NATIONAL SURVEY OF SMALL BUSINESS EXECUTIVES KAISER/HARVARD PROGRAM ON HEALTH POLICY in conjuction with AMERICAN SMALL BUSINESS ALLIANCE EDUCATION FUND National Topline Methodology The National Survey of Small Business Executives on Health Care is a product of the Kaiser-Harvard Program on the Public and Health/Social Policy in conjunction with the American Small Business Alliance Education Fund. It was designed and analyzed by researchers at the Kaiser Family Foundation and Harvard University in conjunction with the ASBAEF. The survey was conducted by telephone by Princeton Survey Research Associates with 800 heads of companies and organizations with fewer than 100 full-time employees between March 18 and May 9, 1998. Respondents included sole/principal owners (45%); presidents/CEOs/executive directors (12%); other decision-makers such as chief operating officers, general managers, partners, chief financial officers, and vice presidents (17%), and decision-making employees including human resource directors (26%). The margin of error for results based on the total sample is plus or minus 5%, although the margin of error is larger for some subsets. RESPONDENT INTRODUCTION: Hello, my name is _________________ and I'm calling for Princeton Survey Research. We=re conducting an important national survey about issues facing U.S. employers for Harvard University, a major foundation, and a small business association. This interview will take only about 15 minutes. As a token of our appreciation, we=ll be happy to send you a copy of our survey findings. S1-3. First, what is the TOTAL number of people now employed by your company or organization at ALL locations and work sites, including yourself? Just your best estimate... 61 4 to 9 20 10 to 19 14 20 to 49 5 50 to 99 100 Unless otherwise noted: Public comparisons are from a January 1998 Kaiser-Harvard Program on the Public and Health/Social Policy Survey, “Americans’ Views on Consumer Protection in Managed Care,” conducted December 12-30, 1997 by Princeton Survey Research Associates, of 1,204 adults. S4-6. What is the TOTAL number of FULL-TIME employees in your company or organization, including yourself? Just your best estimate.. None 15 1 to 3 51 4 to 9 17 10 to 19 12 20 to 49, OR 3 50 to 99? 0 Refused 100 S7. Are you a private, for-profit company, or a private, non-profit organization? 88 For-profit company/professional practice 12 Non-profit organization 0 Government/public institution * Refused 100 MAIN INTERVIEW 1. Including both full-time and part-time workers, how many of your company=s (organization=s) employees are now paid more than $30,000 per year? 26 None 36 Only a few 10 Less than half 10 About half 6 More than half, OR 5 Nearly all? 2 (VOL.) All 5 Don=t know/Refused 100 2 2. Which, if any, of the following benefits does your company (organization) now offer to any of your full-time employees? Do you now offer... Based on those who have full time employees: n=785 Yes, No, Don=t Know/ Offer Do Not Refused a. Paid sick days or vacation days? 83 17 * =100 b. Paid maternity leave? 22 74 4 =100 c. Child care? 5 94 1 =100 d. An employee pension plan? 35 64 1 =100 3. Next, we=d like your opinion on a national policy issue... If it turns out that the federal government has a budget SURPLUS this year, which ONE of the following do you think should be done with the available money? Should it be used... Current Public1 18 For a tax cut? 11 27 To pay off the national debt more quickly? 22 15 For increased spending on domestic programs such as health, 33 education, and the environment? 38 To help make the Social Security and Medicare programs 32 financially sound? 2 Don=t know/Refused 2 100 100 1 Trend from the January 1998 News Interest Index conducted by The Pew Research Center for The People and The Press. 3 4. We=d also like your views on this country=s health care system... Please tell me if you are very satisfied, somewhat satisfied, somewhat DISsatisfied, or very dissatisfied with each of the following. (First,) what about... Very Somewhat Somewhat Very Don=t Know/ Satisfied Satisfied Dissatisfied Dissatisfied Refused a. The quality of health care available for you and your employees 35 39 9 11 6 =100 b. The cost of health care and health insurance 8 21 30 39 2 =100 c. Administrative ease in purchasing employee health insurance and submitting claims for reimbursement 22 33 19 15 11 =100 5. How closely have you followed news reports about the consumer bill of rights for health care proposed by President Clinton and similar bills proposed in Congress? Have you followed news about this ... 8 Very closely 26 Fairly closely 30 Not too closely, OR 22 Not at all closely? 14 Don=t know/Refused 100 4 6. We=re interested in YOUR views on what might happen if these proposed consumer protections were passed into law. If they were passed into law, do you think... a. The cost of health insurance premiums would increase a LOT, only a LITTLE, or not at all? 37 Increase a lot 25 Increase a little 7 Not at all 1 (VOL.) Increasing some 30 Don=t know/Refused 100 b. MANY employers would drop health coverage for their workers, only a FEW would drop coverage, or NONE would drop coverage? 18 Many 42 Only a few 9 None 2 (VOL.) Some 29 Don=t know/Refused 100 c. There would be a LOT more government involvement in health care, only a LITTLE more government involvement, or no more government involvement than there is now? 41 A lot more involvement 22 Only a little more involvement 10 No more involvement 1 (VOL.) Some more involvement 26 Don=t know/Refused 100 d. It would lead to better health care for workers and more information for employers, or not much improvement in these areas? 21 Better health care/more information 49 Not much improvement 2 (VOL.) Would make things worse 28 Don=t know/Refused 100 5 7. How many of your full-time employees are now offered health insurance coverage that is paid for, at least in part, by the company (organization)... Based on those who have full-time employees; n=785 55 All full-time employees 8 Most of them 9 Only some of them, OR 27 None of them? 1 Don=t know/Refused 100 8. What is the MAIN reason your company (organization) does NOT offer health insurance coverage? Based on those who do not offer health insurance; n=183 57 Cost 6 All/most covered elsewhere 4 Employees are self insured or pay for coverage 8 Not necessary 6 Company/organization too small 2 Business too new 3 Largely part-time employees/seasonal business 2 Salary compensates for lack of coverage 13 Other 3 No reason/none 2 Don=t know/refused Total exceeds one hundred percent due to multiple responses QUESTIONS 9-11 BASED ON THOSE WHO OFFER HEALTH INSURANCE; N=594 9. For full-time employees, does your company pay all, one-half or more, less than half, or none of the monthly health insurance premiums? 56 All 32 Half or more 8 Less than half 4 None * Don=t know/Refused 100 6 10. Do you offer employees a choice of more than one health plan, or only one plan? 11. How many different health plans do you offer? 81 One plan 17 More than one plan 9 Two 4 Three 1 Four 1 Five 1 Six or more 1 Don=t know number of plan 2 Don=t know/refused 100 12. We=re interested in why you don=t offer your employees more choices of health plans. As I read you some possible reasons, tell me if each is a MAJOR reason, a MINOR reason, or NOT a reason you don=t offer more choices (First,) what about this... Based on those who offer one or two health plans: n=533 Major Minor Not a Don=t Know/ Reason Reason Reason Refused a. It=s too expensive to offer more choices 51 11 32 6 =100 b. There would be too much administrative burden 40 21 36 3 =100 c. Health plan rules require all or most employees to be in the same plan 51 14 29 6 =100 d. There aren=t enough different plans available locally 21 21 53 5 =100 7 13. Which of these is the MOST important reason you don=t offer more choices of health plans? Based on those who offer one or two plans; n=533 30 It=s too expensive to offer more choices 16 There would be too much administrative burden 25 Health plan rules require all or most employees to be in the same plan 5 There aren=t enough different plans available locally * (VOL.) Other 21 None are major reasons 3 Don=t know/Refused 100 14. Do you NOW offer employees health coverage through an HMO, PPO, or other managed care plan that directs them to a list of doctors and hospitals, or through a traditional health plan that allows them to go to almost any doctor or hospital? 15. Do you NOW offer employees health coverage ONLY through HMOs, PPOs, or other managed care plans that direct them to a list of doctors and hospitals, ONLY through traditional health plans that allow them to go to almost any doctor or hospital, OR do you offer BOTH types of plans? Based on those who offer health insurance; n=594 54 Only HMOs/PPOs/Other managed care plans 33 Only traditional plans 7 Both types of plans 6 Don=t know/Refused 100 16. Is the health plan that now covers the LARGEST NUMBER of your employees... Based on those who offer health insurance; n=594 58 An HMO or other managed care plan, OR 36 A traditional health plan? 6 Don=t know/Refused 100 8 For my next question, please think about the health plan that now covers the LARGEST NUMBER of your employees... QUESTIONS 17-19 BASED ON THOSE WHO OFFER HEALTH INSURANCE; N=594 17. Based on all your company=s (organization=s) experience with this health plan, what letter grade would you give it for its overall performance in serving your company (organization) and its employees: A, B, C, D or F? Current Public2 25 A (excellent) 30 42 B (good) 42 23 C (average) 19 3 D (poor) 4 3 F (failing) 2 1 (VOL.) Not with plan long enough to rate 2 3 Don=t know/refused 1 100 100 18. Has your company (organization) SWITCHED the health plans offered to employees in the past two years, that is, since March 1996? 30 Yes 68 No 2 Don=t know/refused 100 19. Have you, or has someone else in your company (organization) who deals with benefits, EVER been asked to intervene on behalf of an employee who was having problems with any health plan you offered? 20 Yes 78 No 2 Don=t know/Refused 100 2 Based on all who are insured, n=994. 9 20. The LAST time this happened, was it a MAJOR disruption for your company (organization), a MINOR disruption, or NOT a disruption at all? Based on those who ever intervened; n=133 19 Major disruption 52 Minor disruption 25 Not a disruption 4 Don=t know/Refused 100 21. Please think back to the LAST time your company (organization) was making decisions about which health plans to offer your employees... Do you feel you had ALL the information you needed to make good decisions about which health plan or plans to buy, MOST of the information you needed, only SOME of it, or NONE of it? 43 All 37 Most 11 Only some 3 None 6 Don=t know/Refused 100 22. In general, is dealing with health insurance issues an easy and straightforward task for your company, or is it a difficult and confusing task? 23. Would you say it is VERY (easy and straightforward/difficult and confusing), or SOMEWHAT (easy and straightforward/difficult and confusing)? 50 Total easy and straight forward 30 Very easy and straight forward 20 Somewhat easy and straight forward/don=t know 46 Total difficult and confusing 15 Very difficult and confusing 31 Somewhat difficult and confusing 4 Don=t know/Refused 100 10 24. Are any of your full-time employees now offered health insurance coverage for their dependent children that is paid for, at least in part, by the company (organization)? Based on those who offer health insurance; n=594 58 Yes 40 No 2 Don=t know/Refused 100 25. There is a new government program that provides subsidized health insurance coverage for children in families below a certain income level -- for example, $30,000 per year for a family of four. If your state had such a program, what is your company (organization) most likely to do: STOP CONTRIBUTING toward the cost of dependent coverage for your employees, DROP dependent coverage entirely, or CONTINUE dependent coverage as is? Based on those who offer dependent coverage; n=350 7 Stop contributing 8 Drop coverage entirely 71 Continue coverage as is 14 Don=t know/Refused 100 PERSONAL HEALTH INSURANCE COVERAGE 26. Do you have your OWN personal health insurance coverage MAINLY through... one of the health plans/the health plan... your company (organization) offers to employees? 27. What is the MAIN source of your OWN personal health insurance coverage? Do you... 21 Have coverage through your spouse or another family member, OR 12 Do you buy private individual health insurance, OR 3 Are you covered through some other source, OR 6 Are you NOT now covered by any health plan? 55 Company plan 2 Government/military/Medicare 1 Don=t know/Refused 100 11 28. Now I=d like your views on HMOs and other managed care plans in general -- regardless of whether you are now in managed care. During the past few years, do you think managed care plans have... a. Made it easier or harder for people who are sick to see medical specialists? Based on Form 1 respondents; n=399 Current Public 9/973 20 Easier 25 57 Harder 59 10 (VOL.) No effect 4 13 Don=t know/refused 12 100 100 b. Increased or decreased the quality of health care for people who are sick? Current Public 9/97 28 Increased 32 58 Decreased 51 2 (VOL.) No effect 7 12 Don=t know/refused 10 100 100 c. Helped keep health care costs down, or haven=t made much difference? Current Public 9/97 31 Helped 28 43 Haven=t made much difference 55 8 (VOL.) Made costs go up 5 18 Don=t know/refused 12 100 100 Continued... 3 Trend for questions 28a-e from a survey conducted in September 1997 by Princeton Survey Research Associates for The Henry J. Kaiser Family Foundation and The Harvard School of Public Health . 12 28. Continued... Based on Form 2 respondents; n=401 d. Made it easier or harder to get preventive services such as immunizations, health screenings, and physical exams? Current Public 9/97 31 Easier 46 43 Harder 31 8 (VOL.) No effect 8 18 Don=t know/refused 15 100 100 e. Increased or decreased the amount of time doctors spend with their patients? Current Public 9/97 7 Increased 16 65 Decreased 61 7 (VOL.) No effect 9 21 Don=t know/refused 14 100 100 29. I=m going to read you three ways to ensure that consumers in HMOs and other managed care plans are treated fairly and get the proper care. After I read all three, tell me which ONE you think is the BEST way to protect consumers in managed care. Here are the choices... Based on Form1 respondents; n=399 A. The managed care industry monitoring itself and setting voluntary standards for plans to follow, OR... B. The government developing and enforcing regulations that plans must follow, OR... C. A non-government independent organization developing and enforcing standards that plans must follow. Which do you think is the BEST way to protect consumers -- A, B, or C? Current Public 14 A. The managed care industry itself 15 12 B. The government 23 62 C. A non-government independent organization 57 1 (VOL.) Other 1 1 (VOL.) None 1 10 Don't know/Refused 3 100 100 13 30. In recent months, different groups have said something needs to be done to regulate the operations of HMOs and other managed care plans. Would you MOST like to see managed care plans regulated by... Based on Form 2 respondents; n=401 Current Public 9/974 9 The federal government 19 15 State governments 18 36 A independent, non-profit organization, OR 34 23 Should they NOT be regulated at all? 16 2 (VOL.) Regulated by other group 2 15 Don=t know/Refused 11 100 100 4 Trend from a Kaiser-Harvard Program on the Public and Health/Social Policy September 1997 national survey of American’ views of Managed Care, conducted among n=1204 adults by Princeton Survey s Research Associates. 14 31. Next, please tell me whether you would favor or oppose a law requiring HMOs, managed care plans and health insurance companies to do each of the following. (First,) would you favor or oppose a law requiring health plans to... Based on Form 1 respondents; n=399 Don=t Know/ Favor Oppose Refused a. 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 Current 89 5 6 =100 Public 92 6 2 =100 b. Allow a woman to see a gynecologist without having to get permission or see her regular doctor first Current 84 11 5 =100 Public 82 16 2 =100 c. Allow people with serious medical conditions to see a medical specialist without always having to get permission or see their regular doctor first Current 75 21 4 =100 Public 81 18 1 =100 d. 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 Current 77 18 5 =100 Public 79 18 3 =100 e. Allow people to appeal a health plan=s decision to an independent reviewer if they are denied coverage or a particular medical treatment Current 88 8 4 =100 Public 88 9 3 =100 f. Allow patients to sue a health plan for malpractice, like they can now sue a doctor Current 61 30 9 =100 Public 64 31 5 =100 15 32. You said you favor a law requiring health plans to...(INSERT--READ AND ROTATE). Would you still favor this law if you heard it might increase the cost of people=s health insurance premiums? (RECORD RESPONSE) You also said you favor a law requiring health plans to...(INSERT NEXT ITEM) Would you still favor this law if you heard it might increase the cost of people=s health insurance premiums? Based on Form 1A; n=198 Yes, Would No, Would Don=t Know/ Still Favor Oppose5 Refused a. Provide information about the plan Current 69 21 10 =100 Public 58 34 8 =100 b. Allow a woman to see a gynecologist without special permission Current 66 26 8 =100 Public 63 34 3 =100 c. Allow people to see a medical specialist without special permission Current 59 33 8 =100 Public 58 39 3 =100 d. Pay for an emergency room visit if someone believes they need immediate medical attention Current 66 27 7 =100 Public 62 33 5 =100 e. Allow people to appeal a plan=s decision to deny coverage to an independent reviewer Current 72 20 8 =100 Public 63 32 5 =100 f. Allow patients to sue a plan for malpractice Current 51 36 13 =100 Public 48 45 7 =100 5 Includes respondents who opposed initially in Question 31. 16 33. You said you favor a law requiring health plans to...(INSERT--READ AND ROTATE). Would you still favor this law if you heard it might get the government too involved in health care? (RECORD RESPONSE) You also said you favor a law requiring health plans to...(INSERT NEXT ITEM) Would you still favor this law if you heard it might get the government too involved in health care? Based on Form 1B; n=201 Yes, Would No, Would Don=t Know/ Still Favor Oppose6 Refused a. Provide information about the plan Current 49 37 14 =100 Public 55 38 7 =100 b. Allow a woman to see a gynecologist without special permission Current 46 43 11 =100 Public 51 43 6 =100 c. Allow people to see a medical specialist without special permission Current 41 50 9 =100 Public 47 48 5 =100 d. Pay for an emergency room visit if someone believes they need immediate medical attention Current 45 42 13 =100 Public 52 41 7 =100 e. Allow people to appeal a plan=s decision to deny coverage to an independent reviewer Current 44 42 14 =100 Public 51 41 8 =100 f. Allow patients to sue a plan for malpractice Current 33 54 13 =100 Public 38 54 8 =100 6 Includes respondents initially opposed in Question 31. 17 34. Next, I=m going to read you some laws that would require HMOs, managed care plans and health insurance companies to do certain things. As I read each law, tell me whether you favor it as a way to make sure people get the care they need, OR oppose it as unnecessary government involvement in health care. (First,) how do you feel about a law requiring health plans to... Do you favor it as a way to make sure people get the care they need, or oppose it as unnecessary government involvement in health care? Based on Form 2 respondents; n=401 Oppose as Favor To Ensure Unnecessary Don=t Know/ People Get Care Govt. Involvement Refused a. 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 88 8 4 =100 b. Allow a woman to see a gynecologist without having to get permission or see her regular doctor first 81 12 7 =100 c. Allow people with serious medical conditions to see a medical specialist without always having to get permission or see their regular doctor first 76 19 5 =100 d. 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 =100 Continued... 18 34. Continued... Oppose as Favor To Ensure Unnecessary Don=t Know/ People Get Care Govt. Involvement Refused e. 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 =100 f. Allow patients to sue a health plan for malpractice, like they can now sue a doctor 66 25 9 =100 35. If the requirements we just talked about were passed into law, some say it would increase health insurance premiums for employers like yourself. If your share of health insurance premiums increased by ONE TO FIVE DOLLARS per month for a single employee, would your company (organization) be most likely to... Based on Form 1 respondents who offer insurance; n=300 50 Absorb this additional cost 33 Pass on SOME of it to employees 9 Pass on ALL of it to employees, OR 1 Drop coverage entirely? 2 (VOL.) Switch to a plan with lower premiums 5 Don=t know/Refused 100 36. If the requirements we just talked about were passed into law, some say it would increase health insurance premiums for employers like yourself. If your share of health insurance premiums increased by 15 TO 20 DOLLARS per month for a single employee, would your company (organization) be most likely to... Based on Form 2 respondents who offer insurance; n=294 45 Absorb this additional cost 35 Pass on SOME of it to employees 8 Pass on ALL of it to employees, OR 3 Drop coverage entirely? 3 Switch to a plan with lower premiums 6 Don=t know/Refused 100 19 37. We=d like to know if you or someone you know has experienced some different kinds of problems with an HMO, managed care plan or health insurance company. In the last few years, have you or someone you know... "Yes" Public 35 Needed more information about how the health plan 29 operates in order to choose among different health plans 9 Had difficulty getting permission from a health plan or 6 regular doctor to see a gynecologist 25 Had difficulty getting permission from a health plan or 18 regular doctor to see a medical specialist 21 Had difficulty getting a health plan to pay an emergency 19 room bill 20 Wanted to file an appeal to an independent reviewer 17 when a health plan denied coverage for a particular medical treatment 7 Wanted to sue a health plan for malpractice 9 20 DEMOGRAPHICS: D1. RECORD SEX 62 Male 38 Female 100 D2. Now I have just a few background questions... Is there someone in your company (organization) whose MAIN JOB is dealing with employee benefits and other personnel or human resources issues? 51 Yes 49 No * Refused 100 D3. Are you the sole or principal owner of your company? D4. What is your TITLE in your company (organization)? 45 Sole/principal owner 12 President/Chief executive officer (CEO)/Executive director 1 Chief financial officer (CFO) 9 Chief operating officer (COO)/General manager 3 Partner 4 Vice president (VP) (not also CFO or human resources director) 1 Human Resources/Personnel Director 1 Benefits officer/related title 24 Other * Refused 100 21 D5. In politics TODAY, do you consider yourself a Republican, Democrat, or Independent? 41 Republican 20 Democrat 30 Independent 1 (VOL.) Other party 2 (VOL.) No party 2 Don't know 4 Refused 100 D6. What is your race? Are you white, black, Asian, or some other race? Do you consider yourself a WHITE Hispanic/Latino or a BLACK Hispanic/Latino? 91 White 4 Black/African-American 1 Asian 2 Other or mixed race * Don't know 2 Refused 100 22 National Survey of Small Business Executives on Health Care Questionnaire and Topline June 17, 1998