Codes and Frequencies
HIPCAIDR is a recoded variable created by the IPUMS NHIS staff, which indicates, for all persons with at least one private health insurance health plan, whether they had at least one private plan that was paid for by Medicaid.
Rationale for Inquiry
Having a private plan paid for by the government program Medicaid may seem counter-intuitive. In fact, private insurance companies are allowed to administer portions of Medicaid benefits through Medicaid managed care arrangements in which health maintenance organizations contract directly with a state Medicaid agency to provide services on a capitated basis (fixed fee per enrollee). These managed care plans then enroll and provide services for Medicaid beneficiaries.
For example, the Center for Medicare and Medicaid (CMS) published a listing of insurance plans contracting with Medicaid in each state in a 2009 report entitled, "2009 National Summary of State Medicaid Managed Care Programs." Users may want to review other documents from the CMS for further information on such payment arrangements.
Information was collected on up to four private plans per family; for 2004 forward, only data on plans one and two are publicly available. Therefore, for 1997 to 2003, HIPCAIDR indicates whether the person had any one of four plans paid for by Medicaid; for 2004 forward, it indicates whether the person had any of two plans paid for by Medicaid.
Changes in the number of insurance plans considered should have little effect on the results for HIPCAIDR.
Persons with three or more plans have a "yes" response in HIPRIVGT2 (available for 2004 forward). Analysis by IHIS staff indicates that a very small number of persons (less than 0.2 percent of the total number of individuals with private health insurance per year for 2004 to 2009) had three or more private insurance plans.
For all years from 1997 forward, interviewers first asked whether the person was covered by any kind of health insurance or some other kind of health care plan.
For 1997 to 1999, only people with an affirmative answer to this initial question have responses to follow-up questions about their kind of health insurance and the details of coverage; for 1997 to 1999, those who did not say "yes" are coded NIU (not in universe) for follow-up questions on insurance characteristics. Beginning in 2000, the response "no insurance" was included as a valid response to the initial question. Thus, for 2000 forward, the universe for follow-up questions on insurance coverage type and details was "all persons" (including those with an affirmative response to HINONE or "no insurance").
For each private insurance plan, respondents were asked "Who pays for this plan?" and were handed a card that listed various responses (including Medicaid). Respondents could pick all that applied.
For 1997 forward, the NHIS Field Representative Manuals defined private health insurance to be any type of health insurance, including Health Maintenance Organizations (HMOs), other than the public programs of Medicare, Medicaid, Military health care/VA, CHAMPUS/TRICARE/CHAMP-VA, Indian Health Service, state-sponsored health plans, and health insurance from other government programs (including CHIP, the Children's Health Insurance Plan, for 1999 forward).
For 2001 forward, the Manuals indicated that insurance coverage through COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) or by
TCC (Temporary Continuation of Coverage) should be classified as private health insurance (obtained through an employer or workplace).
For 1997 forward, the definition of private insurance remained largely the same, and consistently excluded single service plans. Over a longer time span, the definition and data collection process for private insurance changed greatly (as is documented in the User Notes on "Changes in the Definition of Private Insurance" and "Changes in the Data Collection Process").
HIPCAIDR is largely comparable over time.
The reduction in the number of plans for which data are publicly available has little effect on comparability, given the rarity of persons with more than 2 private insurance plans.
As new insurance programs became available, additions were made to the response categories for the question about who paid for private insurance plans.
The categories of self or family (living in the household), employer or union, someone outside the household, Medicare, and Medicaid were available for all years. For 1999 forward, respondents could report payment by the Children's Health Insurance Program. From 1998 forward, the category "state or local government or community program" was used in place of the 1997 category of "government program."
Errors in the reported type of insurance coverage, evidenced by a mismatch between the verbatim name of an insurance plan and the category chosen by the respondent from a flashcard, were corrected by NCHS staff, who reclassified some survey participants. Such back-editing of insurance data was initiated in 1997 and thus applies across all years of data for HIPCAIDR, raising no comparability problems for that variable.
- 1997-2018: Persons who are covered by a general health insurance plan (excludes single service plans)
- 1997-2018 : PERWEIGHT