Comparison of 2017 to 2018 Changes in Insurance Coverage Across Surveys

A man waits at the reception window of a Department of Children and Family Services office.

Despite falling unemployment and a strong economy in 2017-2018, the number of uninsured people rose during the same time period.



The Issue

Using data from three federal surveys, researchers saw a decrease in unemployment and a rise in incomes during 2017 and 2018, which contributed to fewer people enrolling in Medicaid coverage.

Key Findings

This brief compares changes in health coverage between 2017 and 2018 as measured by the American Community Survey (ACS), the Current Population Survey (CPS), and the National Health Interview Survey (NHIS). Comparing across multiple surveys allows for triangulation of the likely “true” change in uninsurance, Medicaid, and private nongroup coverage between 2017 and 2018.

  • Two of the surveys indicated that insurance coverage losses were concentrated among those who were likely not eligible for Medicaid.

  • Survey data also found mixed results for private insurance coverage. Parallel to the boost in employment, the U.S. Census Bureau’s ongoing American Community Survey showed increases in employer-sponsored coverage between 2017 and 2018 and declines in private, non-group coverage.


Overall, despite a strong economy and growing labor force, uninsurance rates increased in the United States between 2017 and 2018, a consistent story across the three surveys. As the nation faces a time of economic decline due to the COVID-19 pandemic, this research is helpful to prepare for what the future holds.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.