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 abayesian_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|CDC|U.S. Centers for Medicare & Medicaid Services
dataset
Census SAHIE 2023 + CDC PLACES 2025 + CMS Geographic Variation PUF
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_idkey | 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_idkey | 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, state_id, country_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 · Jul 7, 2026