Benchmark on Health Care Coverage Perceptions and Readiness

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1 Benchmark on Health Care Coverage Perceptions and Readiness The First Annual Transamerica Center for Health Studies SM Survey September 2013 Transamerica Center for Health Studies, 2013 Transamerica Center for Health Studies, 2013

2 Table of Contents About the Transamerica Center for Health Studies Page 3 About the Survey Page 4 Methodology Page 5 Terminology Used Page 7 Iconography Used Page 8 Executive Summary Page 9 Recommendations for Affordable Care Act Readiness Page 15 Detailed Findings Page 16 The Current Health Care Landscape Page 16 Health Care Benefits Management Page 25 Health Care Priorities Page 36 Perception of and Preparation for the Affordable Care Act Page 44 Changes in the Future Page 56 The Impact of Company Size Page 61 Appendix Page 81 2

3 About the Transamerica Center for Health Studies SM The Transamerica Center for Health Studies (TCHS) informs the national health care conversation, bringing clarity to the complex decision-making regarding health coverage and personal health and wellness. Through its broad-based analysis and research findings, TCHS offers consumers and employers a guide to navigate the financial implications of the health care decisions they are facing. TCHS engages with the American public through national surveys, its website, research findings and consumer guidance. TCHS also collaborates with health care experts and organizations that are equally focused on health coverage and personal health and wellness. A division of the Transamerica Institute, a nonprofit, private foundation, TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide. The Transamerica Institute is funded by contributions from Transamerica Life Insurance Company and its affiliates (not a major medical insurer) and may receive funds from unaffiliated third parties. 3

4 About the Survey The Transamerica Center for Health Studies SM (TCHS) has conducted a national survey of both the U.S. General Adult Population and businesses (Employers) regarding their attitudes toward health care and health insurance coverage as they face a shifting health care coverage landscape. The Survey took place in July 2013 and asked randomly selected Americans and Employers questions about their health care needs and preferences and also about their preparedness for and expectations relating to the Affordable Care Act. The overall goals for the study are to illuminate emerging trends, promote awareness, and help educate the public about healthcare and health coverage. The 2013 Survey is the first of what will be an annual nationwide health care survey. Harris Interactive was commissioned to conduct the survey for TCHS and it was conducted independently. TCHS is not affiliated with Harris Interactive. 4

5 Methodology: General Population Survey An 18-minute online survey was conducted July 9 22, 2013 among a nationally representative sample of 2,505 members of the U.S. General Adult Population using the Harris online panel. Among the respondents: All were U.S. residents aged ,704 were working (full-time, part-time, or self-employed). Data were weighted (statistically adjusted) on income, education, gender, race/ethnicity, region, employment status, number of employees in company, and health insurance status to: Account for differences between the population available via the Internet versus by telephone. Be a representative sample of the U.S. General Adult Population age Percentages were rounded to the nearest whole percent. Differences in the sums of combined categories/answers are due to rounding. 5

6 Methodology: Employer Survey A 15-minute online survey was conducted July 15 29, 2013 among a nationally representative sample of 758 employers. Respondents were targeted based on company size and for-profit status and met the following criteria: Business executives who make decisions about employee benefits at his or her company. For-profit companies that employ 1 or more employees across all locations. Quotas were set for the following sizes: 1 9 employees, employees, employees, employees, and 500 or more employees. Results were weighted as needed on employee size using weighting targets from the Survey Sampling International database to ensure each quota group had a representative sample based on the number of employees within each company size range. Percentages were rounded to the nearest whole percent. Differences in the sums of combined categories/answers are due to rounding. 6

7 Terminology This report uses the following terminology: General ACA: Affordable Care Act Gen Pop: General Adult Population Workers: Those among the Gen Pop who are full-time, part-time, or self-employed, unless otherwise noted Employers: Weighted sample of employers surveyed Company Size Small company: 1 49 employees (EEs) Micro company: 1 9 employees (EEs) Small non-micro company: employees (EEs) Medium company: employees (EEs) Large company: 500 or more employees (EEs) Generations Millennials : Those born Younger Millennials: Those born Older Millennials: Those born Generation X: Those born Baby Boomer: Those born

8 Iconography This report uses the following iconography: : Slide contains data from the Employer survey. : Slide contains data from the Gen Pop survey. Some slides show subsets of the Gen Pop (e.g., full-time, part-time, or self-employed Workers) rather than all of the Gen Pop. 8

9 Executive Summary The Transamerica Center for Health Studies SM (TCHS) is pleased to release its inaugural research report entitled The First Annual Transamerica Center for Health Studies SM Survey: Benchmark on Health Care Coverage Perceptions and Readiness. This report is intended to shed light on America s preparedness for the implementation of the forthcoming provisions of the Affordable Care Act (ACA) as of 2013 and continuing through It explores the preparations and preferences among the General Adult Population (Gen Pop) and Employers and, in comparing their views, it uncovers some disconnects along the way. Ultimately, this report aspires to outline key issues, areas of concern and opportunity, and ways that consumers, workers and employers can become better educated to make the most informed decisions about health insurance coverage. The extent that the Gen Pop and Employers feel informed about the ACA is mixed and many do not feel informed at all, despite the law s fast approaching requirement that individuals obtain coverage by January 1, Fewer than half of the Gen Pop (48 percent) report being informed about the ACA, however, only 11 percent are very informed. [page 46] The majority of Employers (70 percent) indicate being informed about the ACA, however, only 25 percent are very informed. [page 46] The majority of the Gen Pop and Employers indicate they are prepared to make health coverage decisions related to the ACA, but many have not taken any action to prepare. 63 percent of the Gen Pop and 73 percent of Employers report they are prepared to make health insurance choices after the individual and employer mandates go into effect. [page 52] Although the majorities of both groups say they are prepared, many of the Gen Pop (57 percent) and Employers (28 percent) said they had not taken any action in the past 12 months to prepare for the ACA. [page 55] 9

10 Executive Summary The 2014 mandate for individual health coverage is looming, especially for the 43 percent of the Gen Pop who do not have insurance through an employer. Many of them are still undecided about where they will obtain coverage. 43 percent of the Gen Pop does not currently have coverage through an employer and 21 percent do not have health insurance at all. [page 18] With the individual health coverage mandate taking effect in 2014, and open enrollment in the state exchanges starting October 1, 2013, among those who do not have health insurance through an employer: - 39 percent are not sure about where they will get health coverage - 36 percent plan to keep their current coverage - 17 percent plan to purchase health coverage through a state exchange - 8 percent do not plan to purchase insurance. [page 53] The lack of familiarity and preparedness, along with other unknowns about the ACA, is fueling paradoxical perceptions. The Gen Pop and Employers frequently cited cost and affordability of health insurance as both concerns and possible improvements that might result from the ACA. The majority of the Gen Pop (54 percent) are concerned that the cost of their health insurance coverage and that out-ofpocket expenses will increase. For Employers, the most frequently cited concern is higher costs to the company for Employee health coverage (38 percent). [pages 48-49] In terms of possible improvements resulting from the ACA, the Gen Pop most frequently cites an interest in a decrease in the costs of their health coverage and out-of-pocket expenses (44 percent). Similarly, among Employers, the ability to provide health coverage for all employees at an affordable cost (29 percent) and pay lower costs for employee health coverage (26 percent) are most frequently cited. [pages 50-51] 10

11 Executive Summary Workers and Employers agree on the importance of health insurance coverage; nevertheless, many Employers prefer the idea of providing a bonus/subsidy for their employees to receive health coverage elsewhere. Among full-time and part-time Workers, health coverage is the fourth most frequently cited factor in job satisfaction (55 percent responding very important) behind only salary/pay (70 percent), financial strength of company (57 percent), and work/life balance (56 percent). Employers also cite health care benefits fourth in attracting and retaining employees (48 percent indicate it is very important). [page 20] When presented with the two options of receiving health insurance through their Employer or receiving a bonus/subsidy to purchase insurance elsewhere: The majority of full-time and part-time Workers (71 percent) prefer to receive health coverage through their employer. Many Employers (64 percent) believe this is what employees prefer. [page 43] However, in contrast to employee preferences, Employers are more evenly split just over half of Employers (54 percent) prefer the option to provide health coverage and 46 percent prefer a bonus/subsidy for their employees to purchase coverage elsewhere. [page 43] Employers and Workers face directly conflicting interests regarding health insurance coverage: Employers prioritize lower costs over higher quality, while Workers prioritize higher quality over lower cost. The majority of Workers (62 percent) prefer to pay more for a higher quality health coverage option compared to only 38 percent who would prefer to reduce insurance costs even if it means lower quality. [page 41] In direct opposition, the majority of Employers (57 percent) prefer to reduce coverage costs even if it means a lower quality option. Only 43 percent of Employers prefer to pay more for a higher quality option. [page 41] 11

12 Executive Summary Despite concerns among many Employers that health coverage costs may rise due to the ACA, very few expect to drop their health coverage and the majority do not anticipate labor force reductions. Many Employers (41 percent) expect the ACA to negatively impact their company s health coverage costs in the next 2-3 years, while 27 percent expect a positive impact. The majority of Employers (59 percent) expect their company s benefits plan design to change. However, only 7 percent expect to remove health insurance in the next 1-2 years. [pages 57-59] Few Employers (19 percent) anticipate a reduction in employees as a result of the ACA. The majority of Employers (61 percent) do not anticipate any changes and, interestingly, 20 percent anticipate increasing employees. [page 60] An information gap exists where few Employers provide what Workers say they need to decide about health coverage options. Workers say they need the following information to make decisions about their health insurance options in the next 1-2 years: A description of the benefits available is needed by 51 percent of Workers. A comparison of how health insurance costs may change is needed by 50 percent of Workers. A comparison of coverage among plans available is needed by 47 percent of Workers. [page 35] Only 12 percent of Employers provide all three of these pieces of information. A description of the benefits available is provided by 47 percent of Employers. A comparison of how health insurance costs may change is provided by 24 percent of Employers. A comparison of coverage among plans available is provided by 30 percent of Employers. [page 35] Online tools and benefits advisors are seen as the most helpful channels for seeking health coverage-related information by Workers (59 percent and 47 percent, respectively) yet are less likely to be offered by Employers (40 percent and 32 percent, respectively). [page 33] 12

13 Executive Summary Small companies face unique circumstances and opportunities in light of the ACA. Small companies are far less likely to offer health care benefits to full-time Workers (50 percent vs. 95 percent of medium and 97 percent of large companies). [page 62] Small companies are more likely than medium or large companies to prefer reducing insurance costs even if it means a lower quality health coverage option (61 percent vs. 50 percent of medium and 55 percent of large companies). [page 64] Small companies (32 percent) are more likely to be dissatisfied with current health insurance options than medium (16 percent) or large (11 percent) companies. [page 67] Small companies are more likely to be uninformed about their health coverage options (28 percent vs. 8 percent of medium and 14 percent of large companies) and uninformed about changes in the health care industry that impact their health care coverage options (30 percent vs. 12 percent of medium and 17 percent of large companies). [pages 68, 70] Specific to the ACA, 39 percent of small companies report being not very or not at all informed about the ACA compared to large (35 percent) and medium (22 percent) companies. [page 75] Lastly, almost half (49 percent) of small companies have not taken any actions in the past 12 months to prepare for the ACA, much higher than large (15 percent) or medium (12 percent) companies. [page 78] Despite conflicting views about costs and quality of health insurance coverage, Employers and the Gen Pop share common interests in wellness programs. The vast majority of Employers (83 percent) strongly or somewhat agree that implementing health/wellness and disease management programs lead to better control of health care costs. [page 31] The Gen Pop identified discounts for wellness services (31 percent) just behind low premiums, co-pays, and deductibles (40 percent) as elements missing from their health care options. [page 23] Additionally, when asked about potential approaches to health care, the majority of the Gen Pop (78 percent) indicated interest in receiving cash incentives or insurance premium discounts for healthy behaviors. [page 24] 13

14 Executive Summary In Conclusion The implementation of the ACA s 2014 mandate for individual health insurance and 2015 mandate for employer health insurance coverage over 50 employees, along with the formation of State Exchanges, requires individuals and employers to become educated about their options in order to make informed decisions. Relatively few Employers (25 percent) or members of the Gen Pop (11 percent) are very informed about the relatively new law. Many believe they are prepared to make decisions but few have taken action to prepare. Among those who do not currently receive health coverage through an Employer, many are unsure where they will obtain coverage when the individual mandate takes effect in Health insurance costs and quality are top of mind for all. Workers and Employers agree on the important role of health coverage in employment choices and job satisfaction; however, priorities among Workers and Employers are in direct conflict. Most Workers prefer a higher quality even if it means a higher cost. And many Employers are focused on minimizing costs even if it means a reduction in quality. Workers have also stated a need for information about their health coverage options that Employers are not yet providing. Despite concerns among many Employers that health costs may rise due to the ACA, few anticipate reducing the number of their employees due to the ACA. Even fewer expect to drop their health coverage in the next 1-2 years. Small companies face unique circumstances and opportunities. They are less likely to offer health coverage benefits and less satisfied with options available to them and less likely to be familiar with the ACA which will bring about new alternatives for their employees. Amidst the conflicting views, one thing that the Gen Pop and Employers agree on is the importance of wellness programs to promote healthy behavior. 14

15 Recommendations for Affordable Care Act Readiness Gen Pop/Workers 1. Look over communications from your employer regarding changes in health coverage, and be on the lookout for changes in providers and costs. 2. Ask your employer for additional information if you think it is needed to make informed decisions, such as details of plan options and plan comparisons. 3. Do not pick a plan only based on the lowest monthly premium or lowest annual deductible. Look closely at what is covered and how much you will have to pay out of pocket when you get care. 4. If you do not have health coverage through your employer, look up the health coverage options in your state exchange and/or consult with a benefits advisor/health consultant. 5. Get familiar with the ACA look up the resources at Businesses 1. Provide plan comparisons of costs and coverage features when giving health coverage information to employees. 2. Compare the pricing and benefits you receive for health coverage with what is available in your state exchange or Small Business Health Insurance Options Program (SHOP). 3. Get familiar with the Affordable Care Act (ACA) look up the resources at 4. If you have less than 25 employees, find out if you can qualify for tax incentives if you provide health insurance to your employees. Find out more at 5. Consider implementing an employee wellness program to keep your employees healthy and keep costs down. See if you can qualify for a federal grant to start your wellness program. Find out more at 15

16 The Current Health Care Landscape 16

17 Many Are Satisfied with the Quality of the Health Care System Seventy-nine percent of the Gen Pop are at least somewhat satisfied with the health care system to which they have access. However, only 29 percent are very satisfied. Satisfaction of Quality of Health Care System A similar majority of fulltime/part-time/self-employed Workers (79 percent) are satisfied with the quality of the health care system to which they have access. 100% 80% 60% Very satisfied Somewhat satisfied 40% 50 Not very satisfied Not at all satisfied 20% 13 0% 8 Total Gen Pop BASE: Total Gen Pop (n=2505) Q730. Overall, how satisfied are you with the quality of the health care system you have access to today? When we say health care system we are referring to all things related to health care including doctors, nurses, and other health care providers, hospitals, insurance, etc. 17

18 Employers Are the Most Cited Source of Health Insurance Most of the Gen Pop (57 percent) receive their health insurance primarily through an employer, and about one-fifth (21 percent) currently do not have health insurance.* Primary Health Insurance Benefits Received Through employer Through union percent of Workers receive their health insurance primarily through an employer. 16 percent of Workers do not have health insurance. Through trade association 0 Buy own health insurance, not through work Receive benefits through Medicare Receive benefits through Medicaid or other state funded program Those working part-time (35 percent) or not working (30 percent) are more likely not to have health insurance compared to those working fulltime (13 percent). Receive benefits through military service Receive VA benefits from own or spouse's service 1 2 Workers in small companies (29 percent) are more likely than those working in medium (15 percent) or large (11 percent) companies not to have health insurance. Do not have health insurance at this time 21 Those without a 4 year college degree (26 percent) are more likely than those with a college degree (10 percent) to not have health insurance. *Note: For comparison, the U.S. Census 2012 Current Population Survey (CPS) has an uninsured rate of 21 percent among Americans years of age. BASE : Total Gen Pop (n=2505) Q602. Which of the following best describes how you primarily recieve health insurance benefits today? 18

19 Many Employers Do Not Offer Health Care Benefits to Any Employees The majority of Employers (78 percent) currently offer their full-time employees health care benefits while one fifth (21 percent) currently don t offer these to any employees. Only 14 percent offer benefits to parttime employees. Types of Employees Offered Health Care Benefits 78 Total Employers 14 Small companies (49 percent) are more likely than medium (5 percent), or large (2 percent) companies to offer no health care benefits to their employees. 21 Yes, full-time employees Yes, part-time employees No, none Companies that are not prepared for the ACA (39 percent) are more likely than those who indicate they are prepared (15 percent) to offer no health care benefits to their employees. *Note: Data for Employers was weighted based on the number of employees found within each company size. Therefore, direct comparisons to other surveys with employer data should keep this in mind. BASE: Total Employers (n=758) Q800. Does your company provide health care benefits to any of your employees? 19

20 Health Care Benefits Play a Role in Job Satisfaction Health care benefits was the fourth most cited important factor for job satisfaction among full-time and part-time Workers (55 percent say it is very important), and Employers indicate it is the fourth most important factor in attracting and retaining employees (48 percent say it is very important). Salary/pay Factors for Job Satisfaction Factors for Attracting and Retaining Employees Financial strength/stability of the company Flexibility for work/life balance Health care benefits Retirement benefits Support of direct manager Team environment Commute Career advancement Company s reputation in the industry Company culture Other benefits Very important Somewhat important Not very important Not at all important BASE: Total full-time or part-time Workers (n=1615) Q1105. When thinking about your job/career, how important are each of the following factors in your overall job satisfaction? BASE: Total Employers (n=758) Q716. How important are each of the following attributes in your company s ability to attract and retain employees? 20

21 Quality in the Health Care System Consists of Different Elements The Gen Pop most frequently cites characteristics of quality, such as doctors having sufficient time to treat patients (42 percent), a focus on preventative care (40 percent), and technology to help doctors better understand and diagnose diseases (32 percent). Characteristics of Quality in the Health Care System Full-Time/Parttime/Self-Employed Workers Doctors having sufficient time to treat their patients A focus on preventative care Technology to help doctors better understand and diagnose diseases Universal access to health insurance Having a choice in health insurance plans Follow up care to keep people on the right track Prevention of hospital and facility-related infections Prescription medicines that help me better manage chronic diseases A focus on effective treatment to minimize the length of hospital stays Effective sharing of my health or medical information and coordination among all my healthcare providers Specialized surgeries that were not possible 10 years ago Standardization of processes to reduce mistakes Access to some basic healthcare procedures in more convenient places Other BASE: Total Gen Pop (n=2505) Q735. When you think of the word quality in the health care system today, what are some of the characteristics that come to mind? Please select up to three characteristics from the following list that you associate most with quality. 21

22 Deep Knowledge of Health Insurance Options Is Low Among the General Population and Employers Most of the Gen Pop (75 percent) and Employers (81 percent) are at least somewhat informed about their personal and their company s health insurance options, but only 22 percent and 37 percent, respectively, are very informed. 100% Informed of Health Insurance Options 100% Informed of Health Insurance Options 80% 22 Very informed 80% 37 60% 40% 75 Somewhat informed 60% Not very informed 40% 44 20% 19 Not at all informed 0% 6 0% Total Gen Pop Women (28 percent) are more likely not to feel Employees of small companies (32 informed compared to percent) are more likely than those men (22 percent). in medium (21 percent), or large (18 percent) companies to not feel informed. BASE: Total Gen Pop (n=2505) Q1000. How informed do you feel about your current options for health insurance (i.e., major medical insurance)? BASE: Total Employers (n=758) Q1005. Regardless of whether you offer insurance, how informed do you feel about your company s current options for health insurance (i.e., major medical health insurance)? 20% 13 6 Total Employers 22

23 Ways to Lower Health Care Costs Are the Most Cited Elements Missing from Health Care Options Low monthly premiums, co-pays, and deductibles (40 percent) and discounts for wellness services (31 percent) are the two most cited elements mentioned by the Gen Pop that are missing from their current health care options. Missing Elements from Current Health Care Options Low monthly premiums, co-pays, and/or deductibles Discounts for wellness services (e.g., dietician, fitness equipment) A wider variety of insurance plans to choose from Affordable access to brand name drugs Affordable access to the best doctors in my area Baby Boomers (44 percent) are more likely than Younger Millennials (29 percent) to indicate low monthly premiums, co-pays, and/or deductibles as missing from their current health care options. Direct access to specialists Affordable access to the latest medical technologies Health insurance access for my family Coverage for specific items that my family or I need Physician or hospital reimbursement tied to patient outcomes Affordable access to specialty drugs for diseases like cancer, rheumatoid arthritis, or MS Access to a health advocate who can help me find the best doctors/hospitals and help me understand my medical bills None of the above Baby Boomers (29 percent) are less likely than Older Millenials (37 percent) to indicate discounts for wellness services as missing from their current health care options. Workers (34 percent) are more likely than the Gen Pop to select discounts for wellness as missing from health care options. BASE: Total Gen Pop (n=2505) Q805. Which of the following elements are missing from your current health care options that are important to you? Please select all that apply. 23

24 High Level of Interest Exists in Different Approaches to Health Care Services When asked about possible approaches to health care, receiving cash incentives, or discounts on health insurance premiums for healthy behaviors (78 percent) and receiving primary care or disease management from a nurse practitioner or physician s assistant (68 percent) are the two proposed approaches to generate the most interest. Potential Approaches to Health Care Very/Somewhat Interested Receiving cash incentives or insurance premium discounts for healthy behaviors 78 Receiving regular primary care or disease management from a Nurse Practitioner or Physician's Assistant in lieu of a doctor for lower healthcare costs Receiving healthcare services and procedures from an Accountable Care Organization Receiving routine healthcare procedures from clinics set up in retail locations rather than a doctor's office. 62 Receiving healthcare services and procedures from a Patient Centered Medical Home 61 BASE: Total Gen Pop (n=2505) Q800. How interested are you in each of the following potential approaches to health care? 24

25 Health Care Benefits Management 25

26 Employers Are Satisfied with Their Health Insurance Options The majority (80 percent) of all Employers, regardless if they currently offer health insurance, are satisfied with their company s current health insurance options. 100% Satisfaction with Health Insurance Options 80% 26 Very satisfied 60% 80 Somewhat satisfied 40% 54 Not very satisfied 20% 0% 13 7 Total Employers Not at all satisfied BASE: Total Employers (n=758) Q1007. Regardless of whether your company offers health insurance, how satisfied is your company with its current health insurance options? 26

27 Employers Evaluate Health Care Benefits Infrequently Most Employers (57 percent) review health care benefits offered about once a year. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% % Frequency of Evaluating Health Care Benefits Total Employers 4 About every six months About once a year About every two years or more Never Don t know Small companies (35 percent) are more likely than medium (3 percent) or large companies (0 percent) to never evaluate the health care benefits offered to employees. Companies that do not work with a benefits advisor (28 percent) are more likely than those that work with a benefits advisor (<1 percent) to never evaluate the health care benefits offered to employees. BASE: Total Employers (n=758) Q1000. How frequently does your company evaluate the health care benefits offered to employees? 27

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