The Commonwealth Fund Health Care Opinion Leaders Survey: Assessing Health Care Experts' Views on Health Insurance Issues

Country: United States

Survey Organization: Harris Interactive, Inc.

Field Dates: February 3, 2005–February 15, 2005

Sample: Peer-nominated experts in health care policy, finance, and delivery

Sample Size: 255 (survey successfully e-mailed to 1,251 potential respondents; 20% response rate)

Interview Method: Online/E-mail

The Commonwealth Fund Health Care Opinion Leaders Survey was conducted by Harris Interactive on behalf of The Commonwealth Fund, with a broad group of more than 250 opinion leaders in health policy and innovators in health care delivery and finance. It was the second in a series of six bimonthly surveys designed to highlight leaders' perspectives on the most important and pressing health policy issues facing the nation. This survey focused on health insurance issues, including goals for the next 10 years, the future of employer-sponsored coverage, group purchasing options for small employers, individual mandates, health savings accounts, and state public program expansions. Potential respondents were identified through a two-step process involving a "nomination" survey with a core group of experts in multiple fields who were asked to name additional leaders both within and outside their areas of expertise, as well as a review of published lists and directories of recognized health experts. The detailed methodology is provided in Appendix.

Summary

The inaugural study, conducted in November/December of 2004, found that expanding coverage to the uninsured is the top concern that health care opinion leaders would like Congress to address over the next five years. The second survey focused specifically on health insurance and insurance-related policy initiatives.

Goals for the Next 10 Years: We asked opinion leaders about targets that are both desirable and achievable for various components of the health care system over the next decade. Leaders agree that within 10 years the proportion of the under-65 population without health insurance can and should be cut in half (8% vs. 18% currently). Respondents are in agreement that the maximum amount of money that consumers should spend out of pocket on health care expenses and premiums should be less than 10 percent.

Future of Employer-Sponsored Coverage: There is also consensus that employer-sponsored coverage should not be allowed to continue to decline, and that policy efforts should be made to stem this trend. Leaders' top choices to strengthen employer-sponsored coverage are: giving employers incentives to provide insurance that meets minimum standards (favored by 82%), providing low-wage workers with tax credits or other subsidies to help them enroll in employer plans (favored by 79%), and requiring employers who do not provide benefits to contribute to a fund to insure workers and their families (favored by 70%). Only 12 percent think it is appropriate to let employer-sponsored coverage continue to decline, while a slight majority (52%) would favor mandating that employers offer and contribute to coverage.

Association Health Plans and Small Business Purchasing Pools modeled on the Federal Employees Health Benefits Program: There was much agreement among opinion leaders about strategies to help small employers and the self-employed join together to buy health benefits and share the advantages of large group purchasing. Half of respondents oppose association health plans (AHPs) and the overwhelming majority favors (84%) options similar to the Federal Employees Health Benefits Program (FEHBP). By a large margin, respondents believe that plans modeled on FEHBP are more effective than AHPs in expanding coverage to the uninsured, providing greater value for premium dollars for both employers and employees, providing more essential benefits, and in expanding health plan choices. While respondents rank FEHBPs higher than AHPs in terms of their effectiveness in cutting costs to employers and employees, they express skepticism about either option being effective in achieving this goal.

Individual Mandates: In general, respondents from all sectors indicated that they favor individual mandates to expand health coverage, which would require all individuals to buy insurance, with federal premium assistance for low-income insured. Assuming that there would be some sort of premium assistance for mandated coverage, the favored approach among all respondents is giving the uninsured the option of enrolling in a federal group plan such as FEHBP or, if they fail to do so, automatically enrolling them in the state Medicaid/State Children's Health Insurance Program (CHIP) with an income-assessed premium.

Health Savings Accounts: While opinion leaders agree that the number of Americans with HSAs will increase in the near future, the majority of respondents oppose HSAs as a way to cut costs and make high-deductible plan coverage more widely available.

Expansion of Medicaid/CHIP: Respondents from all sectors favor providing new federal matching funds to support state efforts to expand Medicaid and CHIP to eligible low-income adults and families.

The topline results, survey tables, and summary of key findings are attached at right. You may also be interested in a commentary by Fund President Karen Davis, or commentaries on the future of health insurance by two panel members, Michael Rodgers, interim president and CEO of the Catholic Health Association, and Charles N. Kahn III, M.P.H., president of the Federation of American Hospitals.

The goal for this survey is to expand and inform a healthy public and professional debate. As part of that effort to keep the discussion going, we invite you to take the survey yourself.

Methodology
The online survey was conducted by Harris Interactive with 255 opinion leaders in health policy and innovators in health care delivery and finance between February 3, 2005, and February 15, 2005.

The sample for this survey was developed by using a two-step process. Initially, The Commonwealth Fund and Harris Interactive jointly identified a number of experts across different industries and professional sectors with a range of perspectives, based on their affiliations and involvement in various organizations and institutions. Harris Interactive then conducted an online survey with these experts asking them to nominate others within and outside their own fields whom they consider to be leaders and innovators in the health care industry. Based on the result of the survey and after careful review by Harris Interactive, The Commonwealth Fund, and a selected group of health care experts, the sample for this poll was created. The final list included 1,329 people.

Harris Interactive sent out individual e-mail invitations containing a password-protected link to the survey to the entire sample. Of the 1,329 invitations, 78 were returned as undeliverable. Steps were taken to attempt to correct the e-mail addresses and locate the individuals, however these efforts were unsuccessful. Harris Interactive determined that the undeliverable e-mail addresses appeared to be randomly distributed among the different sectors and affiliations. Data collection took place between February 3, 2005, and February 15, 2005. Two reminders were sent to anyone who had not responded. The response rate was 20 percent. Typically, samples of this size are associated with a sampling error of +/- 6%.