Health insurance coverage trends, 1959-2007: estimates from the National Health Interview Survey.

OBJECTIVES This report presents long-term trends in the number and percentage of persons under age 65 years with different types of health insurance coverage and with no coverage. It documents changes in how the National Health Interview Survey (NHIS) has collected information about coverage over almost 50 years. It also compares recent trends in coverage estimates based on the NHIS and the U.S. Census Bureau's Current Population Survey (CPS). METHODS Estimates were derived from 32 years of the NHIS, from 1959 to 2007. The types of estimates available differ over these years, reflecting changes in the availability of different types of coverage and changes in the NHIS questions. Joinpoint regression was used to estimate average annual percent change over time and to identify statistically significant changes in trends. RESULTS The percentage of persons under age 65 years with private coverage rose between 1959 and 1968, to 79%, remained stable until 1980, and then declined to 67% by 2007. During the 1980s, the percentage of persons with no coverage increased, while the percentage with private coverage declined and the percentage with Medicaid remained stable. Since 1990, the percentage of nonelderly persons without coverage has remained stable, but the number has increased by more than 6 million persons, to 43.3 million in 2007. During this period, the percentage with private coverage has continued to decline, while the percentage with Medicaid has increased. Recent trends in coverage based on the NHIS and CPS are similar.