In September, the National Health Interview Survey (NHIS) released data for the first quarter of 2014 that provide estimates of the number of people without insurance and the sources of coverage. These data represent averages over the first quarter.
The new NHIS data lag behind the data from nonfederal surveys on health insurance status and administrative data on enrollment, which is particularly important during a period of unusually rapid change in health insurance coverage. In particular, because the NHIS estimates reflect interviews conducted continuously during January, February, and March, they do not reflect the full impact of the surge in Marketplace enrollment in late March at the end of the open enrollment period, as reported in HHS enrollment statistics.15 Medicaid and CHIP enrollment were not directly affected by the end of open enrollment and have continued to grow since March: the latest administrative data suggest that by August 2014, enrollment in these two programs was up by 8.7 million compared with the June-September 2013 base period.16
Estimates of the percentage of people that were uninsured during January-March 2014 and their sociodemographic characteristics are available from the NHIS quarterly data released on September 16 and summarized in Table 2. Table 2 also shows the comparable NHIS estimates of the percentage uninsured, overall and by selected subgroups, in CY 2013, and whether the change over this period was statistically significant.
Because most low-income children were eligible for Medicaid or CHIP before the Affordable Care Act and most seniors were already enrolled in Medicare, the early 2014 gains were concentrated among 18 to 64 year olds, particularly young adults. And because eligibility for Medicaid coverage and Marketplace subsidies is based on income, the reduction in the number of people that were uninsured was significant for the poor and near-poor, but not for those with higher incomes, who were less likely to be uninsured before this year’s coverage expansion. The first quarter change was statistically significant for men, but not for women. The new NHIS estimates, like the adjusted Gallup-Healthways WBI estimates presented by Sommers et al. and the unadjusted estimates presented by Long et al. for similar periods, suggest that Latinos and African Americans were particularly likely to gain coverage in early 2014.17
The data reported in Table 2 are for coverage at the time of interview, and thus represent point-in-time estimates averaged over the three-month period in which the data was collected. Estimates of the percentage uninsured for at least part of the previous year (January-December 2013) and the percentage uninsured for more than a year are also available in the NCHS September 2014 report.18 Those data show statistically significant reductions in the percentage of nonelderly adults who were uninsured for more than a year, suggesting that the coverage expansion is reaching the long-term uninsured. These data also represent averages over the three-month collection period.
Table 2. National Health Interview Survey. Estimated Percentage Uninsured, January-December 2013 and January-March 2014, Under 65 Only
|Poor (<100% FPL)||27.3||24.1||3.2*|
|Near-Poor (>=100% FPL and <200% FPL)||29.3||26.2||-3.1*|
|Not Poor (>=200% FPL)||9.6||9.0||-0.6|
|Latino (all races)||30.3||27.2||-3.1*|
|White Non-Latino (single race)||12.1||11.5||-0.6|
|Black Non-Latino (single race)||18.9||15.1||-3.8*|
|Asian Non-Latino (single race)||13.8||13.3||-0.5|
|Other Non-Latino (other/multiple race)||16.0||16.7||0.7|
* Change is statistically significant at the .05 level.
Sources: ASPE calculations from Robin A. Cohen and Michael E. Martinez, Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–March 2014. National Center for Health Statistics. September 2014 (http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201409.pdf, accessed October 27, 2014) and Robin A. Cohen and Michael E. Martinez, Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2013. National Center for Health Statistics. June 2014 (http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201406.pdf, accessed October 27, 2014).
As noted above, because the NHIS first quarter estimates in Table 2 represent averages over the three months from January to March 2014, they do not reflect the full coverage gains that have occurred under the Affordable Care Act in 2014. This means that NHIS data for the second quarter of 2014, based on averages for April-June, will likely show larger enrollment gains than the first quarter data shown in Table 2. The second quarter NHIS data, to be released in December 2014, will capture the full late-March/SEP Marketplace surge, and more of the continuing growth in Medicaid and CHIP.
The second quarter NHIS data may also suggest different conclusions about the distribution of those gains across the subgroups shown in Table 2. Marketplace enrollment data, for example, indicate that younger enrollees were particularly likely to sign up late in the 2014 enrollment period.19 The estimates for 19 to 25 year olds in Table 2 may not reflect the full impact of coverage gains among this age group.