National Survey of Small Business Executives on Health Care Chart Pack Kaiser-Harvard Program on the Public and Health/Social Policy in conjunction with American Small Business Alliance Education Fund June 17, 1998
Small Business Experiences and Practices with Health Insurance and Managed Care
Chart 1 Health Benefits Provided by Small Businesses Percent of small businesses that provide health benefits to... Most commonly cited reasons for not offering health coverage Most FT Employees Some FT 8% Employees 9% Cost 57% Not Necessary 8% All Full-Time Employee 55% No FT Employees 27% All/Most Employees Covered Elsewhere 6% Company Too Small 6% Don't Know/Refused 1% 0% 20% 40% 60% 80% 100%
Chart 2 Larger and Higher Wage Businesses More Likely to Offer Coverage Percent of small businesses offering health insurance to all full-time employees % Offering Coverage to All FT Employees 80% 70% 60% 50% 40% 30% 20% 10% 0% 68% 72% 51% 41% 1 to 3 4 to 9 10 to 19 20 to 99 Number of Full-Time Employees % Offering Coverage to all FT Employees 80% 70% 60% 50% 40% 30% 20% 10% 0% 73% 59% 31% None Few/Less than Half Half or More # of Employees Earning More than $30,000
Chart 3 Health Plan Choices Offered by Small Businesses Number of health plans company offers employees Percent who say each is a major reason for not offering more health plan choices Only one plan 81% It's too expensive to offer more choices 51% Health plan rules require all or most employees to be in the same plan 51% 2% More than one plan 17% There would be too much administrative burden Not enough plans available locally 21% 40% 0% 20% 40% 60% 80% 100%
Chart 4 Making Decisions About Health Plans Percent of small business executives who say... When you last made a decision about which health plan to offer employees, the amount of information you had was... Most of what you needed 37% Dealing with health insurance issues is... Somewhat easy and straightforward 20% Somewhat difficult and confusing 31% All you needed 43% Some of what you needed 11% None of what you needed 3% 6% Very easy and straightforward 30% 4% Very difficult and confusing 15%
Chart 5 Small Business Executives Experiences with Health Plans Percent of small business executives who say... They or someone they knew experienced problems with health plan 51% Company had to switch health plans in past two years 30% They intervened on behalf of another employee who was having problems with his/her plan 20% 0% 20% 40% 60% 80% 100%
Chart 6 How Would You Rate Your Health Plan? Percent who give their health plan a grade of... Small business executives (largest plan offered) All Americans A 25% A 30% B 42% B 42% C 23% C 19% D 3% D 4% F 3% F 2% 4% Don t know 3% 0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50% Source: National Survey of Small Business Executives, Kaiser-Harvard Program on the Public and Health/Social Policy and the ASBA Education Fund, June 1998; Kaiser-Harvard Program on the Public and Health/Social Policy National Survey of Americans Views on Consumer Protection in Managed Care, January 21, 1998.
Chart 7 Source of Personal Health Coverage of Small Business Executives Not covered 6% Other source 5% Private individual coverage 12% Company plan 55% Spouse/family member 21% /refused 1%
Chart 8 Small Business Executives Views of Managed Care Percent who say during the last few years HMOs and other managed care plans have... Small business executives All Americans 7% 65% Decreased the amount of time doctors spend with patients Increased the amount of time doctors spend with patients 16% 61% 28% 58% Decreased the quality of health care for the sick Increased the quality of health care for the sick 32% 51% 20% 57% Made it harder for the sick to see medical specialists Made it easier for the sick to see medical specialists 25% 59% 31% 43% Not made much difference to health care costs Helped keep health care costs down 28% 55% 31% 43% Made it harder to get preventive services Made it easier to get preventive services 31% 46% 0% 50% 100% 0% 50% 100% Source: National Survey of Small Business Executives, Kaiser-Harvard Program on the Public and Health/Social Policy and the ASBA Education Fund, June 1998; Kaiser-Harvard Program on the Public and Health/Social Policy National Survey of Americans Views on Managed Care, November 5, 1997.
Small Business Executives Views of Consumer Protection Proposals and Their Potential Effects
Chart 9 Small Business Executives Views of Proposed Consumer Protections Would you favor or oppose a law requiring health plans to... Provide people with information about how the health plan operates, such as the benefits covered, the doctors in the plan, and how to get complaints resolved Favor 89% Oppose Don t know 5% 6% Allow people to appeal a health plan's decision to an independent reviewer if they are denied coverage or a particular medical treatment 88% 8% 4% Allow a woman to see a gynecologist without having to get permission or see her regular doctor first 84% 11% 5% Pay for an emergency room visit when someone might reasonably believe they need immediate medical attention -- even if the problem doesn't turn out to be serious 77% 18% 5% Allow people with serious medical conditions to see a specialist without always having to get permission or see their regular doctor first 75% 21% 4% Allow patients to sue a health plan for malpractice, like they can now sue a doctor 61% 30% 9% 0% 20% 40% 60% 80% 100%
Chart 10 What if Costs Rose as a Result? Would you still favor this law if you heard it might increase the cost of people s health insurance premiums? Provide people with information about how the health plan operates, such as the benefits covered, the doctors in the plan, and how to get complaints resolved Yes, would still favor 69% No, would oppose Don t know 21% 10% Allow people to appeal a health plan's decision to an independent reviewer if they are denied coverage or a particular medical treatment 72% 20% 8% Allow a woman to see a gynecologist without having to get permission or see her regular doctor first 66% 26% 8% Pay for an emergency room visit when someone might reasonably believe they need immediate medical attention -- even if the problem doesn't turn out to be serious 66% 27% 7% Allow people with serious medical conditions to see a specialist without always having to get permission or see their regular doctor first 59% 33% 8% Allow patients to sue a health plan for malpractice, like they can now sue a doctor 51% 36% 13% 0% 20% 40% 60% 80% 100%
Chart 11 What if Government Involvement in Health Care Increased? Would you still favor this law if you heard it might get the government too involved in health care? Provide people with information about how the health plan operates, such as the benefits covered, the doctors in the plan, and how to get complaints resolved Yes, would still favor No, would oppose Don t know 49% 37% 14% Allow people to appeal a health plan's decision to an independent reviewer if they are denied coverage or a particular medical treatment 44% 42% 14% Allow a woman to see a gynecologist without having to get permission or see her regular doctor first 46% 43% 11% Pay for an emergency room visit when someone might reasonably believe they need immediate medical attention -- even if the problem doesn't turn out to be serious 45% 42% 13% Allow people with serious medical conditions to see a specialist without always having to get permission or see their regular doctor first 41% 50% 9% Allow patients to sue a health plan for malpractice, like they can now sue a doctor 33% 54% 13% 0% 20% 40% 60% 80% 100%
Government Involvement vs. Ensuring People Get Care They Need Would you favor laws that would require HMOs, managed care plans and health insurance companies to do each of the following to make sure people get the care they need or oppose such laws as unnecessary government involvement in health care? Provide people with information about how the health plan operates, such as the benefits covered, the doctors in the plan, and how to get complaints resolved Chart 12 Favor to ensure people get care 88% Oppose as unnecessary gov t. involvement 8% Don t know 4% Allow people to appeal a health plan's decision to an independent reviewer if they are denied coverage for a particular medical treatment 86% 10% 4% Allow a woman to see a gynecologist without having to get permission or see her regular doctor first 81% 12% 7% Pay for an emergency room visit when someone might reasonably believe they need immediate medical attention -- even if the problem doesn't turn out to be serious 74% 19% 7% Allow people with serious medical conditions to see a specialist without always having to get permission or see their regular doctor first 76% 19% 5% Allow patients to sue a health plan for malpractice, like they can now sue a doctor 66% 25% 9% 0% 20% 40% 60% 80% 100%
Chart 13 Who Should Regulate Managed Care? Percent who say each is the best way to ensure consumers are treated fairly and get the proper care A non-government independent organization developing and enforcing standards that plans must follow 57% 62% The government developing and enforcing standards that plans must follow 12% 23% The managed care industry monitoring itself and setting voluntary standards for plans to follow 14% 15% None/other(vol) 2% 2% /refuse 3% 10% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Note: Vol means response was volunteered by respondent, not an explicitly offered choice. All Americans Small Business Executives Source: National Survey of Small Business Executives, Kaiser-Harvard Program on the Public and Health/Social Policy and the ASBA Education Fund, June 1998; Kaiser-Harvard Program on the Public and Health/Social Policy National Survey of Americans Views on Consumer Protection in Managed Care, January 21, 1998.
Chart 14 How Small Businesses Who Now Offer Coverage Say They Would Respond to a Cost Increase If your share of health insurance premiums for a single employee increased by $1-5/$15-20 what would your company be most likely to do? Increase of one to five dollars per month per employee Increase of fifteen to twenty dollars per month per employee 50% Absorb this additional cost 45% 33% Pass on SOME cost to employees 35% 9% Pass on ALL of cost to employees 8% 1% Drop coverage entirely 3% 2% Switch to a plan with lower premiums (vol) 3% 5% 6% 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Note: Vol means response was volunteered by respondent, not an explicitly offered choice.
None 30 Chart 15 What Small Business Executives Say Might Happen If proposed consumer protections were passed into law, percent of small business executives who think... The cost of health insurance premiums would increase... A lot 37% A lot more 41% 30% A little 25% Not at all 7% Some (vol.) 1% Government involvement in health care would be... A little more 22%...employers would drop health coverage for their workers Only a few 42% Many 18% The law would lead to... Better health care/more information 21% 29% None would drop coverage 9% Some (vol) 2% Not much improvement to patient care and information 49% No more 10% Some more (vol) 26% 1% Note: Vol means response was volunteered by respondent, not an explicitly offered choice. 28% Would make things worse (vol) 2%
Chart 16 How Closely the Consumer Protection Debate is Being Followed Percent who followed news reports about health care consumer protection legislation... Not too closely 30% Small business executives Fairly closely 26% Not too closely 24% All Americans Fairly closely 22% Very closely 8% Very closely 11% Not at all closely 22% 14% Not at all closely 37% 6% Source: National Survey of Small Business Executives, Kaiser-Harvard Program on the Public and Health/Social Policy and the ASBA Education Fund, June 1998; Kaiser-Harvard Health News Index, March/April 1998.