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Reasons for no insurance: Too expensive

Codes and Frequencies

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HINOCOSTR is a recoded variable created by the IPUMS NHIS staff, which indicates whether the person did not currently (except for 1993 to 1996 when coverage status referred to the previous month) have health insurance due to the expense or cost of insurance.

Data Collection Process

Those who were asked their reason for not having insurance did not have coverage through Medicare, Medicaid or some other public health insurance program, military health care, or comprehensive private insurance. Except for 1993-1996, those who only had single service plans were classified as uninsured and included in the universe for this variable. For 1980-1996, the universe excludes those receiving Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI), as recipients were eligible for health care through these programs.

For all years prior to 2019, interviewers asked the reason(s) why the person had no insurance and handed the respondent a flashcard with various responses (including "other"). For 2019 forward, interviewers read each reason as an individual question. Initially, respondents were prompted to pick all responses that applied; for 2000-2018, they could specify up to five reasons only. The response categories listed changed over time. For 1976-1996, HINOCOSTR includes those selecting the response "too expensive, can't afford health insurance"; for 1997, it includes those who selected "insurance plan raised cost of premiums"; for 1998-2018, it includes those who selected "cost is too high"; and for 2019 forward, it includes those who selected "coverage is not affordable."

Survey questions

The wording of questions about cost barriers to insurance coverage changed over time.


1976, 1980, 1982-1984, 1989, 1993-1996

  • Many people do not carry health insurance for various reasons. Hand Card Which of these statements describes why -- is not covered by any health insurance (or Medicare)? Any other reason? (Anything else?)Circle all responses given.
  • Which of these are reasons {you/subject's name} stopped being covered or do not have health insurance? Show card
  • 2000-2018 *Enter up to 5 reasons.
2019 forward
  • Are you currently uninsured because coverage is not affordable?

HINOCOSTR differs somewhat from other variables in the original NHIS public use files that relate to cost barriers to insurance coverage.


The related variables from the original NHIS public use files include:

  • HINOREXPEN (Reasons for no insurance: Too expensive)
  • HISTOP10A (Why coverage stopped: Insurance plan raised premium cost)
  • HISTOP11 (Why coverage stopped: Cost is too high)

HINOCOSTR excludes persons with health care coverage through public programs, such as Medicaid or Military health care, whereas the variables listed above include such individuals for some years. For example, for 1993 to 1996, individuals could respond that a reason for "no insurance" was coverage through a public program. Unlike the original public use variables, HINCOSTR also excludes all those covered by AFDC or SSI, which improves comparability between earlier years and 1997 forward.


The comparability of HINOCOSTR is limited somewhat by universe changes, changes in question wording, and differences in data editing.


Note that those with coverage only through single service plans are not included in the universe for 1993 to 1996 (i.e., they were considered to have insurance and hence not asked reasons for no insurance). For 1997 only, the universe includes only those without insurance for less than 3 years.

As noted in the variable description, HINOCOSTR includes people who selected the category "too expensive, can't afford health insurance" for 1976-1996, the category "insurance plan raised cost of premiums" in 1997, the category "cost is too high" for 1998-2018, and the category "coverage is not affordable" for 2019 forward. Because these options all imply a cost barrier, these slight differences in question wording should not greatly affect comparability across years.

For 1997 forward, whether people were classified as uninsured (and thus included in the universe for HINOCOSTR) was affected by back-editing carried out by the NCHS staff. (See the variable description for HINOTCOVE for a description of this back-editing process.) Along with finding errors in the type of insurance coverage reported, the NCHS staff determined that some persons who were reported as lacking insurance were actually covered, while others were reported as insured but actually lacked coverage (e.g., had single service coverage only).

For 1997 forward, data for HINOCOSTR were back-edited to correctly classify peoples' insurance coverage status, while the pre-1997 data were not back-edited. Users may thus want to exercise caution when comparing results from before and after 1997 for HINOCOSTR.

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.


  • 1976; 1980; 1982; 1984; 1986; 1989; 1992: All persons
  • 1983: All person in quarters 3 and 4
  • 1993: Persons in quarters 3 and 4 without any general health insurance coverage
  • 1994-1996: Persons without any general health insurance coverage
  • 1997: Persons without any general health insurance coverage for less than 3 years
  • 1998-2018: Persons who are not covered by any general health insurance coverage
  • 2019-2021: Sample adults age 18+ and sample children age 0-17 without health insurance coverage.


  • 1976, 1980, 1982-1984, 1986, 1989, 1993-2021