Research from other organizations

How to Structure a "Play-or-pay" Requirement on Employers: Lessons from California for National Health Reform
By Ken Jacobs and Jacob S. Hacker, PhD
From the introduction:
This policy brief examines the policy design, economic effects, and political ramifications of employer requirements. We focus in particular on what Congress can learn from the California experience, as well as from an independent cost and coverage analysis of the “Health Care for America” proposal—a national play-or-pay plan closely resembling current legislative initiatives that was developed by one of us (Hacker) with the support of the Economic Policy Institute.

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Will a "Play-or-pay" Policy for Health Care Cause Job Losses?
By Phillip Cryan, for the Institute for America's Future and the Economic Policy Institute
From the executive summary:
This report estimates the effects on employment of adopting a “play‐or‐pay” employer contribution policy for health care. Its main finding is the following: concerns about significant job losses resulting from such a policy are unfounded. Most likely there will be significant job gains. At the very worst, job losses would represent a few hundredths of one percent of employed workers.

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Hard Times in the Heartland: Health Care in Rural America
Provided by the US Department of Health & Human Services
From the introduction:
Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.

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National: Robert Wood Johnson Foundation
On behalf of the Robert Wood Johnson Foundation, Public Opinion Strategies and Lake Research Partners conducted a telephone survey of 400 owners, CEOs and presidents of businesses with between 2 and 50 employees. The national survey was done in June and July 2008.The results, announced in December, echo those of our own research. A few key findings:

• More than one in three small businesses (36%) say that they’re likely to cut some portion of employee health benefits due to rising costs.
• 78% would support a reform solution that combines government-sponsored purchasing pools with tax credits.
• 53% would support an approach requiring that at least one public and one private plan be offered to all employees, and that coverage is guaranteed regardless of age or pre-existing conditions.

Read a one-page summary of the research (PDF)
Download the full report (PDF)

Colorado
In conjunction with the national study sponsored by the Robert Wood Johnson Foundation, Public and Opinion Strategies and Lake Research Partners surveyed 213 small businesses across Colorado in September 2008 (participants included owners, CEOs and presidents of companies with between 2 and 50 employees). The research was co-sponsored by the Colorado Health Foundation. Key findings include:

• A plurality of respondents say it would help their business if healthcare legislation were passed.
• 73% favor a government-sponsored pool that would allow small businesses to negotiate insurance rates that leverage bulk purchasing power.
• 33% say it’s likely their company would consider cutting some portion of employee health benefits in the next 3 to 5 years due to cost.

Download the full report (PDF)

Kansas
As part of the national survey commissioned by Robert Wood Johnson Foundation, the Sunflower Foundation sponsored a state survey of more than 200 small businesses in Kansas. The research was conducted by Public Opinion Strategies and Lake Research Partners in August/September 2008. Respondents included owners, CEOs and presidents of companies with between two and 50 employees. A few key findings:

• 31% of small businesses that previously provided healthcare benefits for employees no longer do.
• 71% believe that a tax credit for small businesses that currently pay at least half of the cost of group health insurance for their employees would make it easier to create and offer new jobs with healthcare benefits.
• 70% feel that health insurance should be portable, so that individuals and families could keep their coverage even when they change jobs or employers.

Download the full report (PDF)

National: Taking the Pulse of Main Street
The Main Street Alliance and the Northwest Federation of Community Organizations co-sponsored a survey of 1,199 small business owners and self-employed entrepreneurs in twelve states: Colorado, Idaho, Illinois, Iowa, Maine, Montana, New Hampshire, New Jersey, New York, Oregon, Rhode Island and Washington. Key findings of the report include:

• 54% report having to switch to insurance coverage with higher out-of pocket costs, 35% switched to a plan that covered fewer services, and 12 dropped coverage entirely, all due to rising costs.
• When asked to choose between two specific reform proposals—one that includes a public insurance option vs expanded private market options—59% selected the proposal with the public option.
• 70% believe government should play a strong role in guaranteeing access to high-quality, affordable healthcare.

Download the full report (PDF)

Vermont
In March/April 2008, AARP sponsored a survey of 400 Vermont small businesses. The research was conducted by Woelfel Research, Inc. Among the key findings of the report:

• 73% feel that small business owners have a responsibility to offer health insurance to employees, but only 57% of respondents currently do.
• 16% have had to drop employee health plans completely due to rising costs, and 48% have been forced to switch to high-deductible plans.
• 80% of those not currently offering any employee health benefits would consider enrolling in Catamount Health—the state’s new comprehensive insurance plan available to the uninsured—if it were open to small businesses; 60% of those already offering a plan would consider switching.

Read a one-page summary of the research (PDF)
Download the full report (PDF)

Washington
On behalf of AARP, Woelfel Research, Inc. conducted a telephone poll of 407 employers in Washington State in March/April 2008. Note that while most of the survey respondents were small business owners, 20% were employers with more than 100 employees. Key findings include:

• In the past 3 years, the cost of providing health benefits for employees has increased by about 91% for small businesses with 2–9 employees.
• Nearly half (48%) of those who don’t currently offer employee health coverage offered it until 3 years ago.
• Among those who don’t currently offer insurance, the top three reasons are that the company can’t afford it (69%), revenues are too uncertain (53%) and employees can’t afford it (51%).

Read a one-page summary of the research (PDF)
Download the full report (PDF)

California farmers and ranchers
From September–December 2007 The Access Project sponsored a telephone survey of 1,787 family farmers and ranchers. Only farmers and ranchers with individual or partnership-type operations were included in the sample; 79% of respondents were sole proprietors. A few key findings:

• 78% of those without health insurance say that premiums are too expensive.
• Among respondents whose principal occupation is farming or ranching, 48% buy insurance in the individual market.
• 16% say they or another household member had to delay necessary healthcare because of costs.

Download the issue brief (PDF)
Read a one-page summary of research on family farmers (PDF)

Great Plains states
The Access Project’s 2007 Health Insurance Survey of Farmers and Ranchers was conducted in collaboration with the University of North Dakota Center for Rural Health and Brandeis University. Researchers surveyed 2,017 family farmers and ranchers in Iowa, Minnesota, Missouri, Montana, Nebraska, North Dakota and South Dakota. Key findings include:

• 44% have spent more than 10% of their income on premiums and other out-of-pocket medical costs.
• 23% say that healthcare costs contributed to financial difficulties for them or a household member; of these, 34% say this caused them to delay making necessary investments in their farm or ranch.
• 36% buy health insurance on the non-group market; the national average is only 8%.

Download the issue brief (PDF)
Read a one-page summary of research on family farmers (PDF)

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