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Reasons for no insurance: Poor health/refused coverage

Codes and Frequencies

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HINOREFUSER is a recoded variable created by the IPUMS NHIS staff, which indicates whether the person did not currently have insurance coverage because the insurance company refused coverage (except for 1993 to 1996 when coverage status referred to the previous month).

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 1993-1996, 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, interviewers asked the reason(s) why the person had no insurance and handed the respondent a flashcard with various responses (including "other"). Initially, respondents were prompted to pick all responses that applied; for 2000 forward, they could specify up to five reasons only. The response categories listed on the card changed over time. For 1976-1996, HINOREFUSER includes those selecting the response "can't obtain because of poor health, illness, or age"; for 1997 forward, it includes those selecting "insurance company refused coverage."

Users may also want to review information about the component variables used to create HINOREFUSER.


Those variables are:

  • HINORPOORH (Reasons for no insurance: Can't obtain due to poor health/age) (1976 to 1996)


  • HISTOP12 (Why coverage stopped: Insurance company refused coverage) (1997 forward)

HINOREFUSER differs from these component variables in excluding persons covered by public insurance programs, and, for the period prior to 1997, excluding recipients of AFDC and SSI.

Survey questions

The wording of questions about why persons did not have 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.
1997 forward
  • Which of these are reasons {you/subject's name} stopped being covered or do not have health insurance? Show card2000 forward *Enter up to 5 reasons.


The comparability of HINOREFUSER 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 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, the wording of the response category included in HINOREFUSER changed in 1997. For 1976-96, the relevant response category was "can't obtain because of poor health, illness, or age"; for 1997 forward, it was "insurance company refused coverage."

For 1997 forward, whether people were classified as uninsured (and thus included in the universe for HINOREFUSER) 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 HINOREFUSER 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 HINOREFUSER.


  • 1976; 1980; 1982; 1984; 1986; 1989: 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


  • 1976, 1980, 1982-1984, 1986, 1989, 1993-2018