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SECOND NATIONAL HEALTH INSURANCE SURVEY FINDS STRONG SUPPORT FOR HEALTH CARE REFORM

 FEW AMERICANS UNINSURED BY CHOICE;
 EVEN INSURED AMERICANS FIND CHOICE LIMITED
 /ADVANCE/ WASHINGTON, Nov. 10 /PRNewswire/ -- Americans are convinced that our health care system needs fundamental change. Following up on an initial 1992 survey of Americans over age 18, a second survey in August 1993, designed and supported by the Henry J. Kaiser Family Foundation and The Commonwealth Fund, finds strong sentiment for health care reform -- 84 percent of Americans feel the system needs fundamental change or complete rebuilding. And while Americans are more secure about their jobs today; they are less secure about health benefits and their ability to pay for health care. Results indicate that some 53 million Americans were uninsured at some point in the past two years, with the majority unable to afford insurance.
 "Particularly alarming is the number of uninsured Americans going without needed care or postponing seeking care," said Karen Davis, executive vice president of The Commonwealth Fund. "Gaps in insurance coverage are a chronic problem for Americans. Half of the uninsured have been uncovered for two years or more."
 Survey findings show that one out of three Americans, ages 18-64, were without coverage at some point in the last two years. Part-time workers, the unemployed and those whose incomes are under $15,000 have the highest rates of uninsurance. The majority of the uninsured adults are over age 30.
 Only 7 percent of the uninsured report that they were without insurance by their own choice. "The survey goes a long way toward putting to rest the argument that Americans are uninsured by choice," said Kaiser Family Foundation President Drew E. Altman. "And in doing so, it helps buttress the case for making universal coverage the most important objective of health reform."
 Results of the survey indicate that Americans already face limits in choosing their health care. More than two out of five workers insured through an employer say that they are currently offered only one choice of an insurance plan and 40 percent say that they are in plans which require additional payments for visits to doctors outside the plan. Half of those who have to pay more to go outside their plan are not very satisfied with the choice of doctors through their plan.
 Americans feel most strongly about retaining the ability to choose their specialist physicians and hospitals. While costs are a concern, a majority of Americans when offered a choice do not select the least expensive plan.
 Nearly one out of five insured Americans is an HMO member, about half of whom report a high level of satisfaction with their health care. HMO members tend to be younger and healthier than non-members. Two out of five HMO members report changing doctors when they joined an HMO. Those with a regular doctor, a serious illness in the family and higher incomes are more likely to find the change of a doctor a problem.
 Survey results show that one out of two Americans not in an HMO would find it a problem to be required to join one. Americans who are least willing to join an HMO are those with a regular physician those with a college education and those with incomes over $50,000.
 One out of two insured Americans are not very satisfied with their health insurance. Medicare beneficiaries are more satisfied with their insurance and with their doctors, compared to the overall insured population.
 In reforming the nation's health care system, universal coverage and affordable health care are high priorities for two out of three Americans. Most Americans rate preventative care and prescription drug benefits as the most important parts of a basic package. Dental, eye, mental health and long-term care are less important.
 Americans support a major role for government in controlling health care spending but are divided on whether federal or state governments should administer the plans under a new health system. If additional taxes are needed to finance the system, Americans prefer a national sales tax (33 percent) or a payroll tax (28 percent). Increases in employer and employee-paid premiums (15 percent) or in income taxes (12 percent) are the least-preferred methods of financing. If some form of health reform is not enacted, two out of five Americans would fault health care interest groups. This is consistent across political parties, income, education, employment status and gender.
 This survey of 2,000 adults aged 18 and over was conducted between Aug. 6 and Aug. 30, 1993, by telephone by Louis Harris and Associates, Inc. The sample was chosen to represent the true proportion of the population living in different regions of the country and those living in metropolitan and non-metropolitan areas. The data is also weighted to the Census Bureau's latest population parameters on sex, race, age, education and insurance status. It has a margin of error of plus or minus 2 percent.
 The 1992 Kaiser/Commonwealth Survey on Americans and their Health Insurance was also a random-sample survey of 2,000 adults by Louis Harris and Associates, conducted between Jan. 31 and Feb. 24, 1992.
 The Henry J. Kaiser Family Foundation is a national philanthropy based in Menlo Park, Calif., dedicated to improving health in the United States and South Africa. It is not associated with Kaiser Permanente or Kaiser Industries.
 The Commonwealth Fund is a national philanthropy located in New York City. Committed to helping Americans achieve their full potential, its major programs focus on health, aging and youth issues.
 Survey Highlights
 1. Americans strongly feel the health care system needs reform.
 -- 84 percent feel the system needs fundamental change or complete
 rebuilding. In January 1992, 57 percent felt major changes or a
 different system was needed.
 -- Americans are more secure about their jobs, but less secure about
 health benefits and the ability to pay for health care.
 -- 16 percent of respondents or their spouses worry a great
 deal about losing their jobs, compared with 22 percent in
 1992;
 -- 31 percent worry a great deal that benefits under their
 current health plan will be substantially cut back, an
 increase from 25 percent in 1992;
 -- 39 percent worry a great deal that health insurance will
 become too expensive for them to afford, up from 36 percent in
 1992.
 2. Gaps in health insurance are a chronic problem for Americans.
 -- 32 percent of Americans age 18-64 are currently uninsured
 or were without insurance coverage at some point in the past two
 years. Another two million age 65 and over were uninsured within
 the past two years, for a total of 53 million adults.
 -- Two-thirds of the uninsured have been uninsured for more than
 12 months and almost half have been uninsured for more than
 two years.
 -- Being uninsured is not solely a problem of young adults. Among
 uninsured adults, 34 percent are between the ages of 30-39 and
 35 percent are between the ages of 40-64, while 31 percent are
 between the ages of 18-29.
 -- 32 percent of those unemployed and 30 percent of those who work
 part-time are uninsured, compared with 13 percent of full-time
 workers.
 -- Almost one million people could not obtain insurance because of
 their history of poor health, illness or age.
 3. Only 7 percent of those without insurance say they are uninsured by choice.
 -- Of those currently insured, very few lack health insurance by
 choice. 7 percent reported that they were without health
 insurance by choice; 59 percent said insurance was too
 expensive; 14 percent said they became uninsured when they
 were without a job; 8 percent said their job didn't cover
 them.
 4. Millions of Americans fail to get needed care and are struggling to pay health care bills.
 -- 34 percent of uninsured Americans report that they did not get
 needed care in the past year, and 71 percent postponed care.
 -- As in 1992, 13 percent of all Americans did not get needed care
 in the past year and 30 percent postponed needed care, primarily
 due to its high cost. Women were more likely not to get care:
 15 percent of women compared with 10 percent of men did not get
 needed care; 35 percent of women compared with 24 percent of men
 postponed care.
 -- Out-of-pocket payments for medical expenses increased somewhat in
 1993. 19 percent of Americans reported paying over $1,000 in the
 past year in the 1993 survey, compared with 16 percent in 1992.
 -- Six million Americans helped pay nursing home and home care
 services of a family member in the past year. Three out of
 10 Americans paid bills of $3,000 or more.
 5. Medicare is very successful with respect to beneficiary satisfaction.
 -- 52 percent of Medicare beneficiaries report being very satisfied
 with their insurance, compared with 44 percent of the overall
 insured population.
 -- Medicare beneficiaries are most likely to be satisfied with their
 doctor: 26 percent had changed doctors, compared with 32 percent
 of total population.
 6. Choice is limited for many Americans.
 -- Choice in employer coverage is often limited. 44 percent of
 those insured through an employer or union report that only one
 plan is offered. Among those in firms with less than
 250 employees, 57 percent are offered only one plan.
 -- 40 percent of those insured through an employer are in plans
 which require additional payments for visits to doctors outside
 the plan. Half of those who have to pay more to go outside their
 plan are less than very satisfied with the choice of doctors
 through their plan.
 -- Americans feel more strongly about losing their choice of
 specialist physicians than their choice of general physicians.
 50 percent found it unacceptable to limit choice of surgeons,
 49 percent specialist physicians and obstetricians/gynecologists,
 48 percent hospitals, 40 percent general physicians and
 38 percent pediatricians.
 -- Americans are wary of enrolling in the cheapest plans offered.
 Only 30 percent of those offered a choice select the least
 expensive plan. High income families are least willing to choose
 the cheapest plan.
 7. Nearly one out of five insured Americans are currently HMO members.


HMO members, who tend to be younger and healthier, are as satisfied with their insurance as non-members, but non-members remain concerned about joining.
 -- HMO members report they are as satisfied and treated as well as
 non-HMO members. Among those with employer-based insurance,
 48 percent of HMO members are very satisfied with their
 insurance, compared with 44 percent of non-members. More HMO
 members report having a regular doctor (87 percent vs.
 80 percent); and they are slightly more satisfied with their
 choice of doctors (83 percent vs. 79 percent) compared with non-
 members.
 -- 50 percent of HMO members are between the ages of 18-39, compared
 with 42 percent of non-members. 12 percent of HMO members are
 age 65 or older, compared with 21 percent of non-members.
 -- 87 percent of HMO members are in excellent or good health,
 compared with 81 percent of non-members.
 -- 40 percent of HMO members had to change doctors when they joined
 an HMO. Change is particularly a problem for those who are more
 likely to have well-established health care; those with a regular
 doctor, a serious illness in the family and higher income
 families are more likely to find this change to be a problem.
 -- 52 percent of insured Americans not currently in an HMO would
 find it a problem to be required to join an HMO: 54 percent of
 those with a regular doctor; 66 percent of those with incomes
 over $50,000; and 64 percent of those with a college education.
 8. Preventive health care and prescription drug benefits are viewed as the most important additions to a basic benefits package.
 -- 43 percent feel preventive benefits are essential, and another
 41 percent rated these services as very important.
 -- 34 percent feel a prescription drug benefit is essential;
 42 percent feel it is very important.
 -- 30 percent feel eye care is an essential benefit; 29 percent
 dental care, 27 percent nursing home and home care and 22 percent
 mental health.
 -- If two services had to be dropped from a benefits package, the
 top candidates were dental and eye care. 44 percent felt dental
 benefits could be dropped, and 38 percent would drop eye care.
 -- Women were more likely than men to feel that preventive care and
 nursing home care were essential: 47 percent of women compared
 with 39 percent of men thought preventive care was essential;
 31 percent of women compared with 23 percent of men thought
 nursing home care was essential.
 9. Americans feel that universal coverage and affordable health care should be the most important goals of health care reform.
 -- 34 percent of Americans feel that the most important goal should
 be making health care affordable for themselves and their
 families.
 -- 33 percent of Americans feel that ensuring that everyone has
 health insurance should be the most important goal.
 -- Support for universal coverage is strongest among those more
 likely to have experienced difficulties with the health care
 system, including people with lower incomes, Medicaid recipients,
 those who have been uninsured at some time in the past two years,
 those who work part-time, are unemployed, or students and those
 who have experienced a serious illness in the family in the past
 year.
 10. The government is expected to take a strong leadership role in the health care system.
 -- 57 percent agree strongly and another 26 percent agree somewhat
 that government should be setting overall limits on health care
 spending to bring it in line with general economic inflation.
 -- The public is approximately equally divided on whether states or
 the federal government should be trusted to define benefits
 (39 percent states; 43 percent federal) or supervise and regulate
 health plans (42 percent states; 41 percent federal).
 11. A national sales tax or payroll tax are the preferred ways of financing the health care system.
 -- 33 percent would prefer a national sales tax; 28 percent a
 payroll tax.
 -- 15 percent favor an increased insurance premium.
 -- 12 percent would prefer an increase in income tax.
 12. If health care reform doesn't pass, Americans feel health care interest groups will be to blame.
 -- 41 percent would place the fault with health care interest
 groups. This feeling is consistent across political parties,
 income, education, employment status and gender.
 -- Only 11 percent feel the president would be to blame; 18 percent
 would blame the Republicans; 9 percent the Democrats.
 -0- 11/10/93/1200
 /CONTACT: Mary Lou Russell for The Commonwealth Fund, 212-606-3842, or Matt James of the Henry J. Kaiser Family Foundation, 415-854-9400/


CO: The Commonwealth Fund; Henry J. Kaiser Family Foundation ST: District of Columbia IN: HEA SU: EXE LEG

DT-DC -- DC001 -- 2571 11/10/93 08:08 EST
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Date:Nov 10, 1993
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