health_access_coverage_county_year
Health insurance coverage and financial access to care per county. SAHIE 2023 all-ages uninsured rate (Tier B spine), CMS PUF dual enrollment and FQHC utilization (most recent year, Tier A), PLACES no-checkup-access (Tier C).
tier bbayesian_estimate
overview
overview
All 3,144 US counties. SAHIE is a complete model-based estimate.
current vintage — 2022
history — SAHIE: 2008-present
provenance
source & licensing
authority
U.S. Census Bureau
dataset
Small Area Health Insurance Estimates (SAHIE)
license
Public domain (U.S. Federal Government work)
citation
U.S. Census Bureau. Small Area Health Insurance Estimates (SAHIE), 2022.
schema
fields
| name | type | definition |
|---|---|---|
| cms_year | int64 | Calendar year of the CMS (Centers for Medicare & Medicaid Services) data extract from which this record is drawn. Used to track changes in coverage and utilization over time. |
| country_id | string | ISO alpha-2 country code (always 'US' for domestic tables). |
| county_idkey | string | 5-character FIPS code identifying the county.Joins dim.counties on county_id. |
| dual_enrollment_pct | float64 · percent (0–100) | Share of Medicare beneficiaries in the county who are also enrolled in Medicaid (dual-eligible). Higher values indicate a greater concentration of low-income elderly or disabled residents. |
| ffs_beneficiary_count | int64 · count | Number of Medicare beneficiaries enrolled in traditional Fee-for-Service (FFS) Medicare in the county. Higher values reflect a larger Medicare FFS population, as distinct from Medicare Advantage enrollees. |
| fqhc_rhc_visits_per_1000_benes | float64 · rate per 1,000 beneficiaries | Number of visits to Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) per 1,000 Medicare fee-for-service beneficiaries. Higher values indicate greater utilization of safety-net primary care facilities. |
| ma_participation_rate | float64 · percent (0–100) | Share of Medicare-eligible beneficiaries in the county enrolled in a Medicare Advantage (Part C) plan rather than traditional FFS Medicare. Higher values indicate greater uptake of managed-care Medicare. |
| pct_adults_no_checkup_access | float64 · percent (0–100) | Share of adults in the county who reported not having a routine checkup or lacking access to preventive care visits within the past year. Higher values indicate poorer access to preventive health services. |
| pct_uninsured | float64 · percent (0–100) | Share of the county population without any form of health insurance coverage. Higher values indicate greater gaps in insurance access. |
| state_id | string | 2-character FIPS code identifying the state.Joins dim.states on state_id. |
| uninsured_count | int64 · count | Estimated number of residents in the county lacking health insurance coverage. Higher values indicate a larger uninsured population. |
| yearkey | int64 | Reference year of the observation. |
relationships
joins
primary key
county_id, year
common joins
dim.geographies on county_id
demographics_population_county_year for total denominators
usage
how to use this table
method
SAHIE uses ACS, CPS, IRS administrative data, and Medicaid/CHIP records in a hierarchical Bayesian model to produce small-area uninsured rates.
do not use for
Year-over-year change in small counties (model smoothing); precise sub-population breakdowns beyond age/sex/income; current uninsured rate (~18-month lag).
known issues
Model-based - Tier B reliability. Medicaid expansion adoption affects state-level baselines.
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last updated · May 5, 2026