NCHS Data Brief No. 382, September 2020 Show
PDF Version (432 KB) Key findingsData from the National Health Interview Survey
Previously published data from the National Health Interview Survey (NHIS) reported that the percentage of uninsured adults aged 18–64 significantly decreased from 20.4% in 2013 to 13.3% in 2018 (1). Lack of health insurance has been associated with not receiving preventive services or screenings and may, in turn, lead to delays in disease diagnosis and poorer health outcomes (2). The 2019 NHIS included six questions for uninsured adults to better understand their reasons for currently being uninsured. This report describes the characteristics of uninsured adults aged 18–64 in 2019 and the percentage who identified with each of the six reasons for being uninsured. For the three most prevalent reasons, the percentage who identified with each reason is presented by selected demographic characteristics, and health status. Keywords: health insurance, lack of coverage, National Health Interview Survey The percentage of adults aged 18–64 who were uninsured varied by selected characteristics.
Figure 1. Percentage of adults aged 18–64 who were uninsured at the time of interview, by selected characteristics: United States, 2019
1Significantly
different from women (p < 0.05). Among adults aged 18–64, the reasons for being uninsured included not affordable, not eligible, do not need or want, signing up was too difficult or confusing, cannot find plan that meets needs, and applied but has not started.
Figure 2. Percentage of adults aged 18–64 who identified with selected reasons for being currently uninsured: United States, 2019
NOTES: “Not affordable,” “Do not need or want,” “Not eligible,” “Signing up was too difficult or confusing,” “Cannot find plan that meets needs,” and “Applied but has not started” are based on positive responses to a series of questions asking, “Are you currently uninsured because … ‘coverage is not affordable,’ ‘you do not need or want coverage,’ ‘you are not eligible for coverage,’
‘the process of signing up for coverage is too difficult or confusing,’ ‘you cannot find a plan that meets your needs,’ and ‘you applied for coverage, but it has not started yet?’” A sample adult can provide more than one reason for being currently uninsured. Access data table for Figure 2. The percentage of adults aged 18–64 who were uninsured because coverage was not affordable varied by selected characteristics.
Figure 3. Percentage of adults aged 18–64 who were uninsured because coverage was not affordable, by selected characteristics: United States, 2019
1Significantly different from women (p < 0.05). The percentage of adults aged 18–64 who were uninsured because they were not eligible for coverage varied by selected characteristics.
Figure 4. Percentage of adults aged 18–64 who were uninsured because they were not eligible for coverage, by selected characteristics: United States, 2019
1Significantly different from women (p < 0.05). The percentage of adults aged 18–64 who were uninsured because coverage was not needed or wanted varied by selected characteristics.
Figure 5. Percentage of adults aged 18–64 who were uninsured because coverage was not needed or wanted, by selected characteristics: United States, 2019
1Significantly different from women (p < 0.05). SummaryIn 2019, 14.5% of adults aged 18–64 were uninsured at the time of interview. Among uninsured adults aged 18–64, the most common reason for being currently uninsured was because they perceived that they could not afford the cost of coverage, followed by not being eligible, not wanting coverage, the process of signing up was too difficult or confusing, could not find a plan that meets their needs, and they signed up for coverage, but the plan has not started yet. In 2019, the percentage of adults who were uninsured due to cost was higher among women, adults aged 50–64, and adults in fair or poor health. The percentage of adults who were uninsured due to ineligibility did not vary by age but was higher among women and adults in fair or poor health. In contrast, the percentage of adults who were uninsured because coverage was not needed or wanted was higher among men, adults aged 18–29, and adults with excellent, very good, or good health. Individuals without health insurance experience barriers to health care such as not having a usual source of care and postponing or forgoing care due to cost, which may lead to negative health outcomes (2,3). DefinitionsHealth status: Adult respondents were asked to assess their health status, specifically, whether their “health in general is excellent, very good, good, fair, or poor?” Race and ethnicity: Categories shown for non-Hispanic respondents are only for those who selected one racial group; respondents had the option to select more than one racial group. Hispanic respondents might be of any race or combination of races. Only selected groups are shown in the individual race and ethnicity bars, but total bars show results for all adults aged 18–64. Reasons for being currently uninsured: “Not affordable,” “Do not need or want,” “Not eligible,” “Signing up was too difficult or confusing,” “Cannot find plan that meets needs,” and “Applied but has not started” are based on positive responses to a series of questions asking, “Are you currently uninsured because … ‘coverage is not affordable,’ ‘you do not need or want coverage,’ ‘you are not eligible for coverage,’ ‘the process of signing up for coverage is too difficult or confusing,’ ‘you cannot find a plan that meets your needs,’ and ‘you applied for coverage but it has not started yet?’” Uninsured: Adults were considered uninsured if they did not have private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (CHIP), a state-sponsored health plan, other government programs, or military health plans (includes TRICARE, VA, and Civilian Health and Medical Program of VA [CHAMP-VA]) at the time of interview. Data source and methodsThis analysis used data from the Sample Adult component of 2019 National Health Interview Survey (NHIS). NHIS is a nationally representative, household survey of the civilian noninstitutionalized U.S. population. In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users. Additional questions on reasons for being uninsured were added to learn more about those who are uninsured. The survey is conducted continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in the respondent’s home, but follow-ups to complete interviews may be conducted by telephone when necessary. For more information about NHIS, visit the survey website. Point estimates and the corresponding variances were calculated using SAS-callable SUDAAN version 11.0 (RTI International, Research Triangle Park, N.C.) to account for the complex sample design of NHIS. All estimates in this report met NCHS standards of reliability as specified in the “National Center for Health Statistics Data Presentation Standards for Proportions” (4). Tests for trend were evaluated using orthogonal polynomials in logistic regression. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorsAmy E. Cha and Robin A. Cohen are with the National Center for Health Statistics, Division of Health Interview Statistics. References
Suggested citationCha AE, Cohen RA. Reasons for being uninsured among adults aged 18–64 in the United States, 2019. NCHS Data Brief, no 382. Hyattsville, MD: National Center for Health Statistics. 2020. Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. National Center for Health StatisticsBrian C. Moyer, Ph.D., Director Division of Health Interview StatisticsStephen J. Blumberg, Ph.D., Director What is a consequence of not having a health insurance?People without health insurance in California must pay a penalty of $750 per adult and $375 per child. However, residents can claim a coverage exemption for the filing situations: Household income below the state threshold. Time without coverage was three consecutive months or less.
What are the most serious consequences of not having a national health care policy?Without health insurance coverage, a serious accident or a health issue that results in emergency care and/or an expensive treatment plan can result in poor credit or even bankruptcy.
How do uninsured people affect the economy?One study found that workers who were uninsured missed almost five more days of work each year than those who had insurance. Health-related productivity losses are estimated to reduce U.S. economic output by $260 billion per year.
What is possible about adverse outcomes from not having health insurance in America today?Because uninsured patients are also less likely to receive necessary follow-up screenings than their insured counterparts,8 they have an increased risk of being diagnosed at later stages of diseases, including cancer, and have higher mortality rates than those with insurance.
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