Understanding Barriers to Health Insurance of Uninsured and Sporadically Insured Alaskans

Transcription

1 Understanding Barriers to Health Insurance of Uninsured and Sporadically Insured Alaskans Summary of Focus Groups with,, and PREPARED FOR Alaska Department of Health and Social Services Office of the Commissioner Health Planning and Systems Development FUNDED BY Health Resources and Services Administration Grant #P09HS05505 PREPARED BY Rosyland Frazier Virgene Hanna Meghan Wilson April 2007 Institute of Social and Economic Research University of Alaska Anchorage 3211 Providence Drive Anchorage, Alaska 99508

2 TABLE OF CONTENTS EXECUTIVE SUMMARY... ix INTRODUCTION...1 Questions for Focus Groups...2 METHODOLOGY AND PROCEDURES FOR FOCUS GROUPS FOR INDIVIDUALS...7 Recruitment...7 Screening and Selection with Demographic Questionnaire...7 Insurance and Employment Questionnaire...8 Discussion Guides...8 Institutional Review Board...8 Special Consideration...9 Data Analysis...9 FOCUS GROUP COMPOSITION: TARGET COMMUNITIES AND POPULATIONS...11 Demographics...11 Insurance and Employment...12 QUESTIONS AND FINDINGS FOR INDIVIDUALS...15 What is Affordable? How Much Are the Uninsured Willing to Pay?...15 Why do Uninsured and Families Not Participate in Public Programs for which They are Eligible?...17 Why do Uninsured and Families Disenroll from Public Programs?...20 Why do and Families Not Participate in Employer-sponsored Coverage for Which They Are Eligible?...20 Do Workers Want their Employers to Play a Role in Providing Insurance or Would Some other Method be Preferable?...21 How Likely Are To Be Influenced by Availability of Subsidies and/or Tax Credits or Other Incentives?...25 What Other Barriers, Besides Affordability, Prevent the Purchase of Health Insurance?...25 How Do the Uninsured Get Their Medical Needs Met?...27 What Are the Features of an Adequate, Barebones Benefits Package?...31 How Should Underinsured Be Defined? How Many of Those Defined as Insured Are Underinsured?...33 FOCUS GROUPS FOR ALASKA NATIVES...37 Methodology and Procedures for Focus Groups with...37 Alaska Native Focus Groups Composition...39 Findings from Alaska Native Focus Groups...40 METHODOLOGY AND PROCEDURES FOR FOCUS GROUPS FOR SMALL-BUSINESS EMPLOYERS AND HEALTH-INSURANCE REPRESENTATIVES...47 Recruitment...47 Screening and Selection with Demographic Questionnaire...47 Page v

3 Health-Insurance Questionnaire...48 Discussion Guide...48 Institutional Review Board...49 Special Consideration...49 Data Analysis...49 FOCUS GROUP COMPOSITION FOR SMALL-BUSINESS EMPLOYERS AND HEALTH-INSURANCE REPRESENTATIVES...51 Composition of Focus Groups...51 Information from Demographic Questionnaire...51 Insurance Status in Response to Health Insurance Questionnaire...52 Composition of Focus Group...53 QUESTIONS AND FINDINGS FOR SMALL-BUSINESS EMPLOYERS AND HEALTH INSURANCE REPRESENTATIVES...55 What Influences the Employer s Decision about Whether or Not to Offer Coverage?...55 What Are the Primary Reasons Employers Give for Electing Not to Provide Coverage?...57 How Do Employers Make Decisions about the Health Insurance They Will Offer to their...60 What Factors Go into their Decisions Regarding Premium Contributions, Benefits Package, and Other Features of the Coverage?...61 What Would Be the Likely Response of Employers to an Economic Downturn or Continued Increases in Costs?...63 Which Employer and Employee Groups Are Most Susceptible to Crowd-Out?...64 How Likely Are Employers Who Do Not Offer Coverage to be Influenced by Expansion/Development of Purchasing Alliances; Additional Tax Incentives; and Individual Employer Subsidies?...65 What Other Alternatives Might be Available to Motivate Employers Not Now Providing or Contributing to Coverage?...67 CONCLUSION...73 APPENDIXES A. RECRUITMENT ACTIVITIES Focus Groups for Focus Groups for B. QUESTIONS FROM ALASKA S DEPARTMENT OF HEALTH AND SOCIAL SERVICES C. DISCUSSION GUIDES Uninsured or Intermittently Insured Page vi

4 D. DEMOGRAPHIC QUESTIONNAIRES E. CONSENT FORMS F. INSURANCE AND EMPLOYMENT QUESTIONNAIRES G. RESPONSES TO INSURANCE AND EMPLOYMENT QUESTIONNAIRE FOR INDIVIDUALS H. RESPONSES TO SURVEY QUESTIONNAIRE FOR SMALL-BUSINESS EMPLOYERS I. MEASURING THE ADEQUACY OF COVERAGE OR UNDERINSURANCE, STATE HEALTH ACCESS DATA ASSISTANCE CENTER J. TABLES Table 1 Community, Insurance Status, and Subcategories of in Focus Groups Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Table 8. Table 9. Number of Participants in Focus Groups for who Completed Demographic Questionnaire by Place of Focus Group Participants in Focus Groups for by Years of Age Race and Ethnicity of Participants in Focus Groups for Gender of Participants in Focus Groups for Education Level of Participants in Focus Groups for Marital Status of Participants in Focus Groups for Number of Participants in Focus Groups for Who Are Below Poverty Line Based on Annual Income and Number of Household Members Number of Participants in Focus Groups by Number of Years They Have Lived in the United States Table 10. Number of Called, Contacted, Scheduled, and Attended each Focus Group of Table 11. Participants in Focus Groups for by Years of Age Table 12. Race and Ethnicity of Participants in Alaska Native Focus Groups Table 13. Martial Status of Participants in Alaska Native Focus Groups Page vii

5 Table 14. Gender of Participants in Alaska Native Focus Groups Table 15. Education Level of Participants of Alaska Native Focus Groups Table 16. Do You Currently Sell Health-Care Benefits to Companies with Fewer than 10, 11 to 50, or More than 50 Table 17. Percentage of Health-insurance Representatives Health-insurance Clients that Are Small Businesses with 2 to 50 Employees Table 18. Which Health Plans Does Your Organization Currently Represent to Small-Business Clients? Table 19. Number of Years Selling Health-Care Plans Table 20. Number of Participants in Focus Groups for who Completed Demographic Questionnaire by Place of Focus Group Table 21. Number of by Years in Business Table 22. Number of by Type of Industry Table 23. Including both Part-time and Full-time Employees at All of Your Locations, How Many Employees in Total Does Your Company or Organization Employ? Table 24. Defining Full-time as Working at Least 30 Hours per Week, How Many People Are Employed Full-time, Including Those in Remote Locations? Table 25. What Is Your Role in the Decision-Making Process for Your Company when Selecting Which Health Plans Are Made Available to Your Table 26. Have You, in the Last Few Years, Contacted Insurance Carriers and/or Brokers to Obtain Information about Providing Health Insurance to Your Table 27. Number of Calls, Contacted, Scheduled, and Attending each Focus Group of and Table 28. Which of the Following Best Describes the Majority of Your Table 29. Has Your Organization or Company Ever Offered Health Insurance to Its Table 30. Which Health Plan Does Your Company or Organization Currently Offer? Page viii