Codes and Frequencies
For sample adults and sample children (and, prior to 2019, all persons), HIMILITE indicates whether the person currently has health insurance coverage through some form of military health insurance.
Beginning in 2004, HIMILITE only distinguishes between those who are and are not covered by military health insurance. From 1997-2003, HIMILITE contains more detailed codes distinguishing between those who have: 1) Military or VA health insurance only; 2) CHAMPUS, TRICARE, or CHAMP-VA coverage only; 3) military health insurance coverage from both of these groups; and 4) military health insurance of an unspecified type. For 2004 forward, more detailed information on the type of military health insurance individuals have can be found in the variables HIMILITOTH, HICHAMPVA, HITRICARE, and HIVA. Additional detail about type of military health insurance coverage can also be found in the variables HICHAMPANY and HIMILVA.
Military Health Care provides medical care on military bases to current armed forces members and their dependents. Medical care from the VA is available to honorably discharged veterans who either have a service connected illness, injury, or disability, or whose incomes are near or below poverty. The Field Representative's Manual for 1997-2003 provided the following definition for this first set of military health care programs: "Military health care/VA refers to health care available to active duty personnel and their dependents; in addition, the VA provides medical assistance to veterans of the Armed Forces, particularly those with service-connected ailments."
The Civilian Health and Medical Program Uniform Service of the Department of Defense (CHAMPUS) is a health care benefits program that provides in-patient and out-patient care from civilian sources and Military Treatment Facilities, on a cost sharing basis. In the late 1990s, a managed care approach was phased in, under the name TRICARE. Retired members of the military are eligible for such coverage, as are the dependents of active-duty, retired, and deceased military.
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs shares the cost of health care services and supplies with eligible beneficiaries. Persons eligible for TRICARE/CHAMPUS are not eligible for CHAMPVA coverage. Persons potentially eligible for CHAMPVA coverage are: the spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by the VA; the surviving spouse or child of a veteran who died from a VA-rated service connected disability; the surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled; or the surviving spouse or child of a military member who died in the line of duty.
The Field Representative's Manual provided two definitions for this second set of military health care programs. For 1997-2000, the Manual stated, "CHAMPUS (Comprehensive Health and Medical Plan for the Uniformed Services) provides health care in private facilities for dependents of military personnel on active duty or retired for reasons other than disability. TRICARE is the 'managed care' version of CHAMPUS. CHAMP-VA (Comprehensive Health and Medical Plan of the Veterans Administration) provides health care for the spouse, dependents, or survivors of a veteran who has a total, permanent service-connected disability." The definition in the Manual for 2001 was more extensive:
Data Collection Process
In the survey for 1997 forward, interviewers first asked, "Are you covered by health insurance or some other kind of health care plan?" Respondents were instructed to "Include health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills." In 1997-2003 the survey form instructed interviewers to only read the preceding statement "if necessary."
Individuals who had an affirmative response to the preceding question were asked, "What kind of health insurance or health care coverage do you have?" Respondents selected the appropriate response from a card listing various types of insurance coverage.
The categories listed were:
- Private health insurance (2004 forward)
- Private health insurance plan from employer or workplace (1997-2003)
- Private health insurance plan purchased directly (1997-2003)
- Private health insurance plan through a State or local government program or community program (1998-2003)
- Medicare (1997 forward)
- Medi-Gap (1997 forward)
- Medicaid (1997 forward)
- CHIP (Children's Health Insurance Program) (1999 forward)
- Military Health Care/VA (1997-2003)
- Military Health Care (CHAMPUS/TRICARE/CHAMP-VA) (1997-2018)
- Military related health care: TRICARE (CHAMPUS)/VA health care/CHAMP-VA (2019 forward)
- Indian Health Service (1997 forward)
- State-sponsored health plan (1997 forward)
- Other government program (1997 forward)
- Single Service Plan (e.g., dental, vision, prescriptions) (1999-2018)
- No coverage of any type (2000 forward)
Respondents could pick more than one type of insurance and interviewers were instructed to mark all that applied.
Instructions regarding single service plans changed over time.
Respondents were consistently instructed to exclude private plans that "only provide extra cash while hospitalized." In 1997-1998 respondents were also instructed to "EXCLUDE private plans that ... pay for only one type of service (nursing home care, accidents, or dental care)." Between 1999 and 2018, "Single Service Plan" was added as a possible response, and, consequently, the instructions were changed to read, "INCLUDE those [private plans] that pay for only one type of service (nursing home care, accidents, or dental care)." Beginning in 2019, respondents were asked three separate questions to determine if they had single service plans for dental services, vision services, and/or prescriptions.
Follow-up questions collected information about the names of coverage plans and confirmed the lack of any type of coverage for the uninsured.
In follow-up questions, interviewers recorded the names of up to four private health insurance plans. If the person was reported as covered by CHIP (beginning in 2000), by a state-sponsored health plan, or by another public program (other than Medicaid) that paid for health care, the interviewer recorded the name of that plan. The placement and wording of these questions about the names of specific government health care plans varied across years.
For persons initially reported as not having health care coverage of any kind, interviewers asked whether the person had Medicare coverage, Medicaid coverage, coverage via a Medicaid program or non-Medicaid state-sponsored health insurance program with the appropriate name for the state, CHAMPUS or CHAMPVA coverage, or any private insurance. For those who acknowledged any such coverage, the interviewer repeated the series of questions mentioned above to determine the specific type of coverage.
During the course of data editing, the NCHS discovered many errors in the responses to questions about insurance coverage. Often, respondents misclassified the type of insurance they had. This might be shown, for example, by a mismatch between the verbatim name of an insurance plan and the type of insurance coverage the person selected from the categories on the card.
Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, such as HIMILITE, the data are back-edited, taking into account such factors as the proper classification of the verbatim names of insurance plans and responses to questions about why insurance coverage had stopped. The NCHS strongly advises analysts to use these recoded insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' original and unedited answers about their insurance type.
Beginning in 2018, a verbatim response to a question about an individual's fourth private health insurance plan was dropped from the construction of HIMILITE. To address the undercount of VA healthcare previously observed in NHIS estimates, and NHIS introduced a new question in 2018 that directly asked veterans who did not previously mention that they were covered by VA health insurance whether they received VA coverage. Additional "yes" responses to this question were incorporated into the construction of HIMILITE.
In addition to HIMILITE, IPUMS NHIS contains the following recoded insurance variables: HIHSE (Covered by Indian Health Service: Recode); HIPRIVATEE (Covered by private health insurance: Recode); HICHIPE (Covered by Children's Health Insurance Program: Recode); HIMCAIDE (Covered by Medicaid: Recode); HIMCAREE (Covered by Medicare: Recode); HISTATEE (Covered by other state-sponsored health plan: Recode); HIOTHGOVE (Covered by other government program: Recode); and HINOTCOVE (No coverage of any type: Recode).
The basic meaning and universe for this variable are consistent over time. Comparability may, however, be limited by changes in the questions used to gather the information used for back-editing the data, and by changes in the back-editing procedures used by the NCHS.
Due to the changes in the construction of HIMILITE in 2018 outlined in the Description tab, there may be an increase in the number of persons identified as covered by military health insurance starting in 2018, but this is likely due to a change in measurement rather than a "real" increase.
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.
- 1997-2018: All persons.
- 2019: Sample adults age 18+ and sample children age 0-17.