U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief ■ No. 249 ■ May 2016

Health Insurance Continuity and Health Care Access and 

Utilization, 2014

Maria A. Villarroel, Ph.D. and Robin A. Cohen, Ph.D.

Key findings 

Data from the National 

Health Interview Survey

● During 2014, 78.1% of 

adults aged 18–64 were insured 

at the time of interview and had 

been insured for more than a 

year.

● About 6.4% of adults 

were insured at the time of 

interview but had a period of no 

insurance in the past year. 

● About 12.3% of adults 

were uninsured at the time 

of interview and had been 

uninsured for more than a year, 

and 3.2% were uninsured at 

the time of interview but had a 

period of insurance coverage in 

the past year.

● Those insured at the time of 

interview and insured for more 

than a year were more likely 

than those with any period of 

no insurance to have a usual 

place of care, visited a health 

care provider, received a flu 

vaccine, and were less likely 

to have had an unmet medical 

need due to cost. 

Between 2013 and 2014, almost 8 million adults aged 18–64 gained health 

care coverage, although 44 million adults were uninsured for at least part 

of the past year in 2014 (1). Having health insurance may facilitate the use 

of health services (2). Some studies of young adults who gained dependent 

coverage as a result of the Affordable Care Act found increases in having 

a primary care doctor and decreases in forgone care (3,4). However, other 

studies found no impact on visits to outpatient care facilities, primary care 

physicians, or emergency departments (5). This report explores access to and 

utilization of care among adults aged 18–64 according to health insurance 

status at the time of interview and during the preceding year. 

Keywords: medical care • unmet medical needs • health care coverage • 

National Health Interview Survey

About 8 out of 10 adults aged 18–64 had health insurance 

coverage for more than a year. 

Figure 1. Percent distribution of adults aged 18–64 according to health insurance coverage status 

at the time of interview and during the preceding year, by age group: United States, 2014 

1

Significantly different from those aged 45–64 for all coverage statuses (p < 0.05).

NOTES: “Insured for more than a year” includes adults who were insured at the time of interview and had been insured for more 

than a year. “Insured for a year or less” includes adults who were insured at the time of interview but had a period of no insurance 

in the past year. “Uninsured for a year or less” includes adults who were uninsured at the time of interview but had a period of 

insurance in the past year. “Uninsured for more than a year” includes adults who were uninsured at the time of interview and had 

been uninsured for more than a year. Access data table for Figure 1 at: 

http://www.cdc.gov/nchs/data/databriefs/db249_table.pdf#1.

SOURCE: NCHS, National Health Interview Survey, 2014, Family Core component.
NCHS Data Brief ■ No. 249 ■ May 2016

■  2  ■

● During 2014, 78.1% of adults aged 18–64 were insured at the time of interview and had 

been insured for more than a year, while 6.4% were insured at the time of interview but had 

a period of no insurance in the past year, 3.2% were uninsured at the time of interview but 

had a period of insurance coverage in the past year, and 12.3% were uninsured at the time of 

interview and had been uninsured for more than a year (Figure 1). 

● Adults aged 18–44 were more likely than those aged 45–64 to be insured at the time of 

interview but to have had a period of no insurance in the past year (7.3% compared with 

5.1%), to be uninsured at the time of interview but to have had a period of insurance in the 

past year (4.2% compared with 1.8%), and to have been uninsured for more than a year 

(14.6% compared with 9.3%). 

Adults with health insurance coverage for more than a year were more 

likely to have a usual place for medical care than those with any period of 

noncoverage. 

● More than 8 in 10 adults aged 18–64 (82.8%) had a usual place for medical care (Figure 2). 

● The percentage of adults aged 18–64 who had a usual place for medical care was higher 

among those insured for more than a year (90.8%) compared with those insured at the time 

of interview but had a period of no insurance in the past year (73.6%), those uninsured at the 

time of interview but had a period of insurance in the past year (57.8%), and those uninsured 

for more than a year (44.3%). 

Figure 2. Percentage of adults aged 18–64 with a usual place for medical care according to health insurance coverage

status at the time of interview and during the preceding year, by age group: United States, 2014 

1

Significantly different from those who were insured for a year or less, uninsured for a year or less, or uninsured for more than a year (p < 0.05). 2

Significantly different from those who were uninsured for a year or less or uninsured for more than a year (p < 0.05). 3

Significantly different from those who were uninsured for more than a year (p < 0.05). 4

Significantly different from those aged 45–64 for total and within each coverage status (p < 0.05).

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db249_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2014, Family Core and Sample Adult components.
NCHS Data Brief ■ No. 249 ■ May 2016

■  3  ■

● Adults who were insured at the time of interview but had a period of no insurance in the past 

year were more likely to have a usual place for medical care than those uninsured at the time 

of interview but had a period of insurance in the past year or those uninsured for more than 

a year.

● Adults who were uninsured at the time of interview but had a period of insurance in the past 

year were more likely to have a usual place for medical care than those who were uninsured 

for more than a year.

● Among adults with the same health insurance coverage status, those aged 45–64 were more 

likely than those aged 18–44 to have a usual place for medical care. 

Adults insured for more than a year were more likely to have visited a 

doctor or other health care professional during the past year than those 

with any period of noncoverage. 

● Nearly 8 in 10 adults (79.0%) visited a doctor or other health care professional about their 

health at least once in the past year (Figure 3). 

● The percentage who visited a doctor or health care provider during the past year was higher 

among those insured for more than a year (84.9%) compared with those insured at the time 

of interview but had a period of no insurance in the past year (77.0%), those uninsured at the 

time of interview but had a period of insurance coverage in the past year (66.8%), and those 

uninsured for more than a year (46.6%). 

● Among adults aged 18–44, the percentage who visited a doctor or health care provider 

during the past year differed by duration of health insurance status. Among adults aged

45–64, those who were insured for more than a year (88.7%) were more likely to have 

Figure 3. Percentage of adults aged 18–64 who visited a doctor or other health care professional about their own health at

least once in the past year according to health insurance coverage status at the time of interview and during the preceding 

year, by age group: United States, 2014 

1

Significantly different from those who were insured for a year or less, uninsured for a year or less, or uninsured for more than a year (p < 0.05). 2

Significantly different from those who were uninsured for a year or less or uninsured for more than a year (p < 0.05). 3

Significantly different from those who were uninsured for more than a year (p < 0.05). 4

Significantly different from those aged 45–64 for total, insured for more than a year, uninsured for a year or less, and uninsured for more than a year (p < 0.05).

NOTE: Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db249_table.pdf#3.

SOURCE: NCHS, National Health Interview Survey, 2014, Family Core and Sample Adult components.
NCHS Data Brief ■ No. 249 ■ May 2016

■  4  ■

visited a doctor or health care professional in the past year than those with any period 

of noncoverage in the past year. Those insured for a year or less (78.5%) and those 

uninsured for a year or less (73.9%) were more likely to have visited a doctor or health care 

professional than those uninsured for more than a year (53.3%).

● Except for those insured at the time of interview but had a period of no insurance in the past 

year, those aged 45–64 were more likely than those aged 18–44 of the same insurance status 

to have visited a doctor or health care provider in the past year. 

Adults with any period without health insurance in the past year were 

more likely to have had an unmet medical need due to cost than those with 

coverage for more than a year. 

● One in five adults aged 18–64 (22.2%) had an unmet medical need due to cost in the past 

year (Figure 4). 

● About 14% of adults aged 18–64 who were insured for more than a year had an unmet 

medical need due to cost in the past year, while three times as many of those with any 

duration of noncoverage in the past year had an unmet need: 48.7% of those insured at the 

time of interview but had a period of no insurance in the past year, 49.6% of those uninsured 

at the time of interview but had a period of insurance in the past year, and 48.8% of those 

uninsured for more than a year.

● Among adults of the same insurance status, those aged 45–64 were more likely than those 

aged 18–44 to have an unmet medical need due to cost in the past year: 16.3% compared 

with 12.8% among those who were insured for more than a year, 57.0% compared with 

44.4% among those who were insured at the time of the interview but had a period of 

no insurance in the past year, and 54.5% compared with 46.0% among those who were 

Figure 4. Percentage of adults aged 18–64 who had an unmet medical need due to cost in the past year according to health 

insurance coverage status at the time of interview and during the preceding year, by age group: United States, 2014 

1

Significantly different from those who were insured for a year or less, uninsured for a year or less, or uninsured for more than a year (p < 0.05). 2

Significantly different from those aged 45–64 for total, insured for more than a year, insured for a year or less, and uninsured for more than a year (p < 0.05).

NOTES: Unmet medical need is a composite measure that includes prescription medicines, mental health care or counseling, dental care, eyeglasses, or needed 

medical care that the respondent did not get or delayed because of cost. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db249_table.pdf#4.

SOURCE: NCHS, National Health Interview Survey, 2014, Family Core and Sample Adult components.
NCHS Data Brief ■ No. 249 ■ May 2016

■  5  ■

uninsured for more than a year.

Adults with health insurance coverage for more than a year were more 

likely to have been vaccinated to protect against the flu than those with any 

period of noncoverage. 

● About 36% of adults aged 18–64 received a flu vaccine in the past year (Figure 5). 

● Among adults aged 18–64, those who were insured for more than a year (40.9%) were more 

likely to be vaccinated for the flu compared with those insured at the time of interview 

but had a period of no insurance in the past year (26.0%), those uninsured at the time of 

interview but had a period of insurance in the past year (23.3%), and those uninsured for 

more than a year (13.3%). 

● Among both adults aged 18–44 and 45–64, those who were uninsured for more than a year 

were less likely to be vaccinated for the flu compared with those of the same age group who 

were either insured at the time of interview but had a period of no insurance in the past year 

or those who were uninsured at the time of interview but had a period of insurance in the 

past year.

● Adults aged 45–64 were more likely to have been vaccinated for the flu than those aged

18–44 with the same insurance coverage status, for those insured for more than a year, those 

insured at the time of interview but had a period of no insurance in the past year, and those 

uninsured for more than a year. 

Figure 5. Percentage of adults aged 18–64 who had a flu vaccine during the past year according to health insurance 

coverage status at the time of interview and during the preceding year, by age group: United States, 2014 

1

Significantly different from those who were insured for a year or less, uninsured for a year or less, or uninsured for more than a year (p < 0.05). 2

Significantly different from those uninsured for more than a year (p < 0.05). 3

Significantly different from those aged 45–64 for total, insured for more than a year, insured for a year or less, and uninsured for more than a year (p < 0.05). 

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db249_table.pdf#5.

SOURCE: NCHS, National Health Interview Survey, 2014, Family Core and Sample Adult components.
NCHS Data Brief ■ No. 249 ■ May 2016

■  6  ■

Summary

Persons currently with health insurance coverage either had continuous coverage for a period of 

time or had experienced a period of noncoverage. Likewise, those who are currently uninsured 

either have been continuously uninsured or have experienced a period of coverage in the recent 

past. The National Health Interview Survey (NHIS) permits the examination of continuity 

of health insurance in the past year. This report examined the association of health insurance 

continuity in the past year with health care access and utilization of health services. 

Having insurance coverage at any given time in the past year increased the likelihood that adults 

had a usual place for medical care, visited a doctor or health care professional about their health, 

and received a flu vaccine. However, those with continuous health insurance coverage at the time 

of interview for more than a year were the most likely to have a usual place for medical care 

and to have used health services during this period, relative to those without continuous health 

insurance coverage. 

Persons who have experienced a period of noncoverage may experience barriers to accessing 

and using health services. NHIS did not collect information on when the period of coverage 

and noncoverage began within the past year for those who were not continuously insured or 

uninsured. Despite this limitation, the findings show that any period without health insurance 

coverage in the past year, even if there was a change to gaining health insurance coverage, 

increased the likelihood of having had an unmet medical need in the past year, relative to those 

continuously insured. 

Persistent lack of coverage, as reflected in those who have been uninsured for more than year, 

was associated with the least use of health services and access to care, hindering opportunities for 

preventive medical care in this segment of the population. 

Definitions

Health insurance coverage: Based on survey questions that help determine health insurance 

coverage at the time of interview. Insurance coverage includes private health insurance, Medicare, 

Medicaid, State Children’s Health Insurance Program (CHIP), a state-sponsored health plan, other 

government programs, or military health plans. 

Duration of health insurance coverage: Persons who were insured at the time of interview were 

asked whether there was any time that they did not have health insurance in the past 12 months 

and, if so, how many months they were without insurance. Persons without insurance at the time 

of interview were asked about the last time they had insurance. Adults were classified as follows: 

insured at the time of interview and had been insured for more than a year, insured at the time of 

interview but had a period of no insurance in the past year, uninsured at the time of interview but 

had a period of insurance in the past year, and uninsured at the time of interview and had been 

uninsured for more than a year. 

Usual place of care: Based on a positive response to the survey question: “Is there a place that 

you usually go to when you are sick or need advice about your health?” Adults whose usual place 

of care was the hospital emergency room were considered not to have a usual place of care.
NCHS Data Brief ■ No. 249 ■ May 2016

■  7  ■

Visit to a doctor or health care provider: Based on a response of one or more visits to the survey 

question: “During the past 12 months, how many times have you seen a doctor or other health 

care professional about your own health at a doctor’s office, a clinic, or some other place? Do not 

include times you were hospitalized overnight, visits to hospital emergency rooms, home visits, 

dental visits, or telephone calls.”

Unmet need due to cost: Based on a positive response to one or more of the following six survey 

questions: “During the past 12 months, was there any time when you needed any of the following 

but didn’t get it because you couldn’t afford it?: a) prescription medicines, b) mental health care 

or counseling, c) dental care, or d) eye glasses; or e) ‘During the past 12 months, has medical care 

been delayed for [person] because of worry about the cost? (Do not include dental care);’ and

f) ‘During the past 12 months, was there any time when [person] needed medical care, but did not 

get it because [person] couldn’t afford it?’”

Flu vaccination: Based on a positive response to one of the following two survey questions: 

“During the past 12 months, have you had a flu shot? A flu shot is injected in the arm” or “Have 

you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health 

professional may have let you spray it.” Both questions also included the statement, “A flu shot 

[this vaccine] is usually given in the fall and protects against influenza for the flu season.”

Data source and methods

Data from the 2014 NHIS were used for this analysis. NHIS is a multipurpose health survey 

conducted continuously throughout the year by the National Center for Health Statistics. 

Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews 

may be conducted over the telephone. Health insurance information and two of the six questions 

used in the composite measure for unmet need due to cost were collected for each person in the 

household in the Family Core component. Questions about usual place of care, visits to a doctor 

or other health care professional, flu vaccination, and remaining questions used in the composite 

measure for unmet need due to cost were collected from one randomly selected adult (the “sample 

adult”) from each interviewed family. Questions on health care access and utilization were asked 

independent of health insurance coverage status. For those insured at the time of interview but 

had a period of no insurance in the past year and those uninsured at the time of interview but 

had a period of insurance in the past year, insurance coverage status when utilizing health care 

services could not be determined in this study. For further information about NHIS, including the 

questionnaire, visit the NHIS website at: http://www.cdc.gov/nchs/nhis.htm. 

All analyses used weights to produce national estimates. Estimates on health access and 

utilization in this report are nationally representative of the noninstitutionalized civilian adult 

population aged 18–64 living in households across the United States. Data weighting procedures 

are described elsewhere (6). Point estimates and their estimated variances were calculated using 

SUDAAN software and the Taylor series linearization method to account for the complex design 

of NHIS. Two-sided significance tests at the 0.05 level were used to compare estimates. 
NCHS Data Brief ■ No. 249 ■ May 2016

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About the authors

Maria A. Villarroel and Robin A. Cohen are with the National Center for 

Health Statistics, Division of Health Interview Statistics.

References

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estimates from the National Health Interview Survey, 2014. National Center 

for Health Statistics. June 2015. Available from: http://www.cdc.gov/nchs/

data/nhis/earlyrelease/insur201506.pdf. 

2. Andersen RM. Revisiting the behavioral model and access to medical 

care: Does it matter? J Health Soc Behav 36(1):1-10. 1995.

3. Akosa Antwi Y, Moriya AS, Simon KI. Access to health insurance and 

the use of inpatient medical care: Evidence from the Affordable Care Act 

young adult mandate. J Health Econ 39:171–87. 2015.

4. Barbaresco S, Courtemanche CJ, Qi Y. Impacts of the Affordable Care 

Act dependent coverage provision on health-related outcomes of young 

adults. J Health Econ 40:54–68. 2015.

5. Chua KP, Sommers BD. Changes in health and medical spending among 

young adults under health reform. JAMA 311(23):2437–9. 2014.

6. Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the 

National Health Interview Survey, 2006–2015. National Center for Health 

Statistics. Vital Health Stat 2(165). 2014.

Suggested citation 

Villarroel MA, Cohen RA. Health insurance 

continuity and health care access and 

utilization, 2014. NCHS data brief, no 249. 

Hyattsville, MD: National Center for Health 

Statistics. 2016.

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics 

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Marcie L. Cynamon, Director

Stephen J. Blumberg, Ph.D., Associate 

Director for Science

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