Core Content
The Health Insurance section of the 2013 NHIS Family Core has a full range of data items addressing health insurance. The flow of the questions pertaining to health insurance programs covered by this section is similar to the 1993–96 NHIS Health Insurance Supplements and the 1997–2012 NHIS Family Cores.
The FHI core section covers several different topic areas:
• Type of health care coverage (Medicare, Medicaid, Children’s Health Insurance Program (CHIP), military (TRICARE, VA, CHAMP-VA), other state-sponsored health plans, Indian Health Service, other government programs, private insurance and single service plans);
• Managed care arrangements and the need for referrals for those covered by Medicare, Medicaid, Children’s Health Insurance Program, other state-sponsored health plans and other government programs;
• Medicare managed care;
• Enrollment in the Medicare Part D program;
• Private insurance characteristics reported by the family respondent, including covered individuals relationships to the policyholder, coverage of individuals outside the household, HMO, PPO, and POS status, high deductible health plan (annual deductible of $1,250 for self-only coverage and $2,500 for family coverage), health savings account or health reimbursement agreement for high deductible plans, source of coverage, existence of employer subsidies for premiums, amount paid by employer, amount paid by individual/family, managed care detail information, need for a referral, prescription drug benefit, dental coverage;
• Types of single service plans; • Type of TRICARE coverage;
U.S. Department of Health and Human Services ● Centers for Disease Control and Prevention ● National Center for Health Statistics • Periods of time without health insurance and reasons for no health insurance;
• Out-of-pocket costs in the past year for medical expenses (excluding health insurance premiums); and • Enrollment in a flexible spending account (FSA) for medical expenses.
A new question was added to the FHI core section in Quarter 4 of 2013 to ascertain if premiums paid by an individual or family for their private health insurance plans were based on income (PLNPRE1 and PLNPRE2). These variables are intended to provide a baseline of persons covered by private plans that are progressive in nature prior to the availability of private health insurance through the Federal Health Insurance Marketplace or state-based exchanges.
Supplemental Questions
In addition to the core health insurance questions, additional supplemental questions sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE, HHS) were included in 2013. The purpose of the FHI supplemental questions is to provide additional information about the following topic areas:
• How private plans were obtained;
• Relationship of the covered individual to the policyholder;
• Employer contributions to private plan premiums and if premiums were based on income; • Primary care provider requirement;
• Confidence in purchasing affordable private health insurance on one’s own;
• Previous health insurance coverage for persons who are either uninsured or who have had a change in insurance coverage within the past year;
• Difficulty paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.
Beginning in 2011, the FHI section has contained numerous variables to address provisions of the Affordable Care Act of 2010 (ACA). The extended health insurance questions can be divided into two lines of questioning. One line of questioning is limited to those who have private health insurance plans. The other line of
questioning is asked of all persons.
For private plans where the policyholder resides outside the household, information is collected on the relationship of the covered individual to the policyholder. For private plans where the policyholder resides within the household, information is collected to find out if a private health insurance plan covers persons who do not reside in the household, and if so, the relationships of these individuals to the policyholder. These variables address a major provision of the ACA that became effective September 23, 2010 that allows parents to keep their children on their health policies until they turn age 26.
U.S. Department of Health and Human Services ● Centers for Disease Control and Prevention ● National Center for Health Statistics FHI variables are also created for the Family File. The inclusion of the FHI section on the Family File is intended to make it easier to analyze insurance data on a family basis.
Major Recodes
Recodes are created for types of health care coverage and noncoverage because of the complicated editing process that takes place in the FHI section. The recodes are: MEDICARE, MEDICAID, PRIVATE, SCHIP, IHS, MILCARE, OTHPUB, OTHGOV, SINGLE, and NOTCOV. NOTCOV reflects the definition of noncoverage as used in
Health, United States (in which persons with only Indian Health Service coverage are considered uninsured).
Other recodes are WHONAM1 and WHONAM2 (whose name the plan is in), COHU191 and COHU192 (total number of covered children under 19 years), COH19251 and COH19252 (total number of covered adults aged 19–25), and COHO251 and COHO252 (total number of covered adults over 25 years). HICOSTR1 and HICOSTR2 are recodes for out-of-pocket premium cost and ECOSTR1 and ECOSTR2 are recodes for employer premium cost. Suppression of Data
To protect confidentiality, detailed information concerning persons’ third and fourth plans is not available on the public use data file. Persons with three or more plans have a “yes” response to the PRPLPLUS variable. Detailed information on persons’ third and fourth plans is available through the NCHS RDC at
http://www.cdc.gov/rdc/. Technical Notes
In looking at the verbatim responses to HIPNAM1, HIPNAM2, HIPNAM3, HIPNAM4 (which ask respondents for the names of their family members’ private health insurance plans), STNAME1, STNAME2, STNAME3 (the names of their family members’ SCHIP, state sponsored or other government coverage respectively), MCANAME (the name of their family members’ Medicare Advantage or Medicare HMO plan), and MACHMD_1, MACHMD_2 (names of Medicaid managed care plans), it was found that some of these respondents indicated plans or programs that were clearly private health insurance, Medicare, Medicaid, Children’s Health Insurance Program, military coverage, Indian Health Service, single service plans, or no coverage at all. These persons were
reassigned to the appropriate enrollment recodes for MEDICARE, MEDICAID, SCHIP, PRIVATE, IHS, MILCARE, and SINGLE.
In addition, some respondents offering an “other” response to the survey item (HISTOPOT) that inquired about the reason(s) coverage stopped subsequently indicated in their verbatim responses that the person did in fact have health insurance. These persons were reassigned to the appropriate response category with the
enrollment recodes for MEDICARE, MEDICAID, SCHIP, PRIVATE, IHS, MILCARE, OTHPUB, and OTHGOV. Analysts are therefore strongly advised to use the recodes MEDICARE, MEDICAID, PRIVATE, SCHIP, IHS, MILCARE, OTHPUB, OTHGOV, and SINGLE for types of health care coverage, because these take into account the above- mentioned back edits. In contrast, the data contained in HIKINDNA-HIKINDNK and MCAREPRB, MCAIDPRB, and SINCOV were not back-edited and reflect the respondents’ original replies.
Using the most conservative estimate of the uninsured (which would exclude persons with IHS coverage only), a total of 669 persons do not have data for the HILAST question, as during the course of the interview the
U.S. Department of Health and Human Services ● Centers for Disease Control and Prevention ● National Center for Health Statistics editing that they lacked coverage (given the information that the family respondent provided about their insurance plan(s)). NHIS staff elected not to edit these individuals out of the universe for HINOTYR. In addition, for a total of 942 persons, the family respondent was not asked either the HILAST or the HINOTYR questions. Again, analysts are strongly advised to use the recodes MEDICARE, MEDICAID, PRIVATE, SCHIP, IHS, MILCARE, OTHPUB, OTHGOV, and SINGLE for estimates of types of health care coverage and NOTCOV to derive estimates of uninsurance. The variables HILAST and HINOTYR, which reflect periods of noncoverage, cannot be used to estimate the rate of uninsurance. If users want to count IHS as coverage or create any other definition of uninsurance, they may use the health insurance recodes (MEDICARE, MEDICAID, PRIVATE, SCHIP, IHS, MILCARE, OTHPUB, and OTHGOV) for this purpose.