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* 1. Do you currently have health insurance, or not?

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* 2. Were you without health insurance for any amount of time in the past 12 months, or not?

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* 3. Who pays for your health insurance? (Check all that apply)

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* 4. Which of the following services are covered, in total or in part, by your health insurance plan(s)? (Check all that apply)

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* 5. Why do you currently not have health insurance? (Check all that apply)

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