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The Small Area Health Insurance Estimates (SAHIE) program was created to develop model-based estimates of health insurance coverage for counties and states. This program builds on the work of the Small Area Income and Poverty Estimates (SAIPE) program. SAHIE is the only source of single-year health insurance coverage estimates.

SAHIE data can be used to analyze geographic variation in health insurance coverage, as well as disparities in coverage by race/ethnicity, sex, age and income levels that reflect thresholds for state and federal assistance programs. Because consistent estimates are available from 2008 to 2020, SAHIE reflects annual changes over time.

For 2008-2020, SAHIE publishes STATE and COUNTY estimates of population with and without health insurance coverage, along with measures of uncertainty, for the full cross-classification of:

  • 5 age categories: 0-64, 18-64, 21-64, 40-64, and 50-64
  • 3 sex categories: both sexes, male, and female
  • 6 income categories: all incomes, as well as income-to-poverty ratio (IPR) categories 0-138%, 0-200%, 0-250%, 0-400%, and 138-400% of the poverty threshold
  • 4 races/ethnicities (for states only): all races/ethnicities, White not Hispanic, Black not Hispanic, and Hispanic (any race).

In addition, estimates for age category 0-18 by the income categories listed above are published.

Each year’s estimates are adjusted so that, before rounding, the county estimates sum to their respective state totals, and for key demographics the state estimates sum to the national ACS numbers insured and uninsured.

This program is partially funded by the Centers for Disease Control and Prevention's (CDC) Division of Cancer Prevention and Control (DCPC). The CDC have a congressional mandate to provide screening services for breast and cervical cancer to low-income, uninsured, and underserved women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Most state NBCCEDPs define low-income as 200 or 250 percent of the poverty threshold. Also included are IPR categories relevant to the Affordable Care Act (ACA). In 2014, provisions of the ACA were implemented that increased access to health insurance. In participating states, Medicaid programs expanded access to individuals and families with incomes less than or equal to 138 percent of the poverty line. For those living between 138 and 400 percent of the poverty line, tax credits became available to help pay for health coverage through the health insurance exchanges.

We welcome your feedback as we continue to research and improve our estimation methods. The SAHIE program's model methodology and estimates have undergone internal U.S. Census Bureau review as well as external review. See the SAHIE Methodological Review page for more details and a summary of the comments and our response.

The SAHIE program models health insurance coverage by combining survey data from several sources, including:

  • The American Community Survey (ACS)
  • Demographic population estimates
  • Aggregated federal tax returns
  • Participation records for the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp program
  • County Business Patterns
  • Medicaid
  • Children's Health Insurance Program (CHIP) participation records
  • Census 2010

For further information on these data sources, see information about data inputs.

Page Last Revised - April 18, 2022
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