Codes and Frequencies
Description
HINOTCOV is a recoded variable created by the IPUMS NHIS staff that indicates, for sample adults and sample children (and, prior to 2019, all persons), whether the individual had any general health insurance coverage. For 1976-1996, IPUMS NHIS staff identified uninsured persons as those without any private insurance, or without public health insurance coverage through Medicaid, Medicare, military health care. Persons covered only by the Indian Health Service (1993-1996) are coded as having no health insurance. For 1997 forward, uninsured persons were identified as those who answered "no" to the question, "{Are you/Is anyone} covered by any kind of health insurance or some other kind of health care plan?" See the survey questions section below for more details.
For most years, HINOTCOV refers to a current lack of insurance coverage; for 1990 to 1996, the variable refers coverage status during the previous month.
Methods of Determining Lack of Insurance
The process used to ascertain the lack of insurance coverage reported in HINOTCOV changed over time. A brief description is provided below, while further information on the data collection process appears in the User Note on Changes in Insurance Data Collection.
For 1976 to 1999, lack of health insurance was ascertained indirectly. In other words, having no coverage was inferred from responses to a series of questions on various forms of coverage. Interviewers asked about coverage through Medicare, Medicaid or other public assistance programs, military health care, and private insurance. Persons not covered by any of these types of insurance were coded as having no health insurance.
For 1980 to 1996, persons who received Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI) were assumed to have health insurance coverage, since they were eligible for health care coverage (i.e., Medicaid) through these programs.
For 2000 forward, HINOTCOV reflects a response of "no coverage of any kind" to a direct question about what type of insurance the person had.
The specific questions used to determine coverage status changed over time.
These questions are as follows:
1997 forward:
- {Are you/Is anyone} covered by any kind of health insurance or some other kind of health care plan?
- In (month) was anyone in the family covered by Medicare?
- In (month), was anyone in the family covered by Medicaid?
- In (month), was anyone in the family covered by any OTHER public assistance program (other than Medicaid) that pays for health care? Do NOT include use of public or free clinics if that is the only source of care.
- In (month), did anyone in the family receive public assistance or welfare payments from the state or local welfare office?
- In (month), did anyone in the family receive Supplemental Security Income or SSI?
- Did -- receive Aid to Families with Dependent Children, sometimes called AFDC or ADC, or some other type of assistance payments in (month)?
- In (month) was anyone in the family covered by military health care, including armed forces retirement benefits, the VA (Department of Veterans' Affairs), CHAMPUS or TRICARE (in 1995 and 1996), or CHAMP-VA?
- In (month) was anyone in the family covered by any other military health care, including armed forces retirement benefits or the VA (Department of Veterans' Affairs)?
- (Not counting the government health programs we just mentioned,) In (month) was anyone in the family covered by a private health insurance plan?
- What was the MAIN reason -- was without coverage?
- In (month) was anyone in the family covered by Medicare?
- In (month), did anyone in the family receive Supplemental Security Income or SSI?
- In (month), was anyone in the family covered by Medicaid or (local name)?
- Did -- receive Aid to Families with Dependent Children, sometimes called AFDC or ADC, or some other type of assistance payments in (month)?
- In (month), was anyone in the family covered by military health care, CHAMPUS, CHAMPVA, or the VA?
- In (month), was anyone in the family covered by any OTHER public assistance program (other than Medicaid) that pays for health care?
- In (month), did anyone in the family receive public assistance or welfare payments from the state or local welfare office?
- (Not counting Medicare) In (month), was anyone in the family covered by a health insurance plan that pays any part of hospital or doctor's bills? Do NOT include plans that pay for ONLY ONE type of service, such as nursing home care or accidents.
- Is anyone in the family now covered by any OTHER health insurance plan?
- Health insurance can also be obtained privately or through a current or former employer or union. Was anyone in the family covered by private health insurance or by membership in a health maintenance organization in (month)?
- Is anyone in this family, that is (read names) now covered by Medicare?
- Does anyone in the family now receive assistance through the "Aid to Families with Dependent Children" program, sometimes called "AFDC" or "ADC"?
- Does anyone in the family now receive the "Supplemental Security Income" or "SSI"?
- Does anyone in the family now have a Medicaid {or (name)} card?
- Is anyone in the family now covered by any other public assistance program that pays for health care?
- Which of those statements describes why -- is not covered by any health insurance (or Medicare)? Any other reason? Circle all reasons given. Response categories: Military dependent, (CHAMPUS), veterans' benefits.
- Which of those statements describes why-- is not covered by any health insurance plan? Any other reason? Response categories: Care received through Medicaid or Welfare; Military dependent, (CHAMPUS), veterans' benefits.
- Which of these statements (Hand card) best describes why -- is not covered by any (private) health insurance plan? Any other reasons? Response categories: Care received through Social Security Medicare; Care received through Medicaid or Welfare; Military dependent, (CHAMPUS), veteran's benefits
Comparability
HINOTCOV is largely comparable before 2019, though the sources of information used to create this variable and the reference period (currently or in the previous month) were not the same in every year. Substantial questionnaire changes introduced in 2019 may limit comparability with earlier years.
Variation in the measurement of Medicaid coverage status may affect the accuracy of levels of coverage over time. See HIPUBCOVE for more detail on this point.
The NHIS questionnaire was substantially redesigned in 2019 to introduce a different data collection structure and new content. For more information on changes in terminology, universes, and data collection methods beginning in 2019, please see the user note.
Universe
- 1976; 1980; 1982; 1984; 1986; 1989; 1990; 1991; 1992; 1994-2018: All persons.
- 1983; 1993: All person in quarters 3 and 4.
- 2019-2023: Sample adults age 18+ and sample children age 0-17.
Availability
- 1976, 1980, 1982-1984, 1986, 1989-2023
Weights
- 1976, 1980, 1982, 1984, 1986, 1989-1992, 1994-2018 : PERWEIGHT
- 1983, 1993, 2019-2023 : SAMPWEIGHT
