ANNUAL RWJF BRIEF • OCTOBER 2020 Comparing Federal Government Surveys That Count the Uninsured: 2020 INTRODUCTION Timely and accurate estimates of the number of people who do not have health insurance coverage are important for understanding trends in health insurance coverage and the impacts of policy changes that affect health insurance coverage. This brief provides an annual update to comparisons of uninsurance estimates from four federal surveysi: • The American Community Survey (ACS) • The Current Population Survey (CPS) • The Medical Expenditure Panel Survey – Household Component (MEPS-HC) • The National Health Interview Survey (NHIS) In this brief, we present current and historical national estimates of uninsurance along with the most recent available state- level estimates from these surveys. We also discuss the main reasons for variation in the estimates across the different surveys. National Estimates Table 1 shows the most recent available estimates of uninsurance from each of the four surveys listed above. Some of the surveys produce estimates of the number of adults who were uninsured for an entire year, while others estimate uninsurance at a specific point in time (i.e., at the time of the survey), and some collect multiple measures of uninsurance. Table 1. 2019 National Uninsurance Estimates from Four Federal Surveys: Total Population Uninsured for the Entire Year Uninsured at a Specific Point in Time Survey Time Period Number (millions) Percent of Population Number (millions) Percent of Population ACS 2019 N/A N/A 29.6 9.2 CPS 2019 26.1 8.0 N/A N/A MEPS 2018 21.2 6.5 N/A N/A NHIS 2019 20.0* 6.3* 33.2 10.3 *Because the question used to create the measure of full-year uninsurance was modified in the 2019 NHIS, caution should be used when making comparisons between the 2019 estimate of this measure and estimates of this measure from prior years. See text box on page 3 for additional details about changes to the 2019 NHIS. Sources: CPS estimates from U.S. Census Bureau, 2020, “Health Insurance Coverage in the United States: 2019”; ACS estimates for civilian noninstitutionalized population from U.S. Census Bureau, 2020, “Health Insurance Coverage in the United States: 2019”; NHIS estimates from Cohen, Cha, Martinez, & Terlizzi, 2020, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2019” and from SHADAC analysis of the 2019 NHIS Public Use Files; MEPS estimates from https://meps.ahrq.gov/ mepstrends/hc_ins/. i See Appendix for key information from each of these surveys, such as who is included in the survey, when and how the survey is conducted, response rates, and the availability of state-level insurance estimates. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 1 Comparing Federal Government Surveys that Count the Uninsured: 2020 National Trends The uninsurance estimates from the four surveys have demonstrated similar national trends over time, as shown in Figure 1. See Appendix for information on historical changes to the CPS that affect trend analyses. Figure 1. Trend in National Number of Uninsured, 2000 to 2019: All Ages ACS and NHIS point-in-time estimates of the uninsured; CPS and MEPS estimates of the full-year uninsured ACS CPS* MEPS NHIS 60 50 Number Uninsured (Millions) 40 30 20 10 0 * Dashed line “---” indicates a break in series. Sources: CPS estimates from U.S. Census Bureau, 2020, “Health Insurance Coverage in the United States: 2019”; ACS estimates for civilian noninstitutionalized population from U.S. Census Bureau, 2020, “Health Insurance Coverage in the United States: 2019;” NHIS estimates from Cohen, Cha, Martinez, & Terlizzi, 2020, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2019”; MEPS estimates from https://meps.ahrq.gov/mepstrends/hc_ins/. Due to COVID-19-Related Declines in 2020 CPS ASEC Response Rates, Use Caution When Examining 2018-2019 Coverage Changes in the CPS Due to the COVID-19 pandemic, the U.S. Census Bureau modified its data collection methods for the 2020 CPS Annual Social and Economic Supplement (ASEC), from which estimates of health insurance coverage for 2019 are generated. Due to the suspension of in-person and computer-assisted telephone interview (CATI) data collection and a complete shift to telephone- based interviewing, the response rate for the ASEC in March 2020 was about 10 percentage points lower than in preceding months and during the same period in 2019, and response rates for households that were normally more likely to be interviewed in person were especially low. At this point, it is not possible to disentangle real changes in health insurance coverage between 2018 and 2019 from changes due to pandemic-related data collection adaptations. Findings from Census Bureau analyses suggest that estimates of year- over-year changes in coverage from 2018 to 2019 using the CPS should be utilized with caution, and data users should bear in mind the context of the pandemic when interpreting these changes. For example, as shown in Figure 1, 2019 is the first instance in recent years where the CPS has shown a decrease in uninsurance and the ACS and NHIS have shown increases in uninsurance.1,2 STATE HEALTH ACCESS DATA ASSISTANCE CENTER 2 Comparing Federal Government Surveys that Count the Uninsured: 2020 State-Level Estimates Until 2019, the NHIS produced partial state-level The ACS and CPS are designed to produce uninsurance estimates for all 50 uninsurance estimates consistently. However, states and the District of Columbia. No state-level estimates of uninsurance state estimates are no longer available due to are currently published from the NHIS or MEPS-HC. reductions in the NHIS sample size. Table 2 presents the most recent state-level estimates of uninsurance from the ACS and CPS. As with the national estimates, the estimated level of uninsurance for states varies across the two surveys; however, general patterns are consistent, insofar as states with low uninsurance levels typically have low levels in both surveys, and states with high levels of uninsurance have high levels both surveys, etc. Table 2. 2019 State-Level Uninsured Rates from Three Federal Surveys: Total Population ACS CPS ACS CPS (Point-in-Time) (Full Year) (Point-in-Time) (Full Year) United States 9.2 8.0 Missouri 10.0 8.5 Alabama 9.7 7.5 Montana 8.3 7.5 Alaska 12.2 12.9 Nebraska 8.3 8.3 Arizona 11.3 10.8 Nevada 11.4 9.9 Arkansas 9.1 6.9 New Hampshire 6.3 4.9 California 7.7 7.0 New Jersey 7.9 6.4 Colorado 8.0 8.6 New Mexico 10.0 8.9 Connecticut 5.9 2.8 New York 5.2 4.8 Delaware 6.6 5.1 North Carolina 11.3 11.1 Dist. of Columbia 3.5 2.9 North Dakota 6.9 5.7 Florida 13.2 13.3 Ohio 6.6 6.0 Georgia 13.4 11.9 Oklahoma 14.3 14.4 Hawaii 4.2 2.4 Oregon 7.2 5.2 Idaho 10.8 9.8 Pennsylvania 5.8 5.3 Illinois 7.4 5.5 Rhode Island 4.1 3.6 Indiana 8.7 5.4 South Carolina 10.8 7.2 Iowa 5.0 5.5 South Dakota 10.2 8.6 Kansas 9.2 7.9 Tennessee 10.1 7.3 Kentucky 6.4 6.4 Texas 18.4 15.7 Louisiana 8.9 7.7 Utah 9.7 9.5 Maine 8.0 4.9 Vermont 4.5 3.3 Maryland 6.0 5.4 Virginia 7.9 6.2 Massachusetts 3.0 2.6 Washington 6.6 6.2 Michigan 5.8 4.2 West Virginia 6.7 4.5 Minnesota 4.9 4.3 Wisconsin 5.7 4.7 Mississippi 13.0 12.0 Wyoming 12.3 8.7 Sources: ACS estimates for civilian noninstitutionalized population from U.S. Census Bureau, 2020, “Health Insurance Coverage in the United States: 2019”; CPS estimates from Flood, S., King, M., Rodgers, R., Ruggles, S., & Warren, J.R, 2018, Integrated Public Use Microdata Series, Current Population Survey: Version 6.0 [IPUMS dataset]. Accessed September 29, 2020. Available at https://doi.org/10.18128/D030.V6.0. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 3 Comparing Federal Government Surveys that Count the Uninsured: 2020 Factors Contributing to Differences in Survey Estimates There are many reasons why health insurance estimates vary across surveys. The surveys are designed to fulfill different goals, and they use different questions, statistical designs, and data collection and processing methods. Each of these factors likely contributes to differences in uninsurance estimates. The following section articulates specific differences between the surveys that are included in this brief. Conceptual differences in measures of uninsurance As noted earlier, some surveys collect information about whether a person lacked health insurance coverage for a full year, while others collect information on insurance status at a particular point in time, and some collect multiple measures. Reference period Differences in the time period for which coverage is being reported contribute to differences in the survey estimates. Differences in the length of time for which respondents are being asked to recall their insurance coverage status can also result in differences in measurement error across the surveys.3,4,5,6,7,8 The CPS Annual Social and Economic Supplement (CPS ASEC), conducted in February through April each year, has historically asked respondents about their health insurance coverage during the entire previous calendar year, with respondents being asked to report their coverage for a time period as long as 16 months prior to the interview. For their measures of coverage during the prior year, NHIS and MEPS have shorter recall periods than the CPS. The ACS collects information about current coverage only. Differences in survey questions Differences in the ways that health insurance questions are asked can also lead to differences in uninsurance estimates. For example, when the Census Bureau added a verification question to the CPS in 2000 that asked people who did not report any coverage if they were in fact uninsured for all of 1999, the estimated number of people without health insurance declined by 8 percent, from 42.6 million to 39.3 million.9 The NHIS and MEPS also verify insurance status for people who do not report any of the specific types of coverage that the survey asks about, but the ACS does not. Another difference in survey questions that can lead to different estimates across surveys is the fact that the CPS, NHIS, and MEPS use state-specific names for Medicaid and Children’s Health Insurance Program (CHIP) programs while the ACS does not, instead referring to these programs as Medicaid, Medical Assistance, or any kind of government-assistance program for those with low incomes or a disability. Missing data and imputation The CPS and ACS surveys have processes in place to manage missing data and impute missing values. In the CPS supplement that includes the health insurance questions, about 39 percent of households did not answer any questions in the 2020 survey, and this nonresponse was corrected by the Census Bureau using survey weights.10 Similarly, in the 2019 ACS about 16 percent of responses had one or more of the health insurance items missing; these missing data were imputed by the Census Bureau.11 In contrast, the NHIS and MEPS impute little or no health insurance coverage information because the data for these two surveys are much more complete than either the CPS or ACS data. Deciding Which Survey Estimates to Use Health policy analysts must decide which estimates to use among the multiple options available. No single survey provides the “best” estimates overall; rather, the most appropriate estimates will depend on the specific policy or research question being examined. The timeliness of the estimates, the geographies for which estimates are available, and the demographic or socioeconomic characteristics that are included in the estimates—along with the other factors described above—are among key considerations when choosing which estimates to use. For example, those interested in a “first look” at new health insurance coverage estimates will want to use the NHIS, since the NHIS estimates are released before the ACS and CPS estimates. If, on the other hand, sub-state estimates are of interest, the ACS will be the best source due to its large sample size, which allows for sub-state analyses. Every research question will require a consideration of survey characteristics in relation to analytic requirements. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 4 Comparing Federal Government Surveys that Count the Uninsured: 2020 CONCLUSION Federal surveys are essential resources for estimating the number of uninsured. Each survey provides a unique view of the problem of uninsurance, and together the surveys provide a wealth of information about how uninsurance varies by population characteristics and how it is associated with differences in access to and use of health care services and with health status. Suggested Citation Au-Yeung, C., & Hest, R. (2020). “Comparing Federal Government Surveys That Count the Uninsured: 2020.” Annual Robert Wood Johnson Foundation Brief. Minneapolis, MN: State Health Access Data Assistance Center. About SHADAC SHADAC is a multidisciplinary health policy research center with a focus on state policy. For over 15 years, SHADAC has produced rigorous, policy-driven analyses, translating complex research findings into actionable information that is accessible to a broad audience. SHADAC faculty and staff are nationally recognized experts on collecting and applying health policy data to inform and evaluate policy decisions, with expertise in both federal and state survey data sources. We provide unbiased technical assistance and in-depth analysis to states and other organizations and collaborate with a wide range of partners including foundations, state and federal agencies, academic institutions, other research organizations, and nonprofits. SHADAC is affiliated with the University of Minnesota, School of Public Health. Learn more at www.shadac.org or contact us at shadac@umn.edu. Support for this brief was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. References 1 Rothbaum, J. (2020, September 15). How Does the Pandemic Affect Survey Response: Using Administrative Data to Evaluate Nonresponse in the Current Population Survey annual Social and Economic Supplement [Blog post]. U.S. Census Bureau Research Matters. Retrieved from https://www.census.gov/newsroom/blogs/research-matters/2020/09/pandemic-affect-survey-response.html 2 Berchick, E.R., Mykyta, L., Stern, S.M. (2020). The Influence of COVID-19-Related Data Collection Changes on Measuring Health Insurance Cover- age in the 2020 CPS ASEC [SEHSD Working Paper 2020-13]. Retrieved from https://www.census.gov/content/dam/Census/library/working-pa- pers/2020/demo/sehsd-wp2020-13.pdf 3 Boudreaux, M., Noon, J.M., Fried, B., & Pascale, J. (2019, October 10). Medicaid expansion and the Medicaid undercount in the American Community Survey. Health Services Research, 54(6), 1263-1272. doi: 10.1111/1475-6773.13213 4 Noon, J.M., Fernandez, L.E., & Porter, S.R. (2019). Response error and the Medicaid undercount in the Current Population Survey. Health Services Research, 54(1), 34-43. doi: 10.1111/1475-6773.13058 5 Pascale, J., Fertig, A., & Call, K. (2019). Validation of two federal health insurance survey modules after Affordable Care Act implementation. Journal of Official Statistics, 35(2), 409-460. doi: 10.2478/jos-2019-0019 6 Sudman, S., Bradburn, N. & Schwarz, S. (1996). Thinking about answers: The application of cognitive processes to survey methodology. San Francisco, C.A.: Jossey-Bass. 7 Bhandari, S. (2004). People with health insurance: A comparison of estimates from two surveys [SIPP-WP-243]. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2004/demo/SEHSD-2004-02.pdf 8 Lewis, K., Elwood, M.R., & Czajka, J. (1998). Counting the uninsured: A review of the literature [Occasional Paper-8]. Retrieved from https://www.urban.org/sites/default/files/publication/70636/308032-Counting-the-Uninsured.PDF 9 Nelson, C.T. & Mills, R.J. (2001). The March CPS health insurance verification question and its effect on estimates of the uninsured. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2001/demo/cps-asec-health-insurance-verification-question.pdf 10 U.S. Census Bureau. (2020). Current Population Survey: 2020 Annual Social and Economic (ASEC) Supplement. Retrieved from https://www2.census.gov/programs-surveys/cps/techdocs/cpsmar20.pdf 11 U.S. Census Bureau. (2019). American Community Survey 1-Year Estimates, Table B992701: Allocation of Health Insurance Coverage [Data set]. Accessed September 29, 2020. Available at https://data.census.gov/cedsci/table?q=ACSDT1Y2019.B992701&tid=ACSDT1Y2019.B992701 STATE HEALTH ACCESS DATA ASSISTANCE CENTER 5 Comparing Federal Government Surveys that Count the Uninsured: 2020 APPENDIX Table A1. Comparison of Federal Surveys Used to Estimate Uninsurance ACS CPS MEPS-HC NHIS Sponsor(s) Census Bureau Bureau of Labor Statistics, U.S. Agency for Healthcare National Center for Health Dept. of Labor (conducted by Research & Quality Statistics, Centers for Disease Census Bureau) (conducted by Census Control and Prevention Bureau) Primary Focus General household survey; Labor force participation and Health care access, Population health replaced decennial census unemployment utilization, and cost long form Target Population Entire population Civilian non- institutionalized Civilian non- institutionalized Civilian non- institutionalized population population population Sample Frame Address-based (National Address-based (Census 2010 NHIS respondents Commercial address list Master Address File) sampling frame updated with new construction) Data Collection Mode Mail; in-person; phone; In-person; phone In-person In-person internet Type of Uninsurance Point-in-time All of prior calendar year: Point-in-time; all of prior Point-in-time; all of prior year; Measures point-in-time year; if uninsured, length of if uninsured, length of time (added in 2014) time uninsured; uninsured at uninsured; uninsured at some some point in the past year point in the past year Health Insurance Coverage: Verification Question for No Yes Yes Yes Uninsured State-Specific Names No Yes Yes Yes Included for Medicaid/CHIP Response Rate 86.0% (2019) 61.1% (2019) 46.8% (2018) 61.1% (2019) Survey Period Monthly February through April Panel over two calendar Continuous years State Health Insurance 50 states and D.C. 50 states and D.C. Not published Not published Estimates Years Available 2008 - 2019 1987 - 2019 (and limited point- 1996 - 2018 1998 - 2019 in-time estimates for 2020) Sources: U.S. Census Bureau. (2020). American Community Survey: Response Rates [Data set]. Available at https://www.census.gov/acs/www/methodology/sample-size-and- data-quality/response-rates/; U.S. Census Bureau. (2020). Current Population Survey: 2020 Annual Social and Economic (ASEC) Supplement. Retrieved from https://www2.census.gov/ programs-surveys/cps/techdocs/cpsmar20.pdf; Agency for Healthcare Research and Quality (AHRQ). (2020). MEPS-HC Response Rates by Panel [Data set]. Available at https:// meps.ahrq.gov/survey_comp/hc_response_rate.jsp; National Center for Health Statistics (NCHS). (2020). National Health Interview Survey: 2019 Survey Description. Retrieved from ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2019/srvydesc-508.pdf Within-survey Changes over Time: Questions & Methodology In the same way that estimates across different surveys may not be comparable, estimates within the same survey may not always be comparable over time. This incomparability can be due to changes in survey questions and/or changes in survey methodology. Changes in the CPS In 2014, the CPS incorporated a revised set of survey questions designed to improve the accuracy of its uninsurance estimates, which researchers have suggested more closely resembled a point-in-time measure than a measure of insurance coverage during the previous year (as was intended).i,ii,iii Because of these revisions, CPS data from 2013 and onward are not comparable to data from 2012 and earlier. Data year 2018 represents another break in series for the CPS, as the CPS file for 2018 is the first official file to feature a new processing system that fully incorporates the information contained in the 2014 survey redesign.iv,v The updated data processing system uses a new method of estimating health insurance coverage and refines the ways in which respondents’ demographic, income, and health insurance data are cleaned, imputed, and weighted. With these new processing mechanisms in place, CPS data from 2018 and onward are not comparable to previous data years. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 6 Comparing Federal Government Surveys that Count the Uninsured: 2020 Changes in the NHIS In 2019, the content and structure of the NHIS were updated in order to improve the measurement of health topics, reduce respondent burden by shortening the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.vi Although the 2019 changes do not constitute an official break in series, the National Center for Health Statistics (NCHS) notes that any differences observed between estimates for 2018 and 2019 may be due either to real change in the population or partly attributable to the 2019 NHIS questionnaire redesign and/or the updated weighting approach.vii Table A2. National Uninsurance Estimates from Four Federal Surveys: Nonelderly Adults (Age 18-64) Uninsured for the Entire Year Uninsured at a Specific Point in Time Survey Time Period Number (millions) Percent of Population Number (millions) Percent of Population ACS (ages 19-64) 2019 N/A N/A 24.9 12.9 CPS 2019 21.5 11.1 N/A N/A MEPS 2018 19.1 9.7 N/A N/A NHIS 2018 18.1 9.3 26.3 13.3 * Because the question used to create the measure of full-year uninsurance was modified in the 2019 NHIS, caution should be used when making comparisons between the 2019 estimate of this measure and estimates of this measure from prior years. See text box on page 3 for additional details about changes to the 2019 NHIS. Sources: CPS estimates from Flood, S., King, M., Rodgers, R., Ruggles, S., & Warren, J.R, 2018, Integrated Public Use Microdata Series, Current Population Survey: Version 6.0 [IPUMS dataset]. Accessed September 29, 2020. Available at https://doi.org/10.18128/D030.V6.0; ACS estimates for civilian noninstitutionalized population from U.S. Census Bureau, 2020, American Community Survey Tables for Health Insurance Coverage: Table HI-05 Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2019; Cohen, Cha, Martinez, & Terlizzi, 2020, “Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2019” and from SHADAC analysis of the 2019 NHIS Public Use Files; MEPS estimates from https://meps.ahrq.gov/mepstrends/hc_ins/. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 7 Comparing Federal Government Surveys that Count the Uninsured: 2020 Table A3. 2019 State-Level Uninsured Rates from Two Federal Surveys: Nonelderly Adults ACS CPS ACS CPS Age 19-64 Age 18-64 Age 19-64 Age 18-64 (Point-in-Time) (Full Year) (Point-in-Time) (Full Year) United States 12.9 11.1 Missouri 14.2 11.9 Alabama 15.0 11.3 Montana 11.8 10.9 Alaska 15.8 17.7 Nebraska 11.7 11.5 Arizona 15.4 14.3 Nevada 15.5 12.7 Arkansas 13.1 9.6 New Hampshire 8.9 6.7 California 10.9 9.8 New Jersey 11.1 9.0 Colorado 10.7 11.3 New Mexico 14.6 12.8 Connecticut 8.3 4.0 New York 7.5 7.2 Delaware 9.3 6.3 North Carolina 16.4 16.1 Dist. of Columbia 4.4 3.4 North Dakota 8.2 7.2 Florida 19.5 18.4 Ohio 9.1 8.5 Georgia 18.9 16.7 Oklahoma 20.5 21.5 Hawaii 5.9 3.2 Oregon 10.3 8.1 Idaho 16.5 14.2 Pennsylvania 7.9 7.4 Illinois 10.5 7.7 Rhode Island 5.9 4.9 Indiana 11.6 7.6 South Carolina 16.1 10.7 Iowa 7.3 7.3 South Dakota 14.2 11.4 Kansas 13.1 11.2 Tennessee 14.9 10.2 Kentucky 9.1 8.1 Texas 24.5 20.3 Louisiana 13.1 11.0 Utah 12.1 12.1 Maine 11.6 6.9 Vermont 6.7 4.5 Maryland 8.3 6.2 Virginia 11.0 8.6 Massachusetts 4.2 3.8 Washington 9.5 8.6 Michigan 8.3 5.4 West Virginia 10.0 7.4 Minnesota 6.9 5.8 Wisconsin 8.1 5.6 Mississippi 19.5 18.4 Wyoming 16.6 12.8 Sources: ACS estimates for civilian noninstitutionalized population from U.S. Census Bureau, 2020,American Community Survey Tables for Health Insurance Coverage: Table HI-05 Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2019; CPS estimates from Flood, S., King, M., Rodgers, R., Ruggles, S., & Warren, J.R, 2018, Integrated Public Use Microdata Series, Current Population Survey: Version 6.0 [IPUMS dataset]. Accessed September 29, 2020. Available at https://doi.org/10.18128/D030.V6.0. STATE HEALTH ACCESS DATA ASSISTANCE CENTER 8 Comparing Federal Government Surveys that Count the Uninsured: 2020 APPENDIX REFERENCES i Turner, J., & Boudreaux, M. (2014). An introduction to redesigned health insurance coverage questions in the 2014 CPS [Issue brief #39; PDF file]. Retrieved from http://www.shadac.org/publications/cpsbrief ii Planalp, C., Sonier, J., & Turner, J. (2014). Using recent revisions to federal surveys for measuring the effects of the Affordable Care Act [Issue brief #41; PDF file]. Retrieved from http://www.shadac.org/publications/using-recent-revisions-federal-surveys-measuring-effects-af- fordable-care-act iii Davern, M., Davidson, G., Ziegenfuss, J., et al. (2007). A comparison of the health insurance coverage estimates from four national surveys and six state surveys: A discussion of measurement issues and policy implications [Final report, Task 7.2]. Retrieved from https://www.shadac.org/ sites/default/files/Old_files/shadac/publications/ASPE_FinalRpt_Dec2007_Task7_2_rev.pdf iv Berchick, E.R., & Jackson, H.M. (2019). Health insurance coverage in the 2017 CPS ASEC research file [SEHSD Working Paper 2019-01]. Re- trieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-01.pdf v Berchick, E.R., & Jackson, H.M. (2019). Health insurance coverage in the Current Population Survey: Estimates from the 2017 research file [SEHSD Working Paper 2019-2]. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/se- hsd-wp2019-02.pdf vi Cohen, R.A., Cha, A.E., Martinez, M., & Terlizzi, E.P. (2020). Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2019. National Center for Health Statistics National Health Interview Survey Early Release Program. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202009-508.pdf vii National Center for Health Statistics (NCHS). (2020). Preliminary Evaluation of the Impact of the 2019 NHIS Questionnaire Redesign and Weighting Adjustments on Early Release Program Estimates. Retrieved from https://www.cdc.gov/nchs/data/nhis/earlyrelease/ EReval202009-508.pdf STATE HEALTH ACCESS DATA ASSISTANCE CENTER 9 Comparing Federal Government Surveys that Count the Uninsured: 2020 STATE HEALTH ACCESS DATA ASSISTANCE CENTER 10