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November 14, 2006
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Christopher Fleming
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Americans Value Health Plan Choice, Expanded Coverage As Long As They Don’t Have To Pay: New Survey

New Health Affairs Issue Asks: Will Employer Coverage Endure?

Bethesda, MD -- A new national survey gauging Americans’ attitudes toward the financing and provision of health insurance shows that consumers want more coverage and choice but don’t want to pay higher insurance costs, that the uninsured are more likely to reject policies that mandate the purchase of health insurance, and that more than one in four Americans are comfortable with charging obese people higher premiums for their benefits. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w596 The survey, conducted by a national opinion research firm, was released today at a Health Affairs briefing in Washington D.C., and published as a November 14 Health Affairs Web Exclusive.

Researchers from NORC at the University of Chicago found that Americans have difficulty  making trade-offs to reform the health system and make coverage more broadly available, preferring instead to put the onus on government and employers. “Overall, Americans seem to be hoping for a better deal: there is little evidence of self-sacrifice,” says Daniel Gaylin, NORC executive vice president and coauthor of the Health Affairs article. “They want employers and the government to do more to help pay for coverage but they still want the right to choose from different policies.”

The survey is part of a series of thematic articles, both online and in the November-December print edition of Health Affairs, that examine trends in private health insurance. The print edition is titled “Will Employer Coverage Endure?” http://content.healthaffairs/org/current.shtml The volume addresses this question through articles by leading experts including James Robinson, Helen Darling, Thomas Buchmueller, Alain Enthoven, John Goodman, Heidi Whitmore, and Martin Feldstein.  The NORC survey and the November-December Health Affairs were both funded by the California HealthCare Foundation.

The NORC survey sought the views of 1,517 people on their attitudes toward employer-based health insurance, mandatory vs. voluntary health insurance, how well the health system is working, the appropriate financing roles of the public and private sectors, and whether personal behavior should drive health insurance premium rates.

Sizable Minority Favor Charging Higher Premiums When People Are Obese

NORC researchers found that at a time when many state and federal policymakers are looking at the merits of Massachusetts’ mandatory health insurance law, support for such policies wavers depending on a person’s situation. More than three-quarters of those who lack health insurance reject the idea of mandating that it be purchased. Researchers say that this could be because they have consciously chosen to avoid coverage and want to reserve the right to make that choice, or because coverage is too expensive.

When it comes to personal responsibility, consumers increasingly support making people pay more for unhealthy behavior. A majority believe that smokers should pay more for health insurance, and a sizable minority believe that charging obese people higher premiums is appropriate. That sentiment is strongest in California. Researchers took a subsample of views in that state because one in five Americans live there. Forty-three percent of Californians said that obese people should be charged higher premiums, compared to 28 percent nationally, an opinion that researchers say could be attributable to the state’s strong emphasis on healthy living coupled with rising levels of obesity.

Does Employer-Based Coverage Have A Future?

Highlights of the November-December issue:

-- A study by Yale University School of Medicine professor Patricia Seliger Keenan and colleagues at Harvard University warns that trends are leading to the “graying” of group health insurance, in which the population with employer-based coverage is becoming older and wealthier at a rate greater than the population overall. http://content.healthaffairs.org/cgi/content/abstract/25/6/1497

Keenan and coauthors David Cutler and Michael Chernew looked at declines in private insurance by income and age and found that older, more affluent people in working families are more likely to keep their employer-based coverage as premiums rise while others increasingly get public coverage or go without altogether. These trends, the authors warn, make it harder for health insurers to pool risks since fewer younger people with lower health costs are covered by these plans.

“If the trends continue, private group health insurance will be increasingly dominated by older and wealthier people,” says Keenan. “As the baby boom generation approaches retirement, population aging, combined with declines from rising premiums could further destabilize the employment-based system,” she says.

-- The University of Michigan’s Thomas Buchmueller and colleagues look at trends in retiree health insurance and reveal a steady erosion in such benefits over the past decade. About a quarter of private-sector employees worked in places that offered health benefits to retirees in 2003, down from 32 percent in 1997, they report. Although the public sector continues to offer health benefits to retirees, the authors warn that these benefits “are also under pressure” because of rising health costs and an aging workforce. http://content.healthaffairs.org/cgi/content/abstract/25/6/1507

-- Business leaders Robert Galvin and Suzanne Delbanco explain why employers are in a Gordian knot when it comes to providing health benefits. The authors say that employers have “largely been ineffective and unenthusiastic managers” of the health benefits they sponsor, but they are constrained from getting out of the health benefits business. Employers are becoming more interested than ever before in exiting their roles as health benefit providers, but the authors doubt that this will happen imminently. A more likely result will be that employers will continue their current course and generally resist proactively managing the health care of their employees, leading to continued frustration. http://content.healthaffairs.org/cgi/content/abstract/25/6/1548

-- Sacramento Healthcare Decisions Executive Director Marjorie Ginsburg and coauthors report that California residents did not opt for high consumer cost-sharing when given limited resources to construct a minimum coverage plan “below which no one should fall.” Participants in a computer-based simulation exercise instead distinguished essential from nonessential health care needs, tolerated tight restrictions on provider choice, and excluded coverage for high-cost, low-value interventions. http://content.healthaffairs.org/cgi/content/abstract/25/6/1648



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2006 Project HOPE–The People-to-People Health Foundation, Inc.