Data Dictionary: ACS 2009 (1-Year Estimates)
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Data Source: U.S. Census Bureau
Table: B27020. Health Insurance Coverage Status And Type By Citizenship Status [17]
Universe: Civilian noninstitutionalized population
Table Details
B27020. Health Insurance Coverage Status And Type By Citizenship Status
Universe: Civilian noninstitutionalized population
Relevant Documentation:
Excerpt from: Social Explorer; U.S. Census Bureau; American Community Survey 2009 Summary File: Technical Documentation.
 
Health Insurance Coverage
In 2009, data on health insurance coverage were derived from answers to Question 16, which was asked of all respondents. Respondents were instructed to report their current coverage and to mark "yes" or "no" for each of the eight types listed (labeled as parts 16a to 16h).

  1. Insurance through a current or former employer or union (of this person or another family member)
  2. Insurance purchased directly from an insurance company (by this person or another family member)
  3. Medicare, for people 65 and older, or people with certain disabilities
  4. Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
  5. TRICARE or other military health care
  6. VA (including those who have ever used or enrolled for VA health care)
  7. Indian Health Service
  8. Any other type of health insurance or health coverage plan


Respondents who answered "yes" to question 16h were asked to provide their other type of coverage type in a write-in field.

Health insurance coverage in the ACS and other Census Bureau surveys define coverage to include plans and programs that provide comprehensive health coverage. Plans that provide insurance for specific conditions or situations such as cancer and long-term care policies are not considered coverage. Likewise, other types of insurance like dental, vision, life, and disability insurance are not considered health insurance coverage.

In defining types of coverage, write-in responses were reclassified into one of the first seven types of coverage or determined not to be a coverage type. Write-in responses that referenced the coverage of a family member were edited to assign coverage based on responses from other family members. As a result, only the first seven types of health coverage are included in the microdata file.

An eligibility edit was applied to give Medicaid, Medicare, and TRICARE coverage to individuals based on program eligibility rules. TRICARE or other military health care was given to active-duty military personnel and their spouses and children. Medicaid or other means-tested public coverage was given to foster children, certain individuals receiving Supplementary Security Income or Public Assistance, and the spouses and children of certain Medicaid beneficiaries. Medicare coverage was given to people 65 and older who received Social Security or Medicaid benefits.

People were considered insured if they reported at least one "yes" to Questions 16a to 16f. People who had no reported health coverage, or those whose only health coverage was Indian Health Service, were considered uninsured. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private health insurance or public coverage. Private health insurance is a plan provided through an employer or union, a plan purchased by an individual from a private company, or TRICARE or other military health care. Respondents reporting a "yes" to the types listed in parts a, b, or e were considered to have private health insurance. Public health coverage includes the federal programs Medicare, Medicaid, and VA Health Care (provided through the Department of Veterans Affairs); the Childrens Health Insurance Program (CHIP); and individual state health plans. Respondents reporting a "yes" to the types listed in c, d, or f were considered to have public coverage. The types of health insurance are not mutually exclusive; people may be covered by more than one at the same time.

The U.S. Department of Health and Human Services, as well as other federal agencies, use data on health insurance coverage to more accurately distribute resources and better understand state and local health insurance needs.

Question/Concept History
The ACS began asking questions about health insurance coverage in 2008. Because 2008 was the first year of collection, the Census Bureau limited the number and type of data products to simple age breakdowns of overall, private, and public coverage status. The evaluation of the 2008 data suggested that the data were of good quality, so the Census Bureau expanded the data products to include estimates of the specific types of coverage along with estimates about social, economic, and demographic details for people with and without health insurance.

For the 2008 data released September 2009, there was no eligibility edit applied. The eligibility edit that was developed for the 2009 was applied to the 2008 data during spring 2010. New estimates of health insurance coverage with this data are available at http://www.census.gov/hhes/www/hlthins/hlthins.html.

Limitation of the Data
The universe for most health insurance coverage estimates is the civilian noninstitutionalized population, which excludes active-duty military personnel and the population living in correctional facilities and nursing homes. Some noninstitutionalized GQ populations have health insurance coverage distributions that are different from the household population (e.g., the prevalence of private health insurance among residents of college dormitories is higher than the household population). The proportion of the universe that is in the noninstitutionalized GQ populations could therefore have a noticeable impact on estimates of the health insurance coverage. Institutionalized GQ populations may also have health insurance coverage distributions that are different from the civilian noninstitutionalized population, the distributions in the published tables may differ slightly from how they would look if the total population were represented.

Comparability
Health insurance coverage was added to the 2008 ACS and so no equivalent measure is available from previous ACS surveys or Census 2000. Because of the addition of the eligibility edit to 2009 ACS health insurance, data users should be careful as to which 2008 ACS estimates they use to make comparisons. National, state, county and place-level 2008 1-year data incorporating the eligibility edit are available at http://www.census.gov/hhes/www/hlthins/data/acs/2008/re-run.html; they are comparable to the 2009 estimates in American Fact Finder. For more information on the logical coverage (eligibility) edits, please see http://www.census.gov/hhes/www/hlthins/publications/coverage_edits_final.pdf.

Because coverage in the ACS references an individual's current status, caution should be taken when making comparisons to other surveys which may define coverage as "at any time in the last year" or "throughout the past year." A discussion of how the ACS health insurance estimates relate to other survey health insurance estimates can be found in "A Preliminary Evaluation of Health Insurance Coverage" in the 2008 American Community Survey (http://www.census.gov/hhes/www/hlthins/acs08paper/2008ACS_healthins.pdf).

Citizenship Status (U.S. Citizenship Status)
The data on citizenship status were derived from answers to Question 8. This question was asked about person's 1 through 5 in the ACS.

Respondents were asked to select one of five categories: (1) born in the United States, (2) born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern Marianas, (3) born abroad of U.S. citizen parent or parents, (4) U.S. citizen by naturalization, or (5) not a U.S citizen. Respondents indicating they are a U.S. citizen by naturalization are also asked to print their year of naturalization. People born in American Samoa, although not explicitly listed, are included in the second response category.

For the Puerto Rico Community Survey, respondents were asked to select one of five categories: (1) born in Puerto Rico, (2) born in a U.S. state, District of Columbia, Guam, the U.S. Virgin Islands, or Northern Marianas, (3) born abroad of U.S. citizen parent or parents, (4) U.S. citizen by naturalization, or (5) not a U.S. citizen. Respondents indicating they are a U.S. citizen by naturalization are also asked to print their year of naturalization. People born in American Samoa, although not explicitly listed, are included in the second response category.

When no information on citizenship status was reported for a person, information for other household members, if available, was used to assign a citizenship status to the respondent. All cases of nonresponse that were not assigned a citizenship status based on information from other household members were allocated the citizenship status of another person with similar characteristics who provided complete information. In cases of conflicting responses, place of birth information is used to edit citizenship status. For example, if a respondent states he or she was born in Puerto Rico but was not a U.S. citizen, the edits use the response to the place of birth question to change the respondents status to "U.S. citizen at birth."

U.S. Citizen
Respondents who indicated that they were born in the United States, Puerto Rico, a U.S. Island Area (such as Guam), or abroad of American (U.S. citizen) parent or parents are considered U.S. citizens at birth. Foreign-born people who indicated that they were U.S. citizens through naturalization also are considered U.S. citizens.

Not a U.S. Citizen
Respondents who indicated that they were not U.S. citizens at the time of the survey.

Native
The native population includes anyone who was a U.S. citizen or a U.S. national at birth. This includes respondents who indicated they were born in the United States, Puerto Rico, a U.S. Island Area (such as Guam), or abroad of American (U.S. citizen) parent or parents.

Foreign born
The foreign-born population includes anyone who was not a U.S. citizen or a U.S. national at birth. This includes respondents who indicated they were a U.S. citizen by naturalization or not a U.S. citizen. The American Community Survey questionnaires do not ask about immigration status. The population surveyed includes all people who indicated that the United States was their usual place of residence on the survey date. The foreign-born population includes naturalized U.S. citizens, lawful permanent residents (i.e. immigrants), temporary migrants (e.g., foreign students), humanitarian migrants (e.g., refugees), and unauthorized migrants (i.e. people illegally present in the United States). The responses to this question are used to determine the U.S. citizen and non-U.S. citizen populations as well as to determine the native and foreign-born populations.

Question/Concept History
In the 1996-1998 American Community Survey, the third response category was "Yes, born abroad of American parent(s)." However, since 1999 in the American Community Survey and since the 2005 Puerto Rico Community Survey, the response category was "Yes, born abroad of American parent or parents." In 2008, respondents who indicated that they were a U.S. citizen by naturalization were also asked to print their year of naturalization. Also in 2008, modifications in wording were made to both the third response category (changed from "Yes, born abroad of American parent or parents" to "Yes, born abroad of U.S. citizen parent or parents") and the fifth response category (changed from "No, not a citizen of the United States" to "No, not a U.S. citizen").

Limitation of the Data
Beginning in 2006, the population in group quarters (GQ) is included in the ACS. Some types of GQ populations may have citizenship status distributions that are different from the household population. The inclusion of the GQ population could therefore have a noticeable impact on the citizenship status distribution. This is particularly true for areas with substantial GQ populations.

Comparability
Citizenship can be compared both across ACS years and to Census 2000 data.