Health Insurance Variables in the American Community Survey

Starting with the 2008 American Community Survey (ACS) and Puerto Rican Community Survey (PRCS), the Census Bureau has included a question on health insurance coverage. The questionnaire contained the seven types of insurance listed below along with space for respondents to write in other types of coverage, which were re-classified into one of the seven types.

Summary Public or private Type of insurance IPUMS variable Data quality flag
Covered by any type (HCOVANY) Private
(HCOVPRIV)
(1) Employer/union HINSEMP QHINSEMP
(2) Purchased directly HINSPUR QHINSPUR
(3) TRICARE/other military HINSTRI QHINSTRI
Public
(HCOVPUB)
(4) Medicare HINSCARE QHINSCAR
(5) Medicaid/other gov't assistance HINSCAID QHINSCAI
(6) VA HINSVA QHINSVA
Not covered (7) Indian Health Service HINSIHS QHINSIHS

For all variables except the data quality flags, codes of 2 indicate that a person is covered (either directly or through another household member's policy) by the given type of insurance ; codes of 1 indicate that a person is not covered. As measured by the Census Bureau, persons are considered insured (HCOVANY = 2) if they are covered by at least one of types (1) through (6). (Persons with only Indian Health Services coverage are not considered to be insured because such coverage is not always comprehensive.)

Coverage measured by HCOVANY can be broken down further into private coverage (HCOVPRIV = 2) and public coverage (HCOVPUB = 2). Private coverage includes employer- or union-provided insurance, insurance purchased directly, and TRICARE or other military health care. Public coverage includes Medicare, Medicaid or another governmental medical assistance program, and Veterans Administration health care.

Individuals can be covered by more than one type of insurance, and they can be covered by both private and public insurers.

For more information, see the variable descriptions (linked above). A more complete treatment of the ACS' health insurance measurement can be found at the State Health Access Data Assistance Center's ACS page.

Special Note on the Editing of Health Insurance Variables

Starting with the 2009 ACS, the Census Bureau has edited health insurance variables for consistency. The edits are described in this Census Bureau working paper. Although the original Census Bureau variables are not comparable across time due to different editing procedures, the health insurance variables in IPUMS-USA are harmonized and can be used to analyze change over time. The data quality flags for these variables contain extra codes describing whether coverage was added (codes of 3) or removed (codes of 2) via the logical edit. Although the standard variables should satisfy most users' needs, we have also included the unedited variables as they appeared in the original Census Bureau PUMS with a suffix of "2" (e.g., HCOVANY2, HINSCAID2, etc.).

Details of the Edits in IPUMS-USA

A summary of the edits follows here (unless otherwise noted, "parent" refers to a person with a child under age 18):

  • Persons who did not claim to be covered by Medicaid were assigned Medicaid coverage if they were:
    1. Less than 19 years old and the unmarried child of a parent with public assistance and/or Medicaid;
    2. A citizen parent with public assistance;
    3. A citizen parent married to a citizen with public assistance and/or Medicaid;
    4. A foster child; or
    5. A Supplemental Security Income (SSI) enrollee living in a state where SSI enrollees are automatically enrolled in Medicaid and who satisfies one of the following three additional conditions:
      • Does not have children
      • Has children but is disabled and/or not working
      • Group quarters resident.
  • Persons who did not claim to be covered by Medicare were assigned Medicare coverage if they were at least 65 years old and satisfied at least one of the following conditions:
    1. Reported Social Security or Railroad Retirement benefits
    2. Reported Medicaid coverage.
  • Persons who did not claim to be covered by TRICARE or other military insurance were assigned such coverage if they were:
    1. Active duty military;
    2. The spouse of an active duty military person and did not report other private coverage; or
    3. Less than 21 years old, lacking in other private coverage, and the unmarried child of an active duty military person.
  • Persons who gave direct reports (i.e., unallocated) of employer-based, privately purchased, military, Medicaid, and Medicare coverage had:
    • VA coverage changed to "No" if the person was not a veteran; and
    • IHS coverage changed to "No" if the person did not identify American Indian / Alaska Native as their only race.
Differences From the Original ACS Data: Application of Edits

The 2008 ACS data were not edited at all; respondents who satisfied the above conditions but did not report Medicaid, Medicare, or TRICARE coverage are listed as not having these types of insurance in the 2008 data.

The 2009 ACS data are partially edited: while they contain most of the edits above, some edits are incomplete. IPUMS has confirmed with the Census Bureau that the following edits will be performed in the 2010 ACS, and we have applied them now to the 2008 and 2009 data:

  • We have included 15-year-old SSI enrollees in Medicaid edit #5 described above. (Only SSI enrollees who were at least 16 years old were included in the Census Bureau's 2009 edit.)
  • For citizens married to other citizens with Medicaid (Medicaid edit #3), we have restricted the edit to parents of children under age 18. (This parent restriction was not applied in the Census Bureau's 2009 edit.)
  • We have included single-person households and householders living with only nonrelatives in Medicaid edit #5 described above. (These individuals were mistakenly left out of the Census Bureau's 2009 edit.)
Differences From the Original ACS Data: Family Interrelationships

Many of the edits rely on family interrelationships. The IPUMS-USA health insurance variables are based on our own family interrelationship variables, which (unlike the Census Bureau measures) include subfamilies that are not related to the householder and are temporally consistent. See our subfamilies page for more information.

Data Quality Flags: Additional Codes

The resulting flags have three additional codes:

  1. Coverage removed by logical edit (QHINSVA and QHINSIHS only)
  2. Coverage added by Census Bureau's logical edit and removed by IPUMS logical edit (QHINSCAI, QHINSCAR, and QHINSTRI only)
  3. Coverage added by IPUMS logical edit (QHINSCAI, QHINSVAR, and QHINSTRI only)