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HIPUBCOV
Has any public insurance (Medicaid/other public assistance/State sponsored plan or CHIP)

Codes and Frequencies



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Description

HIPUBCOV is a recoded variable created by the IPUMS NHIS staff, which indicates, for all persons, whether the individual was covered by a public health insurance program. For all years except 1990-1996, HIPUBCOV refers to coverage at the time of the survey; for 1990-1996, the variable refers to coverage in the past month.

Variable Meaning

HIPUBCOV indicates whether the person had health insurance coverage through Medicaid, any other state or other local government program that pays for health care, or, for 1999 forward, the Children's Health Insurance Program. For 1980 to 1996, HIPUBCOV also includes those who received Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI), because persons in those programs were automatically enrolled in Medicaid. HIPUBCOV does not indicate coverage through any military health care program (see HIMILANY), Medicare (see HIMCARE) or the Indian Health Service (see HIHSE).

Data Collection

For 1976 to 1996, HIPUBCOV reflects responses to questions about whether the person had insurance coverage through Medicaid or some other public assistance program. For 1976 and 1980, HIPUBCOV is also based on responses to a question about why the person did not have private health insurance or Medicare coverage (see HINORMCAID). For 1980 to 1989, those who reported having a Medicaid card (including those whose cards may have been expired) were given an affirmative response in HIPUBCOV. For 1997 forward, HIPUBCOV is based on a direct question about what kind of insurance the person had. Respondents were shown a flashcard listing insurance types and told to pick which one(s) they (and their family members) had.

For 1997 forward, interviewers began by asking whether each family member had any kind of health insurance coverage. For 1997 to 1999, only persons with an affirmative response to this initial question have responses to follow-up questions about the kind of health insurance and details of coverage

 

For 1997 to 1999, those who did not answer the initial question affirmatively 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").

Various definitions of Medicaid were provided to respondents, but the changes in the definition were not substantial.

 

In essence, for 1976 to 1996, Medicaid was defined as a health insurance program that provides medical assistance to persons in need. The Field Representative's Manuals for 1997 forward defined Medicaid as "a medical assistance program that provides health care coverage to low income and disabled persons. The Medicaid program is a joint federal-state program which is administered by the States."

Survey Questions

The order and wording of NHIS questions on health insurance coverage changed over time to reflect the availability of different types of coverage and issues of interest. From 1976 to 1996, respondents were asked a series of questions on whether family members had each of several types of coverage. Starting in 1997, respondents selected the relevant types of coverage from a list on a flashcard. The contents of the flashcard list reflected the types of public programs available at the time. Users are encouraged to read the User Note on "Changes in the Insurance Data Collection Process" for further information.

The survey questions used to collect the information included in HIPUBCOV changed over time.

 

1976For 1976, HIPUBCOV indicates Medicaid coverage or welfare received, with the information ascertained indirectly from responses about the person's reasons for not having private insurance or Medicare. Such indirect measurement of public coverage tends to be less accurate than direct questions about coverage, with a bias towards fewer affirmative responses for public coverage.

  • Which of these statements (Hand card) best describes why -- is not covered by any (private) health insurance plan? Any other reasons? Response categories: Care received through Medicaid or Welfare
1980, 1982-1984,1986, 1989For these years, coverage is indicated by receipt of welfare (AFDC or SSI) and by persons reporting having a Medicaid card. Interviewers read a definition of Medicaid ("There is a program called Medicaid that pays for health care for persons in need"), then asked if any family member had a Medicaid card. If the response was affirmative, the interviewer asked to see the Medicaid card to verify coverage.

  • Does anyone in the family now receive assistance through the "Aid to Families with Dependent Children" program, sometimes called "AFDC" or "ADC"?
  • Does anyone in the family now receive the "Supplemental Security Income" or "SSI"?
  • Does anyone in the family now have a Medicaid {or (name)} card?

In addition, the following questions were asked in these survey years:
1980

  • Which of those statements describes why -- is not covered by any health insurance plan? Any other reason? Response categories: Care received through Medicaid or Welfare.
1982-1984,1986, 1989
  • Is anyone in the family now covered by any other public assistance program that pays for health care?
1990-1992
  • In (month), was anyone in the family covered by Medicaid or (local name)?
  • Did -- receive Aid to Families with Dependent Children, sometimes called AFDC or ADC, or some other type of assistance payments in (month)?
1992 only
  • In (month), was anyone in the family covered by any OTHER public assistance program (other than Medicaid) that pays for health care?
  • In (month), did anyone in the family receive public assistance or welfare payments from the state or local welfare office?
1993 to 1996For 1993 to 1996, interviewers read a description of Medicaid to respondents and then asked the following questions:

  • In (month), was anyone in the family covered by Medicaid?
  • In (month), was anyone in the family covered by any OTHER public assistance program (other than Medicaid) that pays for health care? Do NOT include use of public or free clinics if that is the only source of care.
  • In (month), did anyone in the family receive public assistance or welfare payments from the state or local welfare office?
  • In (month), did anyone in the family receive Supplemental Security Income or SSI?
  • Did -- receive Aid to Families with Dependent Children, sometimes called AFDC or ADC, or some other type of assistance payments in (month)?
1997 forwardInterviewers first asked, "Are you covered by health insurance or some other kind of health care plan?" For individuals who had an affirmative response, the interviewer asked, "What kind of health insurance or health care coverage do you have?" Respondents selected the appropriate response from a flashcard listing various types of insurance coverage, including Medicaid. The options on the card were as follows:

  • 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 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 forward)
  • 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.

Comparability

The comparability of HIPUBCOV is limited somewhat by universe changes, changes in question wording detailed in the variable description, and the development of new public health insurance programs over time.
Users should be aware that, to maximize comparability across multiple decades, the data used to create HIPUBCOV were not edited for accuracy. HIPUBCOV is thus not comparable with such variables as HIMCAIDE or HIPUBCOVE ,available for 1997 forward only, which was back-edited by NCHS staff for accuracy in the classification of coverage.

 

During the course of data editing, the NCHS discovered many errors in the responses to questions about insurance coverage. 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 categories on a flashcard. Beginning in 1997, plan names were used to back-edit responses to verify the accuracy of insurance type. (See the variable description for HINOTCOVE for a description of this back-editing process.)

The NCHS strongly advises analysts to use the back-edited insurance variables as a more reliable source of information about the types of insurance coverage than is provided by respondents' unedited answers about their insurance type. Most researchers studying only the period from 1997 forward should use the back-edited variables such as HIPUBCOVE to analyze public insurance coverage.

HIPUBCOV, which reflects respondents' original replies without back-editing, is more suitable for studying public coverage both before and after 1997. While some responses in HIPUBCOV may be misclassified, analysis by the IHIS staff indicates that grouping together various forms of public coverage minimizes such misreporting.

Universe

  • 1976; 1980; 1982; 1984; 1986; 1989; 1992: All persons.
  • 1983; 1993: All person in quarters 3 and 4.
  • 1994-1996: All persons.
  • 1997; 1998; 1999: All persons with any kind of insurance.
  • 2000-2017: All persons.

Availability

  • 1976, 1980, 1982-1984, 1986, 1989-2017

Weights