Codes and Frequencies
For sample adults and sample children (and, prior to 2019, persons) who are currently covered by health insurance (specifically excluding armed forces members in 1997-1999), but who also report that there was some time in the past 12 months they did not have any health insurance coverage (HINOTYR), HINOTYRMO indicates the number of months without any health insurance coverage during the past 12 months.
Thus, throughout the period, HINOTYRMO is asked of people (specifically excluding armed forces members in 1997-1998) if two criteria are satisfied:
- The person reported currently having health insurance coverage via any of the following: private health insurance, including Medi-Gap; Medicare; Medicaid; Children's Health Insurance Program; Military health insurance (including Military Health Care/VA and TRICARE/CHAMPUS/CHAMP-VA); Indian Health Service; State-sponsored public health care coverage plans; and other government programs.
- The person responded affirmatively to HINOTYR, indicating that there was some point in the past 12 months at which he or she had no health insurance coverage.
For 2000-2018, HINOTYRMO is not asked of people reporting only single service plan coverage.
Use of HINOTYRMO
According to the NCHS, HINOTYRMO cannot be used to estimate the prevalence of uninsurance, due to data errors.
During the course of data editing, the National Center for Health Statistics (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 a card provided by the interviewer. Accordingly, the NCHS created a series of recoded insurance variables. For these recoded insurance variables, 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.
Because of the errors in respondents' original (unedited) answers to questions about insurance coverage, HINOTYRMO (and the complementary variable HINOTYR) cannot be used to estimate the rate of uninsurance.
To estimate the extent of uninsurance, the NCHS recommends using the health insurance recodes, estimating the rate of uninsurance as a residual. See the variable description for HIPRIVATEE (Covered by private health insurance: Recode) for more details.
Users can also use HINOTCOVE, a recoded variable that indicates whether the person currently lacks health insurance coverage.
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 choices included:
- 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.
Respondents were consistently instructed to exclude private plans that "only provide extra cash while hospitalized," but the treatment of single service plans varied by year.
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)." Beginning in 1999, "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)."
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, in sequence, 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. Those who acknowledged current coverage by health insurance (specifically excluding armed forces members in 1997-1998), were asked the question associated with HINOTYR ("In the past 12 months, was there any time when [person] did not have any health insurance coverage?"). If they responded affirmatively to HINOTYR, they were then asked the question associated with HINOTYRMO, namely, "In the past 12 months, about how many months was [person] without coverage?"
As noted in the description of the variable, HINOTYRMO is asked only if there is an affirmative answer to HINOTYR. However, as the NCHS warns, HINOTYR "cannot be used to estimate the rate of uninsurance." Thus, HINOTYRMO also cannot be used to estimate the rate of uninsurance.
The variable is largely comparable for 1997 forward, with four exceptions:
- 1997-1999: Because the NHIS instrument specifically excludes armed forces members for HINOTYR, they are also excluded in these years for HINOTYRMO.
- 2000: The explicit exclusion of armed forces members, present for 1997-1999, was dropped for HINOTYR and HINOTYRMO beginning in 2000.
- 2000-2018: In contrast to 1997-1999, the NHIS instrument explicitly instructs that people reporting only single service plan coverage not be asked the question associated with HINOTYR. Since an affirmative answer to the question associated with HINOTYR is a necessary condition for asking the question associated with HINOTYRMO, it follows that the people reporting only single service plan coverage are not asked the question associated with HINOTYRMO.
- 2019 forward: In this period the NHIS instrument includes respondents who said they were covered by any kind of insurance or answered affirmatively to a probe on whether they had Medicare or Medicaid if they previously reported they did not have insurance coverage. Coverage by single service plans are asked as separate questions and do not impact whether a respondent was included for this period.
Throughout the period 1997 forward, the question associated with HINOTYRMO is asked of persons who report currently having health insurance coverage via any of the following: private health insurance, including Medi-Gap; Medicare; Medicaid; Children's Health Insurance Program; Military health insurance (including Military Health Care/VA and TRICARE/CHAMPUS/CHAMP-VA); Indian Health Service; State-sponsored public health care coverage plans; and other government programs.
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.
- 1997-1999: Persons who now have health insurance (excluding persons in military families) but who did not have health insurance at some point during past 12 months.
- 2000-2018: Persons who now have health insurance but who did not have health insurance at some point during past 12 months.
- 2019-2020: Sample adults age 18+ and sample children age 0-17 who now have health insurance but who did not have health insurance at some point during the past 12 months.