REPORT California Small Business Healthcare Survey

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1 REPORT California Small Business Healthcare Survey August 23, 2007 Small Business for Affordable Healthcare 3030 Bridgeway, Suite 132 Sausalito, CA (866)

2 Table of Contents Executive Summary.1 Methodology..4 Survey Results Conclusion...13 Organization & Contact Information Accompanying Materials Survey Details - PowerPoint Survey Questionnaire

3 Executive Summary Overview Small Business for Affordable Health Care, a coalition of California small business owners and senior managers, recently completed a scientific survey of a randomlyselected small business owners and managers across California. The purpose of the survey was to better understand how California s entrepreneurs feel about healthcare costs and about the various proposals to change the healthcare financing system that are currently pending in Sacramento. Small Business for Affordable Health Care is a project of Small Business Majority (SBM), a California-based national non-profit small business advocacy group. In 2006, SBM conducted an on-line survey of small business owners and managers across the country. That survey showed healthcare to be small business #1 concern, and the survey respondents expressed support for various healthcare reform solutions. Given the results of last year s survey, the economic importance of California, and the existence of the current health care debate in the state, it was decided that it was necessary to better understand the needs and attitudes of California s small business owners with a specific focus on healthcare. Moreover, the only known surveys of small business healthcare attitudes in California have been by organizations of their memberships, not scientific polls of small business owners that disregard organizational, political or other affiliation. A telephone and on-line poll of 506 randomly-selected small business owners and senior managers was conducted between August 2-15, 2007, by Core Strategies, a 10-year old market research firm based in Laguna Hills, California. Responses were limited to owners and senior managers of companies with fewer than 100 employees. The Survey has a 95% confidence interval and a 4% margin of error. Key Findings Key findings from the Survey are: 80% of those who expressed an opinion felt that employers should pay something to provide healthcare to their employees -- four times as many as those who felt that employers should not have to contribute anything (20%). 75% ranked the availability of affordable healthcare as extremely or very important. 57% regard health care financing as a shared responsibility among individuals, employers and government three times as many as do not (19%). 55% were in favor of paying into a statewide pool that would enable their employees to obtain coverage at favorable rates over three times greater than those opposed (17%) Small Business for Affordable Healthcare 1 August 23, 2007

4 Response to Specific California Proposals The survey also examined small business attitudes toward three specific proposals that are currently under consideration in California. 66% of the survey respondents were at least reasonably aware of the current healthcare debate in Sacramento. A substantial plurality (near-majority) said that they favored the basic outline of the health care reform legislation (AB 8) proposed by Assembly Speaker Fabian Núñez and Senate President pro Tem Don Perata requiring businesses that do not offer insurance to to pay 7.5% of their payroll into a pool from which their employees must purchase insurance. A slightly larger plurality supported the basic outline of the proposal made by Governor Arnold Schwarzenegger requiring all Californians to have health insurance and mandating businesses that do not offer insurance to pay 4% of their payroll into a fund. A small plurality said that they favored the single-payer plan (SB 840) authored by Senator Sheila Kuehl. Governor s proposal -- 47% in favor; 31% opposed AB % in favor; 33% opposed SB % in favor; 40% opposed The responses also demonstrate widespread support for many of the other provisions in the pending California healthcare reform proposals, such as requiring health insurers to spend at least 85% of their premiums on care, offering health insurance regardless of health status, and requiring insurers to offer coverage to small businesses regardless of the workforce s health status. Other Responses Other responses further indicate that small business owners and managers support comprehensive healthcare reform. For example: 74% agreed that health insurers and prescription drug companies are making healthcare unaffordable because of their power to dictate prices. 58% felt that more people would start businesses if they knew they could get affordable health insurance without regard to pre-existing conditions. 46% were in favor of a one percent sales tax to make healthcare more affordable vs. 35% opposed. Key Cross-tabs With a few exceptions, responses were remarkably similar across important demographic groups: Whether or not the business offers health insurance: negligible difference on many questions; slight variations from the mean, ranging from 1% to 7%, on most important questions -- 1% to 4% support variations on questions regarding pending proposals Size of business: negligible difference on most questions; slight variations from the mean on a few important questions EXCEPTION: Political party affiliation: significant differences on most (though not all) important questions, based upon party affiliation 2007 Small Business for Affordable Healthcare 2 August 23, 2007

5 Key Demographics 40% offered insurance; 60% did not 84% employed 10 or fewer employees Broad range of business types 53% Male; 47% Female 73% White; 7% Latino; 6% Asian; 5% African-American; 9% Other/Don t Know 38% Democrat; 30% Republican; 3% Other; 29% Independent (of those who expressed a preference) Note: The demographic breakdown was very similar for telephone vs. on-line respondents, except: on-line respondents tended to be more female, more white, and more likely to be business owners (vs. senior managers). Conclusion California s small business owners and managers regard access to affordable healthcare as extremely important to their livelihood and business success. They overwhelmingly feel that companies should provide healthcare to their employees, and, by strong majorities and pluralities, they support a wide range of possible healthcare reform proposals. They feel a sense of responsibility to provide health insurance, including the obligation to pay into a statewide pool. They also support cost-containment and other reform measures. They do not, by and large, evidence a desire to reflexively oppose the reform measures that are currently on the table in Sacramento. A PowerPoint of Survey Details, and a copy of the Survey Questionnaire, are available at Small Business for Affordable Healthcare 3 August 23, 2007

6 Methodology Core Strategies designed and created a questionnaire designed to be completed by owners and senior managers of California small businesses, defined as companies who employ fewer than 100 people. The questionnaire was completed by 506 total respondents between August 2 and August 15, To insure the broadest, most representative cross-section of California small businesses, the survey was fielded using two methods most frequently used in commercial-quality primary market research: telephone and online. 261 respondents completed the survey via telephone. These respondents were selected at random using the Genesys business directory of nationwide businesses. Respondents spent approximately 15 minutes completing the survey, with a live operator asking the questions. 15% of respondents contacted agreed to participate in the survey. Respondents were provided a $25 incentive for completing the survey. 245 respondents completed the survey via online through the erewards global online market research panel. erewards maintains one of the world s largest panels for market research, with over 10 million consumers and businesses participating. Approximately 10,000 respondents were invited through to participate in the survey. The respondents spent approximately 8 minutes completing the survey. Responses were examined to insure that they were valid. Invalid respondents, who showed patterns of incomplete, rapid or spurious answers, were cleansed from the sample. Both telephone and online respondent composition was balanced by geographic region and number of employees to reflect the state business census. Samples from both the telephone and online sources were tabulated separately and were then combined to provide a unified report for this survey. Data analysis was performed on the sample and statistically significant differences between survey respondents were noted in the final report Small Business for Affordable Healthcare 4 August 23, 2007

7 Survey Results Key Findings 80% of those who expressed an opinion felt that employers should pay something to provide healthcare to their employees -- four times as many as those who felt that employers should not have to contribute anything (20%). Employer Subsidy of Premiums 80% of those who expressed an opinion felt that employers should pay to provide healthcare to their employees, but they were split on how much they should pay. Of those who expressed an opinion: 20% felt they should pay 7.5% or more [17% of all respondents] 23% felt they should pay more than 4% up to 7.5% [19% of all respondents] 37% felt they should pay 4% or less [31% of all respondents] 20% felt they should not have to pay anything [17% of all respondents] "For companies that do not currently offer health insurance, and who will be required to in the future, what percentage of their payroll costs do you think they should pay to cover their employees?" (N=506) Employers should not be required to contribute anything 4% 6% 17% 17% 4% or less of payroll costs More than 4, up to 7.5% of payroll costs Approximately 7.5% of payroll costs 6% 19% 31% More than 7.5%, up to 12% of payroll costs Over 12% of payroll costs Don't know 2007 Core Strategies CONFIDENTIAL 75% ranked the availability of affordable healthcare as extremely or very important. Affordable Healthcare Is An Extremely Important Issue 75% of small business owners and top managers rated the availability of affordable healthcare Very Important or One of the top one or two issues we face in business today How Important An Issue Is The Availability Of Affordable Health Care For The People Of California? (N=506) 10% 2% 13% 33% 5- One of The Top 1 or 2 Issues 4- Very Important 3- Somewhat Important 42% 2- Not a High Priority 1- Very Unimportant 2007 Core Strategies CONFIDENTIAL 2007 Small Business for Affordable Healthcare 5 August 23, 2007

8 57% see health care financing as a shared responsibility among individuals, employers and government three times as many as do not (19%). Healthcare Financing: A Shared Responsibility 57% of businesses see healthcare financing as a shared responsibility among individuals, employers and government almost 3 times as many who do not (19%) Share Responsbility Among Individuals, Employers and Government (N=506) Completely Agree 12% 2% Somewhat Agree 7% 31% Neutral 22% 26% Somewhat Disagree Completely Disagree Don't Know 2007 Core Strategies CONFIDENTIAL 55% were in favor of paying into a statewide pool that would enable their employees to obtain coverage at favorable rates over three times greater than those opposed (17%). Access To A Statewide Pool 55% of small business owners and managers were in favor of paying into a statewide pool that would enable their employees to obtain coverage at favorable rates over 3 times greater than those opposed (17%). Pay A Fee To A Statewide Pool That Bargains Down Costs, Then Provide Coverage To Workers (N=506) 7% 24% 10% 4% 32% Completely Agree Somewhat Agree Neutral Somewhat Disagree Completely Disagree Don't Know 23% 2007 Core Strategies CONFIDENTIAL 2007 Small Business for Affordable Healthcare 6 August 23, 2007

9 Response to Specific California Proposals 66% of the survey respondents were at least reasonably aware of the current healthcare debate in Sacramento. A substantial plurality (near-majority) said that they favored the basic outline of the health care reform legislation (AB 8) proposed by Assembly Speaker Fabian Núñez and Senate President pro Tem Don Perata requiring businesses that do not offer insurance to to pay 7.5% of their payroll into a pool from which their employees must purchase insurance. A slightly larger plurality supported the basic outline of the proposal made by Governor Arnold Schwarzenegger requiring all Californians to have health insurance and mandating businesses that do not offer insurance to pay 4% of their payroll into a fund.* A small plurality said that they favored the single-payer plan (SB 840) authored by Senator Sheila Kuehl. Governor s proposal* -- 47% in favor; 31% opposed AB % in favor; 33% opposed SB % in favor; 40% opposed *Note: Governor Schwarzenegger s proposal currently limits the 4% mandate to businesses with 10 employees or more. This distinction was not added to the question so as to get a direct comparison between the 7.5% and 4% mandates, and because the vast majority of the survey respondents employ fewer than 10 people, thus exempting them from the requirement. Proposal: Mandate 7.5% Employer Contribution 47% supported this proposal, while 33% were against it Proposal A. "Expand coverage by requiring all employers that do not provide health coverage to pay 7.5% of their total payroll costs into a statewide pool that would enable their employees to purchase subsidized coverage on a sliding scale..." (N=506) 19% 11% 14% 20% 36% 1-Completely Supportive 2-Somewhat Supportive 3 - Neutral 4-Somewhat Against 5-Completely Against 2007 Core Strategies CONFIDENTIAL 2007 Small Business for Affordable Healthcare 7 August 23, 2007

10 Proposal: Require Individuals To Purchase Insurance; Mandate 4% Employer Contribution 47% were in favor of this proposal, 31% were against it. Proposal B. Expand coverage by requiring all individuals to purchase health coverage, and require all employers that do not provide health insurance to pay 4% of their total payroll costs to help subsidize broader public health programs... (N=506) 16% 15% 15% 32% 22% 1-Completely Supportive 2-Somewhat Supportive 3 - Neutral 4-Somewhat Against 5-Completely Against 2007 Core Strategies CONFIDENTIAL Proposal: Single Payer System Respondents were split: 42% in favor and 40% against This option had the strongest negative and the lowest neutral Proposal C. Guarantee health care for all Californians by having a single statewide system, like Medicare, provide health coverage. The system would be funded through an additional 8 percent... (N=506) 24% 13% 29% 16% 18% 1-Completely Supportive 2-Somewhat Supportive 3 - Neutral 4-Somewhat Against 5-Completely Against 2007 Core Strategies CONFIDENTIAL The responses also demonstrate widespread support for many of the other provisions in the pending California healthcare reform proposals: 75% favored requiring health insurers to spend at least 85% of their premiums on care -- vs. 8% opposed. 70% favored offering health insurance regardless of health status vs. 9% opposed. 67% favored requiring insurers to offer coverage to small businesses regardless of the workforce s health status vs. 10% opposed Small Business for Affordable Healthcare 8 August 23, 2007

11 63% favored a requirement that employers offer Section 125 plans vs. 11% opposed. [Section 125 was explained in the question] 62% favored requiring insurers and HMO s to get state approval prior to raising premiums vs. 15% opposed. 58% favored expanding current public health programs vs. 15% opposed. 56% favored setting a timeline for hospitals and doctors having electronic medical records vs. 10% opposed. 37% favored raising Medi-Cal rates for doctors and hospitals vs. 22% opposed. [Note: very high neutral/don t know = 41%] Other Responses Other responses showed support for healthcare reform: 74% agreed that health insurers and prescription drug companies are making healthcare unaffordable because of their power to dictate prices vs. 11% who disagreed 58% felt that more people would start businesses if they knew they could get affordable health insurance without regard to pre-existing conditions almost three times those who disagreed (21%). 52% agreed that covering the uninsured decreases the hidden tax that we all pay in premiums and taxes vs. 20% who disagreed 46% were in favor of a one percent sales tax to make healthcare more affordable vs. 35% who were opposed. 43% agreed that it is unfair for businesses that provide coverage to compete against those who do not, and that a minimum employer contribution would level the playing field, vs. 25% who disagreed. Respondents split (38%-38%) on whether health care is a societal issue and should fall on the government, not on employers and individuals to provide 34% said that government should get out of the way and let the free market govern vs. 41% who disagreed 32% favored mandating that individuals purchase health insurance vs. 39% opposed. 22% believed that health insurance should be the sole responsibility of individuals, not employers or government vs. 2.5 times as many who disagreed (55%). Key Cross-tabs With a few exceptions, responses were similar across important demographic groups: Whether or not the business offers health insurance There was a negligible difference on many questions between companies that offered insurance and those who didn t (40% offered and 60% did not). There were slight variations from the mean, ranging from 1% to 7%, on most important questions. Here are four examples: 2007 Small Business for Affordable Healthcare 9 August 23, 2007

12 On the question of how much employers should pay to provide healthcare to their employees, here are the differences (among those who had an opinion) Offer Insurance Don t Offer Insurance All 7.5% or more 26% 13% 20% > 4% up to 7.5% 29% 19% 23% 4% or less 33% 40% 37% Should pay 0% 18% 23% 20% On the question of whether individuals without coverage should be obligated to purchase coverage: Offer Insurance Don t Offer Insurance All Favor 34% 30% 32% Oppose 32% 43% 39% On the question of whether responsibility for providing health insurance should fall on the government: Offer Insurance Don t Offer Insurance All Favor 31% 42% 38% Oppose 48% 32% 38% And, on the question of whether there should be a 1% sales tax to help make health care more affordable: Offer Insurance Don t Offer Insurance All Favor 43% 48% 46% Oppose 34% 35% 35% There were 1% to 4% support variations from the mean on the questions regarding pending proposals: Offer Insurance Don t Offer Insurance All Gov.: Favor-Oppose 51%-30% 44%-32% 47%-31% AB 8: Favor-Oppose 50%-32% 45%-34% 47%-33% SB 840: Favor-Oppose 39%-46% 43%-36% 42%-40% Size of business There were negligible differences on most questions among companies of different sizes (84% of respondents employed 10 or fewer people). There were slight variations from the mean on a few important questions. For example, larger companies were slightly more likely than smaller companies to favor higher levels of employer contribution obligations. Similarly, smaller companies were slightly more likely to support the 1% sales tax option. There was virtually no difference in the response to the single payer based upon size of business Small Business for Affordable Healthcare 10 August 23, 2007

13 Political party affiliation Political party affiliation was the one exception to the rule that demographic characteristics did not affect the way the questions were answered. There were significant differences on most (though not all) important questions, based upon party affiliation, with Democrats being far more likely than Republicans to embrace government intervention and the 1% sales tax. Regarding employer contribution obligations, differences still existed, but were less stark. For example, Democrats favored a requirement that government provide healthcare to employees by only 13 percentage points more than the Republicans. And, on the question of whether companies should pay into a statewide pool that would enable their employees to obtain coverage at favorable rates, Republicans still supported this 39%-30% [vs. Democrats: 66%-10% and All: 55%-17%.] Key Demographics 40% offered insurance; 60% did not For those who offered insurance the following reasons were given (multiple answers allowed): o 76%: Attracting good employees o 74%: Feel we have a responsibility o 57%: Workforce is more productive o 64%: Reducing workforce turnover o 25%: Lowering employee training costs For those who did not offer insurance the following reasons were given (multiple answers allowed): o 24%: The business cannot afford it o 14%: Revenues too uncertain o 11%: Too few employees want it o 8%: Do not really need it to attract good people o 6%: Employees cannot afford it o 5%: Employees would rather have higher wages o 3%: Too complicated to administer o 3%: Competitors do not offer it either o 3%: Too complicated to set up o 2%: Don t know o 47%: None of the above 84% or respondents employed 10 or fewer employees: o 37%: Sole proprietor o 36%: 2-5 employees o 11%: 6-10 employees o 8%: employees o 5%: employees o 3%: employees Broad range of business types: o 17%: Financial, legal, consulting or other services o 14%: Retail 2007 Small Business for Affordable Healthcare 11 August 23, 2007

14 o o o o o o o o o 12%: Creative or technical services 7%: Real estate 6%: Health care 6%: Construction 6%: Manufacturing 4%: Wholesaler 3%: Online/Internet business 1%: Agriculture 24%: Other 53% Male; 47% Female Ethnicity: o 73%: White o 7%: Latino o 6%: Asian o 5%: African-American o 1%: Native American o 4%: Other o 4%: Don t Know Broad range of ages: o 7%: o 16%: o 29%: o 31%: o 12%: o 4%: 70 or older o 1%: Refused to say Broad range of business revenue levels: o 16%: Under 50K o 13%: 50-99K o 19%: K o 10%: K o 5%: K o 5%: K o 8%: 1-2 million o 5%: 2-5 million o 4%: Over 5 million o 12%: Don t know o 3%: Refused to say 59% said their business was profitable vs. 24% unprofitable Party affiliation (of those who expressed a preference): o 38% Democrat o 30% Republican o 3% Other o 29% Independent Note: The demographic breakdown was very similar for telephone vs. on-line respondents, except: on-line respondents tended to be more female, more white, and more likely to be business owners (vs. senior managers) Small Business for Affordable Healthcare 12 August 23, 2007

15 Conclusion California s small business owners and managers regard access to affordable healthcare as extremely important to their livelihood and business success. They overwhelmingly feel that companies should provide healthcare to their employees, and, by strong majorities and pluralities, they support a wide range of possible healthcare reform proposals. They feel a sense of responsibility to provide health insurance, including the obligation to pay into a statewide pool. They also support cost-containment and other reform measures. They do not, by and large, evidence a desire to reflexively oppose the reform measures that are currently on the table in Sacramento Small Business for Affordable Healthcare 13 August 23, 2007

16 Organization & Contact Information Small Business for Affordable Healthcare Small Business for Affordable Health Care is a coalition of California small business owners and managers from across the state, representing a variety of types and sizes of businesses, who believe that the time for comprehensive health care reform is now. The coalition is a project of Small Business Majority. Small Business Majority Small Business Majority, based in Sausalito, California, is a national non-profit organization of business entrepreneurs working to ensure prosperity in the 21st Century economy by building a politically aware and active community of small business leaders. Core Strategies Core Strategies is a market research firm based in Laguna Hills, California. The company, founded in 1996, works with clients across the world in providing insights into business and consumer attitudes. One of its sub-specialties is research and analysis of small business target audiences. For further information, please contact: John Arensmeyer, Founder & CEO, Small Business Majority (415) ; Marshall Toplansky, Chairman & CEO, Core Strategies (949) ; Small Business for Affordable Healthcare Small Business for Affordable Healthcare 14 August 23, 2007

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