 0.2 4.1 0.2 *–0.4 0.3 *–4.1 0.3 Mississippi...... N 17.1 0.5 14.5 0.5 12.7 0.4 11.8 0.4 *–0.9 0.6 *–5.2 0.7 Missouri...... N 13.0 0.3 11.7 0.3 9.8 0.3 8.9 0.2 *–0.9 0.3 *–4.1 0.4 Montana...... +Y 16.5 0.8 14.2 0.6 11.6 0.7 8.1 0.5 *–3.5 0.9 *–8.3 0.9 Nebraska...... N 11.3 0.5 9.7 0.4 8.2 0.5 8.6 0.5 0.3 0.7 *–2.8 0.7 Nevada ...... Y 20.7 0.6 15.2 0.5 12.3 0.4 11.4 0.5 *–0.9 0.6 *–9.3 0.8 New Hampshire. . . . . ^Y 10.7 0.5 9.2 0.5 6.3 0.4 5.9 0.4 –0.4 0.6 *–4.8 0.7

New Jersey...... Y 13.2 0.2 10.9 0.2 8.7 0.2 8.0 0.2 *–0.7 0.3 *–5.2 0.3 New Mexico...... Y 18.6 0.6 14.5 0.5 10.9 0.5 9.2 0.5 *–1.8 0.7 *–9.5 0.8 New York...... Y 10.7 0.2 8.7 0.1 7.1 0.1 6.1 0.1 *–1.0 0.2 *–4.6 0.2 North Carolina. . . . . N 15.6 0.3 13.1 0.3 11.2 0.2 10.4 0.2 *–0.8 0.3 *–5.2 0.3 North Dakota...... Y 10.4 0.8 7.9 0.7 7.8 0.7 7.0 0.6 –0.7 0.9 *–3.3 1.0 Ohio...... Y 11.0 0.2 8.4 0.2 6.5 0.2 5.6 0.2 *–0.9 0.2 *–5.4 0.2 Oklahoma ...... N 17.7 0.3 15.4 0.3 13.9 0.3 13.8 0.3 –0.1 0.4 *–3.9 0.5 Oregon...... Y 14.7 0.4 9.7 0.3 7.0 0.3 6.2 0.2 *–0.8 0.4 *–8.4 0.5 Pennsylvania...... ^Y 9.7 0.2 8.5 0.2 6.4 0.1 5.6 0.2 *–0.7 0.2 *–4.1 0.2 Rhode Island...... Y 11.6 0.7 7.4 0.6 5.7 0.6 4.3 0.5 *–1.4 0.7 *–7.3 0.8

South Carolina. . . . . N 15.8 0.4 13.6 0.4 10.9 0.3 10.0 0.3 *–0.9 0.4 *–5.8 0.5 South Dakota...... N 11.3 0.7 9.8 0.5 10.2 0.6 8.7 0.5 *–1.5 0.8 *–2.5 0.8 Tennessee...... N 13.9 0.3 12.0 0.3 10.3 0.3 9.0 0.2 *–1.2 0.4 *–4.8 0.4 Texas...... N 22.1 0.2 19.1 0.2 17.1 0.2 16.6 0.2 *–0.5 0.3 *–5.5 0.3 Utah...... N 14.0 0.5 12.5 0.5 10.5 0.5 8.8 0.4 *–1.7 0.6 *–5.2 0.6 Vermont...... Y 7.2 0.6 5.0 0.4 3.8 0.4 3.7 0.4 –0.1 0.5 *–3.5 0.7 Virginia...... N 12.3 0.3 10.9 0.3 9.1 0.3 8.7 0.3 *–0.4 0.4 *–3.6 0.4 Washington...... Y 14.0 0.3 9.2 0.2 6.6 0.2 6.0 0.2 *–0.7 0.3 *–8.0 0.4 West Virginia...... Y 14.0 0.5 8.6 0.4 6.0 0.4 5.3 0.3 *–0.6 0.5 *–8.7 0.6 Wisconsin ...... N 9.1 0.2 7.3 0.2 5.7 0.2 5.3 0.2 *–0.4 0.2 *–3.9 0.3 Wyoming...... N 13.4 0.9 12.0 0.8 11.5 1.0 11.5 1.0 Z 1.4 *–1.9 1.3 * Statistically different from zero at the 90 percent confidence level. ^ Expanded Medicaid eligibility after January 1, 2014, and on or before January 1, 2015. + Expanded Medicaid eligibility after January 1, 2015, and on or before January 1, 2016. X Not applicable. Z Represents or rounds to zero. 1 Medicaid expansion status as of January 1, 2016. For more information, see . 2 Data are based on a sample and are subject to sampling variability. A margin of error is a measure of an estimate’s variability. The larger the margin of error is in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. Note: Differences are calculated with unrounded numbers, which may produce different results from using the rounded values in the table. Source: U.S. Census Bureau, 2013 to 2016 1-Year American Community Surveys.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 19 Figure 7. Uninsured Rate by State: 2016 AK (Civilian noninstitutionalized population)

0 500 Miles

WA

ME MT ND

OR MN VT NH ID SD WI NY MA MI CT WY RI

IA PA NE NJ NV OH MD UT IL IN DE CA CO WV VA KS MO KY DC

NC TN OK AZ NM AR SC Percentage without GA MS AL health insurance coverage1 TX LA 14.0 or more 12.0 to 13.9 FL HI 10.0 to 11.9

0 100 Miles 8.0 to 9.9 0 100 Miles Less than 8.0

Expansion States* Non-Expansion States*

* Medicaid expansion status as of January 1, 2016. For a list of expansion and non-expansion states, see Table 6: Percentage of People Without Health Insurance Coverage by State: 2013 to 2016. 1 Classification is based on unrounded uninsured rates. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2016 1-Year American Community Survey.

20 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau Figure 8. Change in the Uninsured Rate by State: 2008 to 2016 (Civilian noninstitutionalized population) 2016 2015 2014 2013 2012 2011 2010 2009 2008 1Massachusetts 1 1, 4Hawaii Massachusetts 1, 4Vermont 1District Of Columbia 1, 4District of Columbia 1Vermont 1 Minnesota 1Hawaii 1Minnesota 1Iowa 1Rhode Island 1Iowa 1Connecticut Wisconsin 1Kentucky 1Rhode Island Wisconsin 1Delaware 1Connecticut 1West Virginia 2Michigan 1West Virginia 1Ohio 1Kentucky 2Pennsylvania 1Michigan 1, 4 Delaware 1New Hampshire 1 2, 4New Hampshire Pennsylvania 1Washington 1Ohio 1New York 1Maryland 1 Maryland 1Washington 1 Oregon 1Oregon 1 1Illinois New York 1, 4North Dakota 1Illinois 1California 1, 2North Dakota 1 Colorado 1Colorado 1 Arkansas Nebraska 1New Jersey Maine 4Maine 1California 3Indiana 1New Jersey 3 Montana Kansas 4 Nebraska Virginia United States United States 1Arkansas Virginia Indiana 4 Kansas Missouri South Dakota Alabama Utah Missouri 1, 2South Dakota Tennessee Tennessee Utah Alabama 1Arizona 1New Mexico 1South Carolina 1Arizona South Carolina 1New Mexico Idaho Idaho 1North Carolina Louisiana 2Wyoming North Carolina 1Nevada Montana 4Wyoming Louisiana 1Nevada Mississippi Mississippi Florida Florida Georgia 4Oklahoma Georgia 3, 4Alaska Oklahoma Texas Alaska

0 5% 10% 15% 20% 25% Texas 1 Expanded Medicaid eligibility as of January 1, 2014. 2 Expanded Medicaid eligibility after January 1, 2014, and on or before January 1, 2015. 3 Expanded Medicaid eligibility after January 1, 2015, and on or before January 1, 2016. 4 The change in the uninsured rate between 2015 and 2016 was not statistically different from zero at the 90 percent confidence level for Alaska, Delaware, Hawaii, Kansas, Maine, Nebraska, New Hampshire, North Dakota, Oklahoma, Vermont, Wyoming, and the District of Columbia. Note: For information on confidentiality protection, sampling error, nonsampling error, and definitions in the American Community Survey, see . Source: U.S. Census Bureau, 2008 to 2016 1-Year American Community Surveys.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 21 More Information About Health later because they incorporate ACS annually taking into account births, Insurance Coverage data in the models. deaths, emigration, and immigration.

Additional Data and Contacts Small Area Health Insurance Estimates The CPS is a household survey primar- are available at . The The sample universe for the basic CPS releases, and briefings are available most recent estimates are for 2015. consists of the resident civilian, nonin- electronically on the Census Bureau’s stitutionalized population of the United Health Insurance Web site. The Web Comments States. People in institutions, such as site may be accessed through the prisons, long-term care hospitals, and Census Bureau’s home page at The Census Bureau welcomes the nursing homes, are not eligible to be or directly at comments and advice of data and interviewed in the CPS. Students liv- . or comments on the health insurance coverage report, please write to: estimates only if information about Microdata are available for down- them is reported in an interview at load by clicking on “Data Tools” on Jennifer Cheeseman Day their parents’ home. Since the CPS is the Census Bureau’s home page and Assistant Division Chief, Employment a household survey, people who are then clicking the “DataFerrett” link. Characteristics homeless and not living in shelters Technical methods have been applied Social, Economic, and Housing are not included in the sample. The to CPS microdata to avoid disclos- Statistics Division sample universe for the CPS ASEC is ing the identities of individuals from U.S. Census Bureau slightly larger than that of the basic whom data were collected. Washington, DC 20233-8500 CPS since it includes military personnel or send e-mail to who live in a household with at least State and Local Estimates of Health . one other civilian adult, regardless of Insurance Coverage whether they live off post or on post. All other armed forces are excluded. The Census Bureau publishes annual Sources of Estimates For further documentation about the estimates of health insurance cover- The majority of the data in this report CPS ASEC, see . in the ACS. Single-year estimates are Economic Supplements (CPS ASEC) available for geographic units with and were collected in the 50 states Additional data in this report are from populations of 65,000 or more. Five- and the District of Columbia. The data the American Community Survey year estimates are available for all do not represent residents of Puerto (ACS) 1-year data, 2008 through geographic units, including census Rico and the U.S. Island Areas.48 The 2016. The ACS is an ongoing, nation- tracts and block groups. data are based on a sample of about wide survey designed to provide 95,000 addresses. The estimates in demographic, social, economic, and The Census Bureau’s Small Area Health this report are controlled to indepen- housing data at different levels of Insurance Estimates (SAHIE) program dent national population estimates by geography. While the ACS includes also produces single-year estimates age, sex, race, and Hispanic origin for Puerto Rico and the group quarters of health insurance for states and all March of the year in which the data population, the ACS data in this report counties. These estimates are based are collected. Beginning with 2010, focus on the civilian noninstitutional- on models using data from a variety estimates are based on 2010 Census ized population of the United States of sources, including current surveys, population counts and are updated (excluding Puerto Rico and some administrative records, and intercen- people living in group quarters). It has sal population estimates. In general, 48 The U.S. Island Areas include American an annual sample size of about 3.5 SAHIE estimates have lower variances Samoa, Guam, the Commonwealth of the Northern million addresses. For information on than ACS estimates but are released Mariana Islands, and the Virgin Islands of the United States.

22 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau the ACS sample design and other top- In addition to sampling error, non- the 2017 fiscal year.49, 50 Adjustments ics, visit . during any of the operations used to for the reduction in sample. Further collect and process survey data, such information about the source and Statistical Accuracy as editing, reviewing, or keying data accuracy of the CPS ASEC estimates is The estimates in this report (which from questionnaires. In this report, available at . Successive Difference Replication a sample of the population. Sampling Most of the remaining data presented (SDR) method. error is the uncertainty between an in this report are based on the ACS estimate based on a sample and the Most of the data from the 2017 CPS sample collected from January 2016 corresponding value that would be ASEC were collected in March (with through December 2016. For more obtained if the estimate were based some data collected in February information on sampling and estima- on the entire population (as from a and April). Each year, the CPS ASEC tion methods, confidentiality protec- census). All comparative statements sample consists of approximately tion, and sampling and nonsampling in this report have undergone sta- 100,000 addresses. In 2017, the CPS errors, please see the 2016 ACS tistical testing, and comparisons are ASEC sample had 95,000 addresses, Accuracy of the Data document located significant at the 90 percent level as approximately 5,000 randomly at . sources. Measures of sampling error addresses were given the pre-2013 are provided in the form of margins health insurance questions in order 49 Public Law 113-235, 2017. of error, or confidence intervals, for to fulfill budgetary requirements for 50 The series of questions asking about health all estimates included in this report. insurance coverage in calendar year 2012 and earlier.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 23

APPENDIX A. ADDITIONAL HEALTH INSURANCE COVERAGE TABLES

The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) along with the American Community Survey (ACS) are used to produce additional health insurance coverage tables. These tables are available electronically on the U.S. Census Bureau’s Health Insurance Web site. The Web site may be accessed through the Census Bureau’s home page at , the Health Insurance home page at , or directly at .

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 25 * 1, 58 44 93 less (2016 –236 –100 –199 *–914 *–516 Change *–1,007 *–1,064 *–1,051 2015)

2 of (±) 69 519 508 192 205 179 192 224 257 438 435 error Margin 5 2016 598 3,924 4,203 3,898 5,252 6,237 7,863 28,052 27,453 23,530 23,251 Number

Uninsured 2 of (±) 62 634 624 218 225 190 216 521 513 235 260 error Margin 2015 506 3,866 4,158 4,414 5,489 6,337 8,062 28,966 28,460 24,594 24,302 Number * 1, –9 less 966 267 314 283 161 (2016 –566 –121 *–833 *–880 *1,532 Change 2015) 4

2 of (±) 991 481 689 501 662 263 258 228 408 259 error 1,018 Margin 2016 6,898 8,097 7,728 73,220 31,020 42,200 32,439 40,781 18,058 46,140 Number 119,361

2 of (±) 505 150 486 692 668 232 259 235 396 error 1,067 1,015 Margin Government health insurance Government 2015 7,019 7,814 7,737 73,786 33,320 44,609 31,853 41,933 40,466 17,896 Number 118,395 * 1, less 730 255 475 504 –41 274 *594 226 (2016 –323 *1,965 *1,235 Change 2015)

2 3 of (±) 438 772 452 750 290 313 270 449 378 error 1,145 1,051 Margin 2016 46,393 49,185 21,247 27,692 29,373 62,702 26,005 Number 216,203 190,198 143,805 141,013

2 of (±) 482 739 496 717 322 322 253 368 383 error 1,118 1,050 Margin Private health insurance Private 2015 46,138 48,959 21,288 27,098 29,099 63,025 24,771 Number 214,238 189,467 143,330 140,509 * 1, less 783 –72 –76 277 *855 *859 *876 (2016 –143 –151 *2,417 *1,635 Change 2015)

2 of (±) 541 582 246 535 240 525 274 267 197 342 225 error Margin 2016 70,123 73,948 25,917 33,499 34,794 75,487 48,675 Number 292,320 243,645 173,521 169,697

2 of (±) 64 650 639 264 549 255 543 298 293 226 259 error Any health insurance Any Margin 2015 70,196 74,024 26,060 32,622 34,517 75,639 47,041 Number 289,903 242,862 172,666 168,838 74,047 78,150 29,815 39,736 40,046 83,351 49,274 2016 Number 320,372 271,098 197,051 192,948 Total 74,062 78,182 30,475 38,960 40,005 83,701 47,547 2015 Number 318,868 271,322 197,260 193,140 . . . . . 7 . . . . 6 . . . Total . Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they Medicaid/CHIP. for Children under the age of 19 are eligible plan. health insurance to be a dependent on parent’s be eligible Individuals aged 19 to 25 may provision. dependent coverage Care Act’s is of special interest because the Affordable This age group Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. from zero the estimates are statistically different * Changes between 1 2 3 4 5 6 7 Characteristic Aged 19 to 25 Aged 26 to 34 Aged 35 to 44 Aged 45 to 64

Under age 18 Age Under age 65 Aged 18 to 64 Aged 19 to 64 Under age 19 Aged 65 and older >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval.

Table A-1. Table of Health Insurance Coverage by Age: 2015 and 2016 Number of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in thousands. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf

26 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau

* 17 1, 25 –9 54 less –21 –152 –105 –129 –158 –140 –231 –535 *–471 *–581 *–899 *–582 *–252 *–914 *–635 (2016 *–1,051 Change 2015)

2 86 73 61 (±) 133 110 147 232 189 386 247 292 385 109 417 320 132 333 435 519 225 Mar - error gin of 5 2016 863 506 1,038 2,496 1,642 3,082 6,890 4,205 6,568 1,349 2,707 9,001 6,154 19,353 10,528 16,682 21,902 10,174 23,251 28,052 Number Uninsured

2 84 61 (±) 100 146 110 167 248 198 449 222 322 436 106 516 297 154 325 513 634 245 Mar - error gin of 2015 968 489 1,013 2,517 1,652 3,240 7,031 4,436 7,039 1,501 2,959 9,131 6,789 19,888 10,474 17,263 22,801 10,756 24,302 28,966 Number

* 11 59 73 27 1, 80 –61 146 376 114 252 145 966 230 less –96 285 108 436 314 *184 –126 (2016 4 Change 2015)

2 96 (±) 122 172 171 227 328 218 547 395 313 474 287 558 392 101 212 447 662 286 Mar - 1,018 error gin of 2016 2,098 4,239 3,454 6,324 5,806 8,933 1,394 1,218 5,223 9,573 11,961 33,883 19,984 11,224 20,797 30,989 14,716 18,230 40,781 119,361 Number

2 87 (±) 131 176 149 214 354 212 590 444 303 449 271 547 109 334 205 478 668 258 Mar - 1,067 error gin of Government health insurance Government 2015 1,914 4,159 3,550 6,449 5,698 8,820 1,383 1,160 5,150 9,343 11,676 33,447 20,045 11,078 20,421 30,737 14,570 18,204 40,466 118,395 Number

* 74 90 90 1, 546 449 –46 522 less 333 262 235 690 504 *779 –152 –434 –186 *–630 *–986 (2016 *1,677 *1,965 Change 2015) 3

2 (±) Total 432 498 323 383 541 218 685 413 669 661 765 231 144 552 117 317 666 750 441 Mar - 1,145 error gin of 2016 6,293 6,633 2,512 2,131 19,342 31,698 13,820 19,102 29,512 21,517 90,853 42,272 12,503 81,594 28,643 119,766 119,497 134,162 141,013 216,203 Number

2 (±) 429 517 296 398 508 244 644 410 670 676 695 224 135 559 117 310 699 717 505 Mar - 1,118 Any health insurance Any error gin of Private health insurance Private 2015 6,923 6,559 2,558 2,041 19,009 30,919 13,558 19,536 29,277 21,702 89,177 42,182 12,655 81,072 29,630 119,221 118,806 133,713 140,509 214,238 Number * 1, 639 272 –99 224 165 674 less 383 678 277 617 *859 –105 –494 –323 *–458 *–807 (2016 *1,002 *1,989 *1,182 *2,417 Change 2015)

2 (±) 437 503 354 407 605 300 473 507 652 587 572 358 169 547 158 363 670 525 541 514 Mar - error gin of 2016 3,632 3,127 20,444 34,032 16,096 23,512 38,511 11,184 37,275 97,049 13,899 53,364 16,753 92,821 35,374 143,780 132,422 154,940 169,697 292,320 Number

2 (±) 432 518 335 411 572 301 495 491 671 655 300 578 173 566 142 358 686 543 650 534 Mar - error gin of 2015 3,731 2,962 20,062 33,354 15,820 24,006 37,894 11,642 37,598 95,059 13,627 53,140 16,858 92,147 36,181 142,778 131,240 154,301 168,838 289,903 Number 4,495 3,633 21,482 36,528 17,739 26,594 45,401 15,389 43,843 15,248 63,537 19,460 41,528 2016 163,133 107,577 149,105 176,842 101,822 192,948 320,372 Number 4,698 3,451 21,075 35,870 17,471 27,246 44,925 16,079 44,637 15,128 63,896 19,817 42,970 2015 162,665 105,533 148,503 177,102 101,277 193,140 318,868 Number . . . .

. .

.

7 . . ree raduate , no . . . .

s degree ...... 6 y Characteristic y T

Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they “married, spouse absent.” and “married, spouse present,” armed forces “married, civilian spouse present,” includes three individual categories: The combined category“married” individuals in the armed forces. The sum of those with and without a disability does not equal the total because status is defined for Total Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. at the 90 percent confidence level. from zero the estimates are statistically different * Changes between 1 2 3 4 5 6 7 degree full-time year-round Gr Bachelor’ Associate deg Some college High school g No high school diploma W W one week

old ears , year-round

ears old professional degree professional (includes equivalency) Educational Attainment With no disability Experience Work All workers Never married Never Disability Status Divorced Separated Widowed Marital Status Married Did not work at least >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. aduate or

otal, 26 to 64 less than orked full-time, orked With a disability Table A-2. Table Adults Aged 19 to 64: 2015 and 2016 of Health Insurance Coverage for Working-Age Number of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in thousands. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf 19 to 64 Total,

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 27 * 1, 71 64 208 178 less 142 196 *694 *-944 *-877 *-914 *-532 (2016 *-1,229 *-1,027 Change 2015)

2 (±) 272 192 258 309 316 261 222 166 214 262 519 290 290 Mar - error gin of 5 2016 5,733 3,204 5,574 6,894 9,357 6,612 3,188 1,917 3,344 5,383 6,622 7,598 28,052

Number

Uninsured 2 (±) 285 200 232 341 368 317 223 160 199 634 247 322 321 Mar - error gin of 2015 5,662 3,062 4,880 7,838 7,489 2,980 1,739 3,148 5,319 7,649 8,130 10,586 28,966 Number * 99 1, 966 -12 less 356 *847 -578 -241 *-945 (2016 *1,269 *1,337 *1,204 4 *-1,210 *-1,422 Change 2015)

2 (±) 575 448 478 651 692 585 463 327 396 525 674 709 Mar - 1,018 error gin of 2016 7,181 29,793 13,258 19,631 30,518 38,522 25,826 14,371 11,607 20,236 32,887 33,080 119,361 Number

2 (±) 596 386 535 670 814 713 465 296 420 571 685 770 Mar - 1,067 error gin of 2015 Government health insurance Government 7,082 28,524 12,411 19,275 31,096 39,732 26,772 13,033 11,848 19,032 34,309 33,092 118,395 Number * 1, -53 less 965 -134 -920 -735 *-732 (2016 *3,870 *3,596 *1,206 *1,965 *-2,067 *-1,743 *-1,130 Change 2015)

3 2 (±) 640 742 671 537 420 683 776 813 465 675 Total Mar - 1,217 1,028 1,145 error gin of 2016 32,525 34,216 24,786 19,001 11,620 67,610 27,606 35,112 37,618 14,699 33,558 112,884 216,203 Number

2 (±) 694 681 664 583 470 721 741 839 478 681 Mar - 1,143 1,087 1,118 error gin of Any health insurance Any Private health insurance Private 2015 32,659 33,251 26,853 20,744 12,352 64,014 27,659 33,906 38,538 15,829 34,293 109,014 214,238 Number * 1, 122 -25 less 730 -698 (2016 *4,126 *1,343 *3,937 *1,235 *2,417 *-2,198 *-2,443 *-1,630 *-2,153 Change 2015)

2 (±) 753 825 876 820 683 753 835 927 541 776 936 Mar - 1,256 1,025 error gin of 2016 39,359 46,131 47,735 51,681 34,004 73,186 31,037 40,881 49,446 41,724 56,046 124,665 292,320 Number

2 (±) 783 798 829 971 853 763 829 968 650 783 944 Mar - 1,178 1,128 error gin of 2015 38,629 44,788 49,932 54,124 35,634 69,248 30,915 39,646 49,472 43,878 56,744 120,539 289,903 Number 42,562 51,705 54,629 61,039 40,616 76,374 32,954 44,225 54,829 48,346 63,644 2016 130,398 320,372 Number 41,691 49,668 57,770 64,711 43,123 72,229 32,654 42,794 54,791 51,526 64,874 2015 126,202 318,868 Number ...... T Characteristic Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. from zero the estimates are statistically different * Changes between 1 2 3 4 5 of poverty percent of poverty percent of poverty percent of poverty poverty Ratio poverty >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. At or above 400 percent At or above Between 300 and 399 Between Between 200 and 299 Between Between 100 and 199 Between Below 138 percent of Below Below 100 percent of Below Income-to-Poverty Income-to-Poverty $125,000 or more $75,000 to $99,999 . $100,000 to $124,999 Household Income Less than $25,000 $50,000 to $74,999 . otal $25,000 to $49,999 . Table A-3. Table of Health Insurance Coverage by Household Income and Income-to-Poverty Ratio: Number of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of error in thousands. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf 2015 and 2016

28 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau * 2 Z 31 57 81 1, 82 66 –67 –24 less –722 –192 –338 –185 –642 –200 *–785 *–971 *–914 *–753 *–576 (2016 Change 2015)

2 37 (±) 490 579 504 105 373 360 134 316 438 519 404 217 194 227 455 223 312 125 269 Mar - error gin of 5 2016 ber 163 4,091 1,355 1,442 9,237 6,956 3,807 6,680 4,428 7,872 1,726 6,147 Num - 13,820 23,961 21,208 12,314 20,180 28,052 10,142 20,813

Uninsured 2 40 (±) 512 664 373 563 115 411 120 309 513 634 221 214 284 452 210 313 112 288 529 Mar - error gin of 2015 ber 163 4,282 1,422 1,360 9,235 7,141 3,741 7,257 4,627 7,815 1,750 6,066 Num - 13,789 24,684 21,546 13,100 21,150 28,966 10,895 21,454 * 67 1, 447 828 138 721 966 381 245 178 less –46 341 186 280 –11 622 *671 –140 –322 *–788 (2016 *1,071 4 Change 2015)

2 89 (±) 936 237 982 335 481 238 701 378 419 437 847 389 259 262 Mar - 1,274 1,589 1,397 1,018 1,121 error gin of 2016 ber 587 5,124 7,591 6,330 Num- 60,024 94,707 99,455 19,905 30,074 30,180 10,603 70,136 18,377 23,125 24,067 39,431 90,220 13,921 105,440 119,361

2 82 (±) 389 478 255 739 381 202 446 976 429 990 911 399 245 288 Mar - 1,187 1,075 1,565 1,403 1,067 error gin of Government health insurance Government 2015 ber 633 4,937 7,413 6,263 Num- 59,577 94,366 98,627 19,768 29,794 30,968 10,743 69,065 18,387 23,447 23,396 89,598 13,676 39,050 118,395 104,719 * –5 1, 658 359 299 less 316 140 475 409 238 930 *973 *840 –113 1,307 (2016 *2,045 *1,965 *2,084 *2,975 *1,274 *–1,010 Change 2015) 3

2 (±) Total 102 458 440 224 645 949 839 415 260 453 469 346 346 Mar - 1,910 1,145 1,203 2,012 1,720 1,126 1,350 error gin of 2016 ber 585 Num- 26,609 58,954 45,793 13,848 37,217 23,739 14,013 30,192 26,258 13,726 12,532 66,859 122,735 216,203 178,401 189,594 189,946 170,839 144,398

2 97 (±) 466 483 226 691 947 785 430 237 554 521 327 419 Mar - 1,987 1,118 1,242 2,184 1,886 1,103 1,380 Any health insurance Any error gin of Private health insurance Private 2015 ber 699 Num- 57,981 45,477 13,708 37,222 27,620 23,330 13,775 29,352 25,600 13,366 12,233 65,930 120,689 214,238 176,318 186,619 169,565 143,922 188,639 * 1, 51 727 347 380 less 139 475 *840 *592 *536 *566 *796 –137 –729 1,839 1,308 (2016 *2,417 *2,080 *3,146 *1,146 *1,691 Change 2015)

2 (±) 541 883 437 261 128 135 729 491 422 227 208 319 767 538 405 380 Mar - 2,449 2,596 1,917 2,528 error gin of 2016 ber 1,045 Num- 75,899 68,867 22,175 52,621 94,153 39,466 37,612 17,455 48,433 35,982 18,684 17,298 158,701 292,320 238,655 252,854 225,497 183,139 256,338

2 (±) 650 997 413 270 138 115 813 539 442 213 193 315 843 591 364 498 Mar - 2,402 2,748 1,740 2,694 error gin of 2015 ber 1,181 Num- 75,058 68,817 22,037 52,146 92,845 40,194 37,076 16,889 47,637 35,255 18,336 16,919 156,863 289,903 236,575 249,708 224,351 182,546 254,648 ber 1,208 Num- 2016 82,854 72,674 23,531 59,301 43,556 42,040 18,897 57,670 43,854 20,409 23,445 172,521 320,372 259,863 276,816 104,295 246,310 195,453 276,518 ber 1,344 Num- 2015 82,199 72,558 23,459 59,403 44,477 41,703 18,249 56,873 43,070 20,086 22,984 170,652 318,868 258,121 274,392 103,740 245,805 195,646 275,798 ...... 6 ...... Characteristic . Total and Hispanic Origin . . . 7 Details may not sum to totals because of rounding. Details may the 90 percent confidence forms from the estimate, when added to and subtracted This number, the estimate. the less reliable of the estimate, The larger the margin of error in relation to size variability. A margin of error is a measure an estimate’s through someone outside the household. or coverage company, an individual from insurance purchased directly by or union, coverage through an employer provided includes coverage health insurance Private and the military. Affairs Veterans the Department by and care provided of Affairs), Veterans of the Department (Civilian Health and Medical Program of TRICARE, CHAMPVA includes Medicaid, Medicare, coverage health insurance Government the entire calendar year. for coverage health insurance do not have Individuals are considered to be uninsured if they see < www.census.gov/programs-surveys/metro-micro/about more information, For category includes both micropolitan statistical areas and territory“Outside metropolitan statistical areas” The outside of metropolitan and micropolitan statistical areas. be defined as those who reported (the race-alone such as Asian may Asian and no other race A group are possible. group of defining a race basic ways two Therefore, respondents the option of reporting give more than one race. now surveys Federal Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during more than one type of health insurance the year. by people can be covered exclusive; are not mutually type of coverage The estimates by Note: Social and Economic Supplements. 2016 and 2017 Annual Survey, Census Bureau, Current Population U.S. Source: * Changes between the estimates are statistically different from zero at the 90 percent confidence level. from zero the estimates are statistically different * Changes between Z Represents or rounds to zero. 1 2 3 4 5 6 7 statistical areas areas Outside metropolitan In unrelated subfamilies Unrelated individuals Inside principal cities race) Hispanic (any Race Black Nativity born Native born Foreign Family Status Family In families Householder Related children under 6 Outside principal cities Not a citizen Residence Inside metropolitan statistical Related children under 18 not Hispanic White, Asian citizen Naturalized White >. at < www2.census.gov/library/publications/2017/demo/p60-260sa.pdf Their Use” “Standard Errors and see more information, For are based on standard errors calculated using replicate weights. in this table Margins of error shown interval. >. /glossary.html population does The use of the single-race alone). data using the first approach (race shows This table concept) or as those who reportedor single-race also reported concept). Asian regardless of whether they (the race-alone-or-in-combination another race or or Asian and Black White and American Indian and Alaska Native on people who reported Information such as more than one race, of approaches. The Census Bureau uses a variety method of presenting or analyzing data. not imply that it is the preferred Islanders, and Other Pacific Hawaiians Native American Indians and Alaska Natives, Data for About 2.9 percent of people reported in the 2010 Census. more than one race from the 2010 Census through American FactFinder. African American, is available and those reporting separately. are not shown or more races two

Table A-4. Table 2015 and 2016 of Health Insurance Coverage by Selected Demographic Characteristics: Number of People by Type see and definitions, nonsampling error, on confidentiality protection, sampling error, information For year. as of March the following Population margins of errors in thousands. (Numbers in thousands, ) www2.census.gov/programs-surveys/cps/techdocs/cpsmar17.pdf

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 29 Table A-5. Number of People Without Health Insurance Coverage by State: 2013 to 2016 (Numbers in thousands. Civilian noninstitutionalized population. For information on confidentiality protection, sampling error,nonsampling­ error, and ­definitions, seewww2.census.gov/programs-surveys/acs/tech_docs/accuracy/ACS_Accuracy_of_Data_2016.pdf ) Medicaid 2013 uninsured 2014 uninsured 2015 uninsured 2016 uninsured Difference in uninsured expansion 2016 less 2015 2016 less 2013 State state? Yes (Y) or Margin of Margin of Margin of Margin of Margin of Margin of No (N)1 Number error2 (±) Number error2 (±) Number error2 (±) Number error2 (±) Number error2 (±) Number error2 (±)

United States . . . . . X 45,181 200 36,670 190 29,758 179 27,304 162 *–2,453 242 *–17,876 257

Alabama ...... N 645 17 579 17 484 16 435 14 *–49 21 *–210 22 Alaska...... +Y 132 7 122 6 106 5 101 6 –5 8 *–31 10 Arizona ...... Y 1,118 24 903 18 728 21 681 21 *–47 30 *–437 32 Arkansas...... Y 465 14 343 13 278 12 232 12 *–46 17 *–233 18 California...... Y 6,500 57 4,767 47 3,317 34 2,844 41 *–473 53 *–3,656 70 Colorado...... Y 729 18 543 16 433 15 410 14 *–23 21 *–319 23 Connecticut...... Y 333 14 245 11 211 13 172 11 *–38 17 *–160 18 Delaware...... Y 83 6 72 6 54 6 53 5 –1 7 *–30 7 District of Columbia. . . . Y 42 4 34 4 25 4 26 4 1 6 *–16 6 Florida...... N 3,853 43 3,245 43 2,662 40 2,544 47 *–117 62 *–1,309 64

Georgia...... N 1,846 30 1,568 28 1,388 26 1,310 30 *–79 40 *–537 42 Hawaii...... Y 91 6 72 5 55 4 49 5 –6 7 *–42 8 Idaho...... N 257 12 219 11 180 10 168 8 –12 13 *–89 15 Illinois...... Y 1,618 27 1,238 22 900 22 817 20 *–84 30 *–802 33 Indiana...... +Y 903 19 776 22 628 17 530 17 *–97 24 *–373 25 Iowa...... Y 248 9 189 8 155 8 132 8 *–23 11 *–116 11 Kansas...... N 348 12 291 11 261 12 249 9 –12 15 *–99 15 Kentucky...... Y 616 14 366 11 261 11 223 10 *–38 14 *–393 17 Louisiana...... N 751 17 672 16 546 17 470 17 *–76 24 *–281 24 Maine...... N 147 7 134 8 111 7 106 7 –5 10 *–41 10

Maryland...... Y 593 17 463 16 389 11 363 16 *–26 19 *–230 23 Massachusetts...... Y 247 10 219 8 189 9 171 10 *–18 14 *–76 15 Michigan ...... ^Y 1,072 19 837 18 597 14 527 14 *–70 20 *–545 24 Minnesota...... Y 440 14 317 12 245 11 225 10 *–20 15 *–215 17 Mississippi...... N 500 16 424 14 372 12 346 12 *–25 17 *–154 20 Missouri...... N 773 18 694 19 583 15 532 14 *–51 21 *–241 23 Montana...... +Y 165 8 143 6 119 7 83 6 *–35 9 *–81 10 Nebraska...... N 209 9 179 7 154 9 161 9 7 13 *–48 13 Nevada ...... Y 570 17 427 15 351 12 330 13 *–20 18 *–240 21 New Hampshire. . . . . ^Y 140 7 120 7 83 6 78 6 –6 8 *–63 9

New Jersey...... Y 1,160 22 965 19 771 22 705 19 *–66 29 *–455 29 New Mexico...... Y 382 13 298 10 224 9 188 10 *–36 14 *–195 17 New York...... Y 2,070 30 1,697 28 1,381 25 1,183 26 *–198 36 *–887 40 North Carolina...... N 1,509 26 1,276 25 1,103 23 1,038 21 *–64 31 *–471 34 North Dakota...... Y 73 6 57 5 57 5 52 5 –5 7 *–21 7 Ohio...... Y 1,258 21 955 20 746 19 644 18 *–103 26 *–614 27 Oklahoma ...... N 666 13 584 11 533 12 530 13 –3 17 *–136 18 Oregon...... Y 571 15 383 13 280 12 253 10 *–27 16 *–318 18 Pennsylvania...... ^Y 1,222 22 1,065 21 802 17 708 21 *–93 27 *–514 31 Rhode Island...... Y 120 7 77 6 59 6 45 5 *–14 7 *–75 8 South Carolina...... N 739 18 642 17 523 14 486 14 *–37 20 *–253 23 South Dakota...... N 93 5 82 4 86 5 74 4 *–12 7 *–19 7 Tennessee...... N 887 20 776 19 667 19 592 16 *–75 25 *–294 25 Texas...... N 5,748 55 5,047 43 4,615 55 4,545 55 –70 78 *–1,203 78 Utah...... N 402 13 366 13 311 14 265 12 *–47 18 *–137 18 Vermont...... Y 45 4 31 3 24 2 23 2 –1 3 *–22 5 Virginia...... N 991 22 884 22 746 23 715 21 *–31 31 *–276 31 Washington...... Y 960 22 643 17 468 13 428 15 *–40 19 *–532 26 West Virginia...... Y 255 10 156 8 108 6 96 6 *–12 9 *–159 12 Wisconsin ...... N 518 14 418 12 323 10 300 10 *–22 14 *–218 17 Wyoming...... N 77 5 69 5 66 6 67 6 Z 8 *–11 8

* Statistically different from zero at the 90 percent confidence level. ^ Expanded Medicaid eligibility after January 1, 2014, and on or before January 1, 2015. + Expanded Medicaid eligibility after January 1, 2015, and on or before January 1, 2016. X Not applicable. Z Represents or rounds to zero. 1 Medicaid expansion status as of January 1, 2016. For more information, see . 2 Data are based on a sample and are subject to sampling variability. A margin of error is a measure of an estimate’s variability. The larger the margin of error is in relation to the size of the estimate, the less reliable the estimate. This number, when added to and subtracted from the estimate, forms the 90 percent confidence interval. Note: Differences are calculated with unrounded numbers, which may produce different results from using the rounded values in the table. Source: U.S. Census Bureau, 2013 to 2016 1-Year American Community Surveys.

30 Health Insurance Coverage in the United States: 2016 U.S. Census Bureau APPENDIX B. ESTIMATES OF HEALTH INSURANCE COVERAGE

Quality of Health Insurance cating that the CPS ASEC did not cap- In 2014, the Census Bureau imple- Coverage Estimates ture as much health insurance cover- mented changes to the CPS ASEC, The Current Population Survey Annual age in comparison.2 Additionally, these including a complete redesign of Social and Economic Supplement (CPS concerns extended to undercounting the health insurance questions that ASEC) is used to produce official esti- Medicaid enrollment and general mis- replaced the existing questions in mates of income and poverty, and it reporting of the source and timing of the CPS ASEC. Due to the differences serves as the most widely cited source health insurance coverage.3 To address in measurement, health insurance of estimates on health insurance and these concerns, the U.S. Census Bureau estimates for calendar year 2013 and the uninsured. Detailed health insur- substantially redesigned the CPS ASEC later years are not directly comparable ance questions have been asked in health insurance module to improve to previous years; this report does not the CPS ASEC since 1988 as a part of estimates of health insurance cover- compare estimates from the rede- a mandate to collect data on noncash age. Evaluation of the new questions signed CPS ASEC to the previous ver- benefits. included over a decade of research, sion of the health insurance questions. including focus groups, cognitive inter- Researchers should use caution when However, researchers have questioned views, and two national field tests.4 comparing results over time. In par- the validity of the health insurance 2 See Jacob A. Klerman, Michael Davern, ticular, the estimate of the uninsured estimates in the previous version of the Kathleen Thiede Call, Victoria Lynch, and population is lower than in previous CPS ASEC.1 In particular, the estimate of Jeanne D. Ringel, “Understanding the Current Population Survey’s Insurance Estimates and the years, since the redesigned questions the uninsured in the previous calendar Medicaid ‘Undercount,’” Health Affairs—Web capture more health insurance cover- year was not in line with other federal Exclusive: w991–w1001, 2009. Available at . more information on why the CPS ASEC 3 See Kathleen T. Call, Michael E. Davern, was redesigned, as well as the results 1 The issues with the traditional CPS ASEC Jacob A. Klerman, and Victoria Lynch, health insurance estimates have been well estab- “Comparing Errors in Medicaid Reporting across from the 2013 field test, see lished, as discussed in the Census Bureau’s annual Surveys: Evidence to Date,” Health Services . -redesign.html>. the CPS estimates. For an example, see page 22 in 4 See the infographic “Improving Health Insur- the report, P60-245, “Income, Poverty, and Health ance Coverage Measurement: 1998–2014, A Insurance Coverage in the United States: 2012” at History of Research and Testing” at . -kits/2015/health_insurance_research.pdf>.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 31

APPENDIX C. REPLICATE WEIGHTS

Beginning in the 2011 Current One study found that the CPS ASEC error estimates with SDB estimates.3 Population Survey Annual Social GVF standard errors performed poorly Replicate weight estimates performed and Economic Supplement (CPS against more precise Survey Design- markedly better against SDB standard ASEC) report, the variance of CPS Based (SDB) estimates.2 In most cases, errors than those calculated using the ASEC estimates used to calculate results indicated that the published published GVF parameters. the standard errors and confidence GVF parameters significantly underesti- Since the published GVF parameters intervals displayed in the text tables mated standard errors in the CPS ASEC. generally underestimated standard were calculated using the Successive This and other critiques prompted errors, standard errors produced using Difference Replication (SDR) method.1 the U.S. Census Bureau to transition SDR may be higher than in previous This method involves the computa- from using the GVF method of estimat- reports. For most CPS ASEC estimates, tion of a set of replicate weights, ing standard errors to using the SDR the increase in standard errors from which account for the complex survey method of estimating standard errors GVF to SDR will not alter the find- design of the CPS. The SDR method for the CPS ASEC. In 2009, the Census ings. However, marginally significant has been used to estimate variances in Bureau released replicate weights for differences using the GVF may not be the American Community Survey (ACS) the 2005 through 2009 CPS ASEC col- significant using replicate weights. since its inception. lection years and has released replicate weights for 2010 to 2015 with the The Census Bureau will continue to Before 2011, the standard errors of release of the CPS ASEC public-use data. provide the GVF parameters in the CPS ASEC estimates were calculated source and accuracy statement. using a Generalized Variance Function Following the 2009 release of CPS (GVF) approach. Under this approach, ASEC replicate weights, another study generalized variance parameters compared replicate weight standard were used in formulas provided in the source and accuracy statement to estimate standard errors. 2 Michael Davern, Arthur Jones, James 3 Michel Boudreaux, Michael Davern, and Peter 1 Robert E. Fay and George F. Train, “Aspects Lepkowski, Gestur Davidson, and Lynn A. Graven, “Alternative Variance Estimates in the of Survey and Model-Based Postcensal Estimation Blewett. “Unstable Inferences? An Examination Current Population Survey and the American of Income and Poverty Characteristics for States of Complex Survey Sample Design Adjustments Community Survey,” presented at the 2011 Annual and Counties,” Proceedings of the Section on Using the Current Population Survey for Health Meeting of the Population Association of America. Government Statistics, American Statistical Services Research,” Inquiry, Vol. 43, No. 3, 2006, Available at .

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 33

APPENDIX D. ADDITIONAL DATA AND CONTACTS

Press releases, briefings, and data access are available electronically on the U.S. Census Bureau’s Health Insurance Web site. The Web site may be accessed through the Census Bureau’s home page at , the Health Insurance home page at , or directly at .

For assistance with health insurance data, contact the Census Bureau Customer Services Center at 1-800-923-8282 (toll-free), or search your topic of interest using the Census Bureau’s “Question and Answer Center” found at .

Customized Tables been applied to CPS microdata to avoid requirements of Title 13.1 This process The CPS Table Creator disclosing the identities of individuals is often called topcoding. During the period prior to the March 1996 survey, Gives data ACS ing the values for dollar amounts to be users the ability to create customized no greater than a specified maximum tables from the Current Population The ACS Public-Use Microdata Sample value (the topcode). Values above Survey Annual Social and Economic files (PUMS) are a sample of the actual the maximum were replaced by the Supplement (CPS ASEC). Table Creator responses to the ACS and include most maximum value. Beginning with the can access data back to the 2003 CPS population and housing characteris- 1996 survey, the censorship method ASEC. tics. These files provide users with the flexibility to prepare customized tabu- was modified so that mean values American FactFinder lations and can be used for detailed were substituted for all amounts above Provides edited to protect the confidentiality all amounts above the topcode made access to data about the United States, of all individuals and of all individual it impossible to examine the distribu- Puerto Rico, and the Island Areas. The households. The smallest geographic tions above the topcode. In an effort tabular data in American FactFinder unit that is identified within the PUMS to alleviate this problem and improve come from several censuses and the is the Public Use Microdata Area the overall usefulness of the CPS American Community Survey (ACS). (PUMA). These data are available online ASEC, the Census Bureau sponsored at Users /pums.html>. Because the PUMS files the distributions above the topcode. can also generate customized tables are a sample of the ACS, estimates of This research led to the implementa- using the DataFerrett tool. CPS ASEC health insurance coverage will differ tion in the 2011 ASEC of rank prox- files from 1992 to the present and slightly. imity swapping methods that switch ACS files from 2005 to the present are dollar amounts above the topcode for available through DataFerrett. Topcoding respondents that are of similar rank. Swapped amounts are rounded follow- Public-Use Microdata In the Census Bureau’s long history of ing the swapping process to provide releasing public-use microdata files CPS ASEC additional disclosure avoidance. Microdata for the 2015 CPS ASEC and based on the CPS ASEC, the Census earlier years is available online at Bureau has censored the release of or via 1 For more information, see . Technical methods have _information.html>.

U.S. Census Bureau Health Insurance Coverage in the United States: 2016 35

P60-260 Health Insurance Coverage in the United States: 2016 Current Population Reports U.S. Census Bureau Permit No. G-58 Permit No. FIRST-CLASS MAIL FIRST-CLASS U.S. Census Bureau U.S. Census POSTAGE & FEES PAID POSTAGE Penalty for Private Use $300 Penalty for Private U.S. CENSUS BUREAU U.S. CENSUS DC 20233 Washington, BUSINESS OFFICIAL U.S. Department of Commerce Department U.S. and Statistics Administration Economics