Census Bureau: 'Health Insurance Coverage in U.S.: 2020'
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Contents TEXT
Introduction ... 1
What Is Health Insurance Coverage? ... 1
The Impact of the Coronavirus (COVID-19) Pandemic on the Current Population Survey Annual Social Economic Supplement (CPS ASEC) ... 2
Health Insurance Coverage by Type and Selected Characteristics. ... 2
Highlight ... 2
Selected Social Characteristics ... 6
Selected Economic Characteristics ... 8
Income-to-Poverty Ratio and Medicaid Expansion Status ... 9
Health Insurance Coverage by Age and Selected Characteristics ... 10
Additional Information About Health Insurance Coverage ... 12
State and Local Estimates of Health Insurance Coverage ... 12
Additional Data ... 14
Data.census.gov ... 14
Public-Use Microdata ... 14
Census Data API ... 14
Source and Accuracy of the Estimates ... 14
Comments ... 15
Appendix A. ... 17
Appendix B. Estimates of Health Insurance Coverage: 2013 to 2020 ... 27
TABLE
Table 1. Number and Percentage of People by Health Insurance Coverage Status and Type: 2018 to 2020 ... 4
FIGURES
Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2018 to 2020 ... 5
Figure 2. Percentage of People Uninsured by
Figure 3. Health Insurance Coverage by Characteristics: 2018 and 2020 ... 7
Figure 4. Health Insurance Coverage and Type by Income-to-Poverty Ratio: 2020 ... 9
Figure 5. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2018 and 2020 ... 10
Figure 6. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2018 and 2020 ... 11
Figure 7. Percentage of Working-Age Adults Without Health Insurance Coverage by Selected Characteristics: 2018 and 2020 ... 13
APPENDIX TABLES
Table A-1. Percentage of People by Health Insurance Coverage Status and Type by Selected Characteristics: 2018, 2019, and 2020 ... 17
Table A-2. Health Insurance Coverage Status and Type by Age and Selected Characteristics: 2018, 2019, and 2020 ... 20
Table A-3. Health Insurance Coverage Status and Type by Family Type and Family Income-to-Poverty Ratio: 2018, 2019, and 2020 ... 23
APPENDIX FIGURES
Figure B-1. Percentage of People Without Health Insurance Coverage: 2013 to 2020 ... 28
Figure B-2. Percentage of People With Private Health Insurance Coverage: 2013 to 2020 ... 29
Figure B-3. Percentage of People With Public Coverage and Medicaid Coverage: 2013 to 2020 ... 30
Figure B-4. Percentage of People With Medicaid Coverage by
Figure B-5. Percentage of People With Health Insurance Coverage at Time of CPS ASEC Interview by Type: 2019 and 2021 ... 32
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INTRODUCTION
Health insurance is a means for financing a person's health care expenses. While the majority of people have private health insurance, primarily through an employer, many others obtain coverage through programs offered by state and federal governments. Other individuals do not have health insurance coverage at all (The "What Is Health Insurance Coverage?" text box contains more information).
Year to year, the rate of health insurance coverage and the distribution of coverage types may change due to economic trends, shifts in the demographic composition of the population, and policy changes that affect access to care.
This report presents estimates of health insurance coverage in
The CPS is the longest-running household survey conducted by the
The 2020 estimates highlighted in this report were collected from
People are only considered uninsured if they had no coverage at any time during the year. As a result, people who lost coverage during 2020 are not included in the uninsured rate./2
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What Is Health Insurance Coverage?
Health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) refers to comprehensive coverage at any time during the calendar year for the civilian, non-institutionalized population of
For reporting purposes, the
Private Coverage
* Employment-based: Plan provided through an employer or union.
* Direct-purchase: Coverage purchased directly from an insurance company, or through a federal or state Marketplace (e.g., healthcare.gov).
* TRICARE: Coverage through TRICARE, formerly known as
Public Coverage
* Medicare: Federal program that helps to pay health care costs for people aged 65 and older and for certain people under age 65 with long-term disabilities.
* Medicaid: This report uses the term Medicaid to include the specific Medicaid government program and other programs for low-income individuals administered by the states such as
* CHAMPVA or
Additionally, people are considered uninsured if they only had coverage through the
i Comprehensive health insurance covers basic health care needs. This definition excludes single service plans such as accident, disability, dental, vision, or prescription medicine plans.
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The Impact of the Coronavirus (COVID-19) Pandemic on the Current Population Survey Annual Social and Economic Supplement (CPS ASEC)
The
During collection of the 2021 CPS ASEC, for the safety of both interviewers and respondents, in-person interviews were only conducted when telephone interviews could not be done. In
Of particular interest, for the estimates in this report, are the differences in median income and educational attainment, indicating that respondents in 2020 and 2021 had relatively higher incomes and were more educated than non-respondents. For more details on how these sample differences and the associated non-response bias impact income and official poverty estimates, refer to <www.census.gov/newsroom/blogs/research-matters/2021/08 /how-did-the-pandemic-affect-survey-response.html>.
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Estimates of health insurance coverage for 2019 were collected between February and April of 2020, during the first months of the COVID-19 pandemic. In the middle of the collection period, the
In addition, the
"The Impact of the Coronavirus (COVID-19) Pandemic on the Current Population Survey Annual Social and Economic Supplement (CPS ASEC)" text box provides more information.
Estimates for 2018 were collected in 2019, prior to the pandemic. In order to make the most consistent comparisons, the majority of the estimates in this report focus on changes in health insurance coverage between 2018, prior to the pandemic, and 2020. More information presenting the 2020 coverage estimates in the context of a longer time frame is available in Appendix B: Estimates of Health Insurance Coverage 2013-2020.
HEALTH INSURANCE COVERAGE BY TYPE AND SELECTED CHARACTERISTICS
Highlights
* In 2020, 8.6 percent of people, or 28.0 million, did not have health insurance at any point during the year (Table 1 and Figure 1).
* The percentage of people with health insurance coverage for all or part of 2020 was 91.4 (Table 1).
* In 2020, private health insurance coverage continued to be more prevalent than public coverage at 66.5 percent and 34.8 percent, respectively./5 Of the subtypes of health insurance coverage, employment-based insurance was the most common, covering 54.4 percent of the population for some or all of the calendar year, followed by Medicare (18.4 percent), Medicaid (17.8 percent), direct-purchase coverage (10.5 percent), TRICARE (2.8 percent), and
* Between 2018 and 2020, the rate of private health insurance coverage decreased by 0.8 percentage points to 66.5 percent, driven by a 0.7 percentage-point decline in employment-based coverage to 54.4 percent (Table 1 and Figure 1)./7
* Between 2018 and 2020, the rate of public health insurance coverage increased by 0.4 percentage points to 34.8 percent (Table 1 and Figure 1)./8,9
* In 2020, 87.0 percent of full-time, year-round workers had private insurance coverage, up from 85.1 percent in 2018. In contrast, those who worked less than full time, year-round were less likely to be covered by private insurance in 2020 than in 2018 (68.5 percent in 2018 and 66.7 percent in 2020) (Figure 3)./10
* More children under the age of 19 in poverty were uninsured in 2020 than in 2018. Uninsured rates for children under the age of 19 in poverty rose 1.6 percentage points to 9.3 percent (Figure 6).
This report classifies health insurance coverage into three different groups: overall coverage, private coverage, and public coverage (The "
In 2020, most people (91.4 percent) had health insurance coverage at some point during the calendar year (Table 1 and Figure 1). More people had private health insurance (66.5 percent) than public coverage (34.8 percent).
Employment-based insurance was the most common sub type of health insurance (54.4 percent), followed by Medicare (18.4 percent), Medicaid (17.8 percent), direct-purchase insurance (10.5 percent), TRICARE (2.8 percent), and
The percentage of people covered by any type of health insurance in 2020 was not significantly different than the percentage in 2018. Although this result seems counter to reports of coverage loss during the COVID-19 pandemic, the CPS ASEC measures coverage in calendar year 2020 based on whether an individual had coverage for all or part of the year during 2020. For example, a person who held coverage in
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[See link at end of text for Table 1. Number and Percentage of People by Health Insurance Coverage Status and Type: 2018 to 2020]
Source:
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[See link at end of text for Figure 1. Percentage of People by Type of Health Insurance Coverage and Change From 2018 to 2020]
Note: The estimates by type of coverage are not mutually exclusive: people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions in the
Source:
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[See link at end of text for Figure 2. Percentage of People Uninsured by
Note: There were no significant changes between 2018 and 2020 at the 90 percent confidence level. Information on confidentiality protection, sampling error, nonsampling error, and definitions in the
Source:
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Between 2018 and 2020, of the subtypes of private health insurance, employment-based coverage and direct-purchase insurance decreased, while TRICARE increased. The percentage of people covered by employment-based insurance and direct-purchase insurance decreased by 0.7 percentage points to 54.4 percent and by 0.3 percentage points to 10.5 percent, respectively, in 2020. TRICARE coverage increased by 0.2 percentage points to 2.8 percent in 2020 (Table 1 and Figure 1).
Additionally, the percentage of people covered by a public health insurance plan increased between 2018 and 2020 to 34.8 percent (Table 1 and Figure 1). Of the three subtypes of public health insurance, only the Medicare rate increased between 2018 and 2020. The percentage of people covered by Medicare increased by 0.5 percentage points to 18.4 percent in 2020. This increase in coverage was partly due to growth in the number of people aged 65 and older. The Medicaid rate in 2020 was 17.8 percent, which was not statistically different from 2018.
Age is associated with the likelihood that a person has health insurance coverage. Older adults (those over the age of 65) and children (those under the age of 19) are more likely to have health insurance coverage than those aged 19 to 64, in part because their age makes them eligible for certain public health insurance programs. Medicare provides health coverage benefits for most adults aged 65 and older. Children under the age of 19 may qualify for coverage through Medicaid or the
In 2020, 1.0 percent of adults aged 65 and older were uninsured for the entire calendar year, while 5.6 percent of children under the age of 19 were uninsured in the same period. Among working-age adults, the age group with the largest percentage uninsured for the entirety of calendar year 2020 was those aged 19 to 25 (14.4 percent), followed by those aged 26 to 34 (14.2 percent), adults aged 35 to 44 (12.4 percent), and those aged 45 to 64 (9.6 percent) (Figure 2)./13
Between 2018 and 2020, there were no significant changes in the uninsured rate by age groups.
Selected Social Characteristics
The CPS ASEC can also be used to look at the prevalence and type of health insurance coverage across certain social and economic characteristics, as well as changes in coverage across race and Hispanic origin groups.
Overall, Hispanics had the highest uninsured rate (18.3 percent) in 2020, followed by Blacks (10.4 percent), Asians (5.9 percent), and non-Hispanic Whites (5.4 percent) (Table A-1)./14,15,16
In 2020, Blacks had the highest rate of public coverage (41.4 percent) followed by Hispanics (35.9 percent), non-Hispanic Whites (33.8 percent), and Asians (27.0 percent). In the same year, non-Hispanic Whites had the highest rate of private coverage (73.9 percent), followed by Asians (72.4 percent), Blacks (54.6 percent), and Hispanics (49.9 percent) (Figure 3).
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[See link at end of text for Figure 3. Health Insurance Coverage by Characteristics: 2018 and 2020]
Note: The estimates by type of coverage are not mutually exclusive: people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, nonsampling error, and definitions in the
Source:
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Non-Hispanic Whites experienced changes in health insurance status between 2018 and 2020. Specifically, private coverage decreased by 0.9 percentage points to 73.9 percent, and public coverage increased by 0.6 percentage points to 33.8 percent in 2020. In contrast, there was no significant change in either private or public coverage between 2018 and 2020 for Hispanics of any race, Blacks, or Asians.
Selected Economic Characteristics
For many adults aged 15 to 64, health insurance coverage is related to work status such as working full-time, year-round, working less than full-time, year-round, or not working at all during the calendar year. Workers were more likely than non-workers to be covered by private health insurance. In 2020, 87.0 percent of full-time, year-round workers were covered through a private insurance plan, compared with 66.7 percent of those working less than full-time, year-round. Those who did not work were the least likely to have private health insurance coverage, at 52.2 percent (Figure 3 and Table A-2).
Overall, between 2018 and 2020, workers' private coverage declined by approximately 0.7 percentage points. However, this decrease was not equal across all types of workers. For example, the percentage of full time, year-round workers with private coverage increased by 1.9 percentage points, while private insurance coverage rates for those who worked less than full-time, year-round decreased by 1.9 percentage points. There was no statistical change in private coverage for non-workers between 2018 and 2020.
Rates of public coverage followed a different pattern. Non-workers were more likely than those working less than full-time, year-round to have public coverage (39.1 percent of non-workers versus 20.9 percent of less than full-time, year-round workers). Full-time, year-round workers were the least likely to have public coverage, at 6.1 percent. In 2020, public insurance coverage rates decreased by 1.0 percentage point for full-time, year-round workers and 1.0 percentage point for non-workers compared to 2018.
Many adults obtain health insurance coverage through their spouses, and, therefore, health insurance coverage is related to marital status. Adults aged 19 to 64 who were not married were less likely to have private health insurance than married adults (63.6 percent and 82.1 percent, respectively). There were no changes in private or public health insurance rates between 2018 and 2020 for either married or unmarried people (Figure 3 and Table A-2).17 Health insurance coverage and type is also associated with family income-to-poverty ratio, which provides a measure of a family's economic resources./18
Family resources may determine the ability to afford private health insurance, and families below certain income-to-poverty thresholds may qualify for public health insurance options. Figure 4 shows the public coverage rate, private coverage rate, and uninsured rate for individuals based on their family's income-to-poverty ratio in 2020.
For private insurance, those living in poverty are the least likely to have private insurance (23.2 percent), and each group with a higher income-to-poverty ratio has a higher rate of private insurance. Those living at or above 400 percent of the poverty line are the most likely to have private health insurance (88.2 percent) (Figure 4).
In contrast, those living in poverty are the most likely to have public insurance (64.3 percent), while those living at or above 400 percent of the poverty line are the least likely to have public health insurance (19.1 percent). The percentage of people with public insurance decreases as the income-to-poverty ratio increases.
As the income-to-poverty ratio increases, the percentage of uninsured declines. Those in poverty have the highest rate of people uninsured for the full calendar year (17.2 percent), while those living at or above 400 percent of the poverty line have the lowest rate of people uninsured for all of 2020 (3.4 percent). Other income-to-poverty groups fall between these rates, and those with higher income-to-poverty ratios are less likely to be uninsured.
Changes in health insurance coverage by type were not distributed equally across income-to-poverty ratio groups. For example, people with an income-to-poverty ratio between 100 and 399 percent and those at or above 400 percent of poverty increased their rates of public insurance use between 2018 and 2020 (by 2.2 percentage points and 0.6 percentage points, respectively) (Figure 3).
In contrast, between 2018 and 2020, rates of private insurance decreased for people with an income-to-poverty ratio between 100 and 399 percent of poverty and those at or above 400 percent of poverty (by 2.9 percentage points and 1.0 percentage point, respectively). However, those in poverty saw an increase in private health coverage by 1.3 percentage points (Figure 3).
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[See link at end of text for Figure 4. Health Insurance Coverage and Type by Income-to-Poverty Ratio: 2020]
Note: The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year. Information on confidentiality protection, sampling error, non-sampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar21.pdf>.
Source:
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Income-to-Poverty Ratio and Medicaid Expansion Status
The Patient Protection and Affordable Care Act provided the option for states to expand Medicaid eligibility to adults whose income-to-poverty ratio fell under 138 percent of the poverty line./19
As of
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[See link at end of text for Figure 5. Uninsured Rate by Poverty Status and Medicaid Expansion of State for Adults Aged 19 to 64: 2018 and 2020]
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions, is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar21.pdf>.
Source:
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The uninsured rate in 2020 varied by state Medicaid expansion status. In 2020, among adults aged 19 to 64, those in expansion states had lower uninsured rates (8.9 percent) than those in non-expansion states (17.6 percent) (Figure 5).
Further, the relationship between poverty status, health insurance coverage in 2020, and the change in coverage between 2018 and 2020 may be related to an individual's state of residence and whether that state expanded Medicaid eligibility (Figure 5).
Uninsured rates were lower for all income-to-poverty groups in expansion states than in non-expansion states. For people in families living in poverty in non-expansion states, there was a 2.6 percentage-point increase in the uninsured rate, to 38.1 percent between 2018 and 2020, while there was no statistically significant change in the uninsured rate for those in poverty in expansion states./21
Among people with family income between 100 and 399 percent of poverty, 23.0 percent of people in non-expansion states did not have health insurance for the full year, representing a 1.8 percentage-point increase in the percentage of uninsured from 2018. For the same group in expansion states, there was a 1.1 percentage-point increase in the percentage of uninsured to 13.8 percent. For all other income-to-poverty groups, there was no significant change in the uninsured rate between 2018 and 2020.
Health Insurance Coverage by Age and Selected Characteristics
In 2020, 5.6 percent of children under the age of 19 did not have health insurance coverage, which was not statistically different from 2018 (Figure 6). Examining coverage by children's characteristics reveals that changes in health insurance coverage between 2018 and 2020 did not occur equally across groups.
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[See link at end of text for Figure 6. Percentage of Children Under the Age of 19 Without Health Insurance Coverage by Selected Characteristics: 2018 and 2020]
Note: Information on confidentiality protection, sampling error, non-sampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar21.pdf>.
Source:
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Among children living in poverty, 9.3 percent did not have health insurance at any time in 2020, representing an increase of 1.6 percentage points since 2018. For children in families at or above 400 percent of poverty, the uninsured rate decreased by 0.4 percentage points, to 2.2 percent. In 2020, 7.0 percent of children between 100 and 399 percent of poverty did not have health insurance, which is not statistically different from 2018. In both years, the percentage of children without health insurance coverage decreased as the income-to-poverty ratio increased.
The percentage of non-Hispanic White children without health insurance coverage was not statistically different in 2020 compared with 2018. However, the uninsured rate decreased for Asian children (by 1.4 percentage points) and increased for Black children (by 1.4 percentage points), to 2.8 percent and 6.0 percent, respectively. In 2020, 9.5 percent of Hispanic children were uninsured, which is not statistically different from 2018.
In 2020, 5.2 percent of children born in
Health insurance rates for children varied by region as well.23 For example, 7.7 percent of children living in the South were uninsured, while the uninsured rates for children in the Northeast (3.3 percent), Midwest (4.4 percent), and West (4.9 percent) were lower./24
Health insurance rates varied for children who lived in expansion states compared to those who lived in non-expansion states (4.0 percent and 8.5 percent, respectively).
Health insurance outcomes for working -age adults aged 19 to 64 may differ from those in other age groups because they do not qualify for certain programs, such as CHIP, and only qualify for Medicare under limited circumstances. In 2020, 11.9 percent of working-age adults (aged 19 to 64) did not have health insurance coverage, which was not statistically different from 2018 (Figure 7).
The uninsured rate for noncitizen adults aged 19 to 64 increased 2.2 percentage points between 2018 and 2020. In 2020, 33.8 percent of working-age noncitizens did not have health insurance, which is higher than foreign-born adults (22.9 percent), naturalized citizen adults (10.7 percent), and native-born adults (9.6 percent).
The uninsured rate decreased by 1.1 percentage points for working-age adults who worked full-time, year-round, from 9.5 percent in 2018 to 8.4 percent in 2020. However, the uninsured rate increased by 1.8 percentage points for working-age adults who worked less than full time, year-round to 16.4 percent.
Among working-age adults in 2020, those who were separated (20.2 percent), never married (16.0 percent), divorced (13.2 percent), or widowed (12.1 percent) were more likely to be uninsured than those who were married (8.5 percent)./25
Health insurance rates for working age adults also varied by region. For example, 11.3 percent of adults living in the West in 2020 were uninsured, a 0.8 percentage-point increase from 2018. There was no significant change in uninsured rates for working-age adults in other regions.
ADDITIONAL INFORMATION ABOUT HEALTH INSURANCE COVERAGE
State and Local Estimates of Health Insurance Coverage
Since the CPS ASEC produces thorough and timely estimates of income, poverty, and health insurance, the
Due to the impact of the pandemic on data collection, the standard 1-year estimates from the 2020 ACS will not be released. However, the
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[See link at end of text for Figure 7. Percentage of Working-Age Adults Without Health Insurance Coverage by Selected Characteristics: 2018 and 2020]
Note: Information on confidentiality protection, sampling error, nonsampling error, and definitions is available at <https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar21.pdf>.
Source:
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Small Area Health Insurance Estimates are available at <www.census.gov/programs-surveys/sahie.html>. The most recent estimates are for 2019.
Additional Data
The CPS ASEC is used to produce additional health insurance coverage tables. These tables are available on the
For assistance with health insurance data, contact the
Data.census.gov is the new platform to access data and digital content from the
In addition to the pretabulated detailed and historical tables available online, data users of all skill levels can create custom statistics from Public Use Microdata files using the Microdata Access Tool (MDAT) available at <https://data.census.gov /mdat>. The MDAT provides data users the ability to create customized tables using public-use data from the CPS ASEC.
Public-Use Microdata
Census Data API
The Census Data Application Programming Interface (API) gives the public access to pretabulated data from various
SOURCE AND ACCURACY OF THE ESTIMATES
The estimates in this report are from the CPS ASEC. The CPS is the longest-running survey conducted by the
The CPS ASEC collects data in February, March, and April each year, asking detailed questions categorizing income into over 50 sources. The key purpose of the CPS ASEC is to provide timely and comprehensive estimates of income, poverty, and health insurance and to measure change in these national-level estimates. The CPS ASEC is the official source of national poverty estimates calculated in accordance with the
The CPS ASEC collects data in the 50 states and the
The 2021 CPS ASEC sample consists of about 90,800 addresses. The CPS ASEC includes military personnel who live in a household with at least one other civilian adult, regardless of whether they live off post or on post. All other armed forces personnel are excluded. The estimates in this report are controlled to
The estimates in this report (which may be shown in text, figures, and tables) are based on responses from a sample of the population and may differ from actual values because of sampling variability or other factors. As a result, apparent differences between the estimates for two or more groups may not be statistically significant. All comparative statements have undergone statistical testing and are statistically significant at the 90 percent confidence level unless otherwise noted. In this report, the variances of estimates were calculated using the Successive Difference Replication (SDR) method.
Beginning with the 2011 CPS ASEC report, the standard errors and confidence intervals displayed in tables were calculated using the SDR method, unless otherwise noted. In previous years, the standard errors of CPS ASEC estimates were calculated using the generalized variance function (GVF) approach. Under this approach, generalized variance parameters were used in formulas provided in the source and accuracy statement to estimate standard errors. Further information on replicate weights, standard errors, income top-coding and data swapping on the public-use file, and changes to the CPS ASEC data file is available at <https://www2.census.gov/programs -surveys/cps/techdocs/cpsmar21.pdf>.
Comments
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View figures, tables, footnotes and report at https://www.census.gov/content/dam/Census/library/publications/2021/demo/p60-274.pdf
UPDATE: H.R.5256 – To provide for the disclosure and sharing of certain policy and claims information under the National Flood Insurance Program, and for other purposes.
County discusses health insurance costs [Gallipolis Daily Tribune, Ohio]
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