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National Federation of Independent Business
HEALTH CARE SURVEY The survey on which the following is based was conducted by mail across a random sample of 10,000 NFIB members during March/April 2007 with a return of 1684 usable responses.
1. What is the single most serious issue facing our health care system today? (Mark ONE only.) 9% Expanding health insurance coverage
74% Reducing health care costs/the increase in health care costs
3% Improving health care quality and reducing errors
1% Insufficient medical research to cure major diseases, e.g., cancer, heart disease, AIDS
13% Government trying to fix problems in the health care system
*% No serious issues in health care Go to question #2.
2% did not answer this question 1a. What is the second most important problem? (Mark ONE only.) 28% Expanding health insurance coverage
20% Reducing health care costs/the increase in health care costs
17% Improving health care quality and reducing errors
4% Insufficient medical research to cure major diseases, e.g., cancer, heart disease, AIDS
21% Government trying to fix problems in the health care system
4% No second most important issue
6% did not answer this question Analysis: The principal health care issue for small-business owners is cost, not coverage. 94 percent make cost a first or second choice; only 37 percent make expanded coverage a first or second choice. The small business problem is cost; the elected official’s problem is coverage. If the elected official doesn’t help small business with its cost problem, small business can’t help the elected official with their coverage problem. 2. What is the BEST general approach to controlling health care costs? (Mark ONE only.) 49% Individuals shopping for the best prices in health care and health insurance
28% Government regulating health insurance and health care prices
17% Employers choosing/purchasing health insurance on employees behalf
6% did not answer this question 3. Does making consumers more sensitive to the price/cost of health care encourage them use less health care? 39% Yes, strongly
31% Yes, not so strongly
20% No, not so strongly
8% No, strongly
2% did not answer this question 3a. Is that a good thing? If “Yes” in Q#3. 35% Yes, strongly
26% Yes, not so strongly
15% No, not so strongly
13% No, strongly
11% did not answer this question If “No” in Q#3. 9% Yes, strongly
23% Yes, not so strongly
40% No, not so strongly
17% No, strongly
11% did not answer this question Analysis: Seventy (70) percent of NFIB members think that making consumers more sensitive to health care and health insurance costs will encourage consumers to use less health care; 28 percent do not think it will. Those who think prices influence behavior say that is a good thing by a 61 percent – 28 percent margin. Those who think prices do NOT affect behavior think that is a bad thing by 32 percent – 57 percent margin. Thus, small business owners think prices affect behavior with respect to health care and that is a good and expected thing. 4. A proposal designed to reduce costs and improve quality of care would establish groups of experts in their health care fields who would determine the most cost-effective treatments for common illnesses. Insurance companies would ONLY pay health care providers who used treatments within those guidelines. Is the idea behind the proposal generally:
5% Very promising
38% Worth exploring
13% Resources better used elsewhere
31% Very dangerous
10% Don’t know
3% did not answer this question 4a. Should all health care providers who expect to be reimbursed by insurers be required to computerize their records? 41% Yes, strongly
30% Yes, not so strongly
17% No, not so strongly
8% No, strongly
4% did not answer this question 5. Employer-provided health insurance is tax-excluded (pre-tax) for the employee. (A tax exclusion means that the money used to purchase health insurance for the employee is not counted as taxable income for the employee.) Health insurance that individuals purchase on their own have no similar tax benefit. Employers get a tax deduction for money spent on employee health insurance. Should we: A. Eliminate the employee’s tax-exclusion on employer-sponsored health insurance and use the revenue generated to increase insurance coverage among the working uninsured? 6% Favor, strongly
7% Favor, not so strongly
13% Oppose, not so strongly
60% Oppose, strongly
9% Don’t know
5% did not answer this question B. Cap the employee tax-exclusion on health insurance premiums at $15,000 for families and $7,500 for individuals? Under the proposal, anything an employer or employee spends on an employee’s health insurance over the cap would be taxable to the employee. The revenue would be used to increase insurance coverage among the working uninsured. 8% Favor, strongly
18% Favor, not so strongly
15% Oppose, not so strongly
41% Oppose, strongly
14% Don’t know
5% did not answer this question
C. Equalize the tax benefits for the purchase of health insurance between those who have employer-sponsored health insurance and those who purchase health insurance individually? 60% Favor, strongly
20% Favor, not so strongly
4% Oppose, not so strongly
4% Oppose, strongly
9% Don’t know
3% did not answer this question
6. Which general approach to health insurance for the working uninsured should we take? (Mark ONE only.)
9% Expand existing government programs like Medicaid
5% Require employers to cover all of their full-time employees
63% Provide tax credits to help people purchase private health plans
9% Require everyone to have insurance and subsidize those who can’t afford it
11% Hands off, as people who need help typically get taken care of now.
4% did not answer this question 7. Most Americans have private health insurance. The very poor are covered by Medicaid. Should the government financially assist those without private health insurance or Medicaid coverage? (The elderly are covered by Medicare.) 11% Yes, strongly
30% Yes, not so strongly
3% No, not so strongly
23% No, strongly
3% did not answer this question 7a. If the decision is made for the government to financially assist this group of people (whether you favor or oppose it), how should the assistance be provided? (Mark ONE only.) 25% Directly pay insurance companies for beneficiary’s chosen plan
9% Directly pay beneficiaries to purchase health insurance
61% Directly reimburse health-care providers for services to beneficiaries
5% did not answer this question 7b. Should everyone who benefits from such assistance be required to pay some portion of their health care, or health insurance, even if the payment is modest? 80% Yes, strongly
15% Yes, not so strongly
3% No, not so strongly
1% No, strongly
2% did not answer this question 7c. If the decision is made for the government to financially assist this group of people (whether you favor or oppose it), how should the assistance be paid for? (Mark ONE only.) 12% A special payroll tax
9% A tax on health insurance premiums
29% Cap the employee’s tax exclusion on employer sponsored health insurance
37% General tax increase
13% did not answer this question
8. Employer-based health insurance is underwritten (premiums determined) on a group’s size, health experience, and characteristics. Individual insurance is often underwritten on the individual’s personal characteristics, behaviors, and experience. What are fair factors to use when underwriting (setting premiums for) individuals? A. Smoking (current smoker) -- 89% Fair, 8% Unfair, 2% Don’t Know, 2% did not answer this question B. Frequency/intensity of medical use in last five years -- 52% Fair, 39% Unfair, 6% Don’t Know , 2% did not answer this question C. Age -- 51% Fair , 42% Unfair, 5% Don’t Know, 3% did not answer this questio
D. Location (area medical prices) -- 39% Fair, 50% Unfair , 8% Don’t Know, 3% did not answer this question E. Body mass (weight/overweight -- 72% Fair, 22% Unfair, 5% Don’t Know, 2% did not answer this question
F. Family medical history -- 35% Fair, 58% Unfair, 4% Don’t Know, 3% did not answer this question G. Driving record (last five years) -- 44% Fair, 47% Unfair, 7% Don’t Know, 2% did not answer this question
H. Credit score -- 16% Fair, 73% Unfair, 8% Don’t Know, 3% did not answer this question Conclusions: Strict community rating is NOT considered fair. There are legitimate factors, primarily revolving around personal behaviors, that should be part of the rate calculation. But, full actuarial rating is not fair, either. Everyone should be able to buy health insurance somewhere. 9. Should an insurer be able to deny health insurance to an applicant based on any of the factors A – H in the question immediately above? 9% Yes, strongly
21% Yes, not so strongly
33% No, not so strongly
36% No, strongly
2% did not answer this question 10. Should the behavior of individuals that could influence health outcomes be included in the calculation of health insurance premiums? 35% Yes, strongly
40% Yes, not so strongly
15% No, not so strongly
7% No, strongly
2% did not answer this question 11. Should individuals above a reasonable income level be required to have health insurance (employer provided or individually purchased) or be able to prove financial responsibility (assets to cover a very large health care liability)? 23% Yes, strongly
34% Yes, not so strongly
20% No, not so strongly
20% No, strongly
2% did not answer this question 11a. If “Yes” in question 11: Why do you think so? 47% It is irresponsible to leave potential, large unpaid bills to others
8% People should not be able to risk everything on a possible illness or accident
32% Uninsured people cause higher premiums for insured people
9% If society is going to treat you, like when hit by a bus, it has a right to expect
you will pay the bill
2% Other (please specify) _________________________
1% did not answer this question
11b. If “No” in question 11: Why do you think so? 59% None of the government’s business; people should be able to choose how
to spend their money
24% The requirement is unenforceable as a practical matter
5% Health insurance is an actuarially bad deal for some people
4% Other (please specify) _________________________
9% did not answer this question Analysis: Fifty-seven (57) percent of NFIB members support a personal mandate requiring health insurance coverage for those financially able to purchase insurance compared to 40 percent who oppose it. However, 54 percent do NOT hold their position strongly one way or the other. The most common reasons to support the personal mandate (among those who do) are irresponsible behavior associated with leaving large, unpaid medical bills (47 percent) and the belief that uninsured people cause higher premiums for insured people (32 percent). The most common reasons to oppose the personal mandate (among those who do) are that it is none of the government’s business (59 percent) and the requirement is unenforceable as a practical matter (24 percent). 12. How would you assess the overall quality of health care available to MOST Americans? 16% Excellent
63% Pretty good
16% Not so good
4% Poor
1% did not answer this question Analysis: Small business owners believe the health delivery system typically performs well, if expensively. They are reluctant to change things that they think will affect quality of care. 13. What should the employer’s role be in financing employee health care? (Mark ONE only.) 6% Mandatory provision of employee health insurance
58% Voluntary provision of employee health insurance
3% Payroll tax on employers to finance employee private purchases of insurance
23% No role for employers - individual’s responsibility
7% No role for employers - government’s responsibility
4% did not answer this question Conclusions: NFIB members prefer the current voluntary role of employers in health care financing. They are not prepared at this time to remove employers entirely, at least not without a viable (also visible) alternative. 14. Do you offer employee health insurance? 58% Yes
40% No -- Go to Question #17
3% did not answer this question 15. Do you agree or disagree with the following statement: A. I would like to get out of the “employee health insurance business,” but I really can’t given the current way health care is financed and delivered. 35% Agree, strongly
35% Agree, not so strongly
22% Disagree, not so strongly
6% Disagree, strongly
3% did not answer this question B. I wish the government would just take over health care and then I wouldn’t have to worry
about employee health insurance and related issues. 14% Agree, strongly
13% Agree, not so strongly
23% Disagree, not so strongly
47% Disagree, strongly
3% did not answer this question
Analysis: For the most part, small-business owners don’t like their role in the health care financing and delivery system. They would like out, if they thought they could get out. Still, most are not willing to turn health care over to the government. 16. Suppose the government offered employers a tax credit to offer health insurance to any non-covered employee who earns the equivalent of $25,000 a year or less. The credit would be ON TOP OF the current tax deduction. To qualify for the credit, the insurance offered must have a minimum benefit package and the employer must pay at least 60 percent of it. The credit would be equivalent to 25 percent of the employer’s contribution.
A. Would such a tax incentive lead you to cover any currently non-covered employees?
9% Yes, strongly
23% Yes, not so strongly
20% No, not so strongly
14% No, strongly
31% Everyone already covered and/or no employee earns less than $25,000
2% did not answer this question B. Do you favor a tax credit, on top of the current tax deduction, for employers who provide a health insurance plan for his/her employees?
57% Yes, strongly
27% Yes, not so strongly
11% No, not so strongly
4% No, strongly
2% did not answer this question C. Do you favor tax credits, on top of the current tax deduction, for employers, who do NOT currently offer employee health insurance. The credit would be available ONLY if they start and maintain an employee health insurance plan for at least five years? 26% Yes, strongly
40% Yes, not so strongly
19% No, not so strongly
11% No, strongly
3% did not answer this question Analysis: Small business owners are suspicious of new and/or expanded initiatives with which they are not familiar or would involve government even more deeply in health care. They are familiar with tax credits as a method to subsidize and direct socially desirable activity, including its simplicity. 17. What would you like to see our health care system look like 10 years from now? (Mark ONE only.) 18% The government would run the health care system. Everyone would be covered. Taxes would pay for care. Health care providers would receive payment on virtually all services/products from the government. Private insurance would largely be gone.
22% Everyone must purchase and pay for their own health insurance. Low income people would receive subsidies to purchase theirs. Employers would no longer be involved. Health care providers would be paid much as they do today.
56% A system more like today’s than not, with incentives and regulations added for the heath care industry to become more efficient and less costly. Insurance would be obtained from a combination of employer and individual sources with financing a combination of individuals, employers, and government. Everyone would not necessarily be covered with private insurance, but those uncovered would obtain care through paying their bills, charity, subsidized emergency rooms, etc. 5% did not answer this question --END-- |
Health Care 
