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Business Insurance Survey

Copyright © 2003 Community Health Alliance. All rights reserved.

Unless otherwise indicated, all materials in this document are copyrighted by the Greenville Community Health Alliance. Materials may be used and distributed, but must be cited.

Copyright © 2003 Community Health Alliance. All rights reserved.

Unless otherwise indicated, all materials in this document are copyrighted by the Greenville Community Health Alliance. Materials may be used and distributed, but must be cited.

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The Research ToolsThe Research Tools

Expert Interviews

Community Focus Groups

Underserved Resident Focus

Groups

Resident Telephone

Survey

Health Indicators Data Scan

Qualitative Methods“Putting a Face on the Issues”

Quantitative Methods“Measuring the Issues”

Business Insurance

Survey

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Research MethodologyResearch Methodology

Web-based 31-question survey circulated to 1,717 current Greater Greenville Chamber of Commerce members

Primary responses collected between June 1 and June 15.

292 returned, for an overall response rate of 17%, substantially higher than the response rate of 10% from a similar study two years ago.

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Quantitative Methods: Business SurveyQuantitative Methods: Business Survey

Resident Telephone

Survey

Business Insurance

Survey

Health Indicators Data Scan

• Circulated an extensive web-based survey to 1,700 current Chamber of Commerce members.

• 292 companies responded, for a response rate of 17%.

• Focus on providing insurance to employees and the barriers to providing coverage.

Key ComponentsKey Components

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The FaceThe Data

Findings are based on reliable, comprehensive tools.Findings are based on reliable, comprehensive tools.

• 1,507 completed telephone interviews with over-sampling of ZIP codes with higher levels poverty.

• 13 minute survey focusing on the uninsured with 90% response rate.

• Precision of +/-2.5% at 95% confidence interval.

Resident Telephone

Survey

• Web-based survey sent to 1,700 Greater Greenville Chamber of Commerce members.

• Completed by 292 Chamber of Commerce members for a response rate of 17%.

• Focus on providing insurance to employees and the barriers to providing coverage.

Business Insurance

Survey

• Revisited issues explored in 1998 with more emphasis of changes over time.

• Deeper analysis including census tract level reporting.

• Benchmarks against other similar communities.

Health Indicators Data

Scan

• One on one and telephone interviews with community leaders and health care providers.

Expert Interviews

• 15 focus groups wrapped around health care issues.

• Participants included a wide representation of health care and community leaders.

Community Focus Groups

• Two focus groups with uninsured and underserved residents.

• Participants recruited from telephone survey respondents.

Underserved Focus Groups

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Business Insurance Survey:Business Insurance Survey:Summary of FindingsSummary of Findings

One in four companies (23%) in Greenville do not offer health insurance to their employees, and are not likely to offer health insurance in the next two years (74%).

89% of the companies that do not offer insurance to employees have ten or less employees. Almost half (44%) of companies with ten or less employees do not offer health insurance to employees. The burden of uninsurance falls clearly among small employers with less than ten employees.

Cost is the most significant reason employers do not offer health insurance to employees, especially among small, newer companies.

An average of 16% of employees who have insurance available to them through their employer choose not to take the insurance. 82% of companies say it is because employees are covered under a spouse’s policy.

84% of companies say employees believe it is important for the company to offer insurance and the same number believe insurance is valuable in helping to attract employees to the firm.

Greenville companies responding to the survey are paying an average of $470 per month per employee for insurance. This is an increase of 31% from two years ago ($358). Companies expect costs to increase 32% in the next two years to an average of $620.

Employers are taking significant steps to manage the increasing cost of insurance. Almost half of those surveyed (45%) say they have switched insurance companies in the last two years. A majority have increased employees’ deductibles (52%), 47% have increased the employees’ share of the cost, and 46% have increased employees’ co-payments.

While reducing coverage and shifting more of the burden of health insurance on employees, very few companies surveyed say they would completely drop current health insurance even if costs increased by 50% in the next two years.

The burden of uninsurance, in the opinions of employers, is on the hospitals and on the taxpayers who eventually pay for indigent care.

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One in four companies surveyed do not offer health One in four companies surveyed do not offer health insurance to their employees… and are not likely to in the insurance to their employees… and are not likely to in the near future.near future.

Provision of Health Insurance

Don't offer employees insurance

23%

Offer employees insurance

77%

Q3. Does your company currently offer health insurance coverage to its employees?

Q4. Has your company offered health insurance to its employees within the last five years?

Q5. How likely is it that your company will offer health insurance to its employees in the next two years?

•Of those who do not currently offer insurance to their employees, only 13% have offered health insurance in the last five years.

•74% who currently do not offer insurance say they are not likely to offer health insurance in the next two years.

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All companies surveyed with more than 25 employees offer All companies surveyed with more than 25 employees offer health insurance to employees, while less than half of those health insurance to employees, while less than half of those with five or fewer employees offer insurance.with five or fewer employees offer insurance.

Insurance for Employees

14%

51%

81%

90%94%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

One Two to five Six to ten 11 to 25 26 to 50 51 or moreNumber of Employees

% o

f R

esp

on

den

ts

Q3. Does your company currently offer health insurance coverage to its employees?

Q2, How many employees does your company employ?

44% of companies with 10 or less employees offer insurance

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Cost is the most significant reason employers do not offer Cost is the most significant reason employers do not offer health insurance to employees, especially among small, health insurance to employees, especially among small, new companies.new companies.

We're a startup and will bring our first employees mid-July. We are working on the benefits package now.

We give a health stipend, but since we are small it is cost prohibitive

We are a small start up business that is just now experiencing growth.

We are a small business and are not yet financially ready.

Unable to find small group plan at a price we can afford to pay

Too expensive. Need two employees for a group rate

Too costly. We are a non-profit association

Too small/not necessary

They have it elsewhere

The additional cost to our small business presently does not outweigh the benefits and all my employees currently have their own health insurance through their spouses or partners

Startup company. Will add with growth

Old Owner didn't want to furnish health coverage before

Not reasonably available

No good group rates and we didn't have enough employees last year.

Insurance would be too costly to our employees, if provided by the company.

Insurance provided through other means; however, my company needs to have its own plan in order to offer an attractive but affordable employment package to the right candidate.

I buy it for myself because of cost. If it was lower, I might consider hiring employees and offering it. Health insurance is one of the reasons that I don't have employees.

I am the only employee and I have retiree insurance.

I am covered through my wife

I am covered on my spouse's insurance

High cost with low benefit.

Full and part-time employees are covered under spouse plans elsewhere.

Expense involved

Expense and unable to find group coverage

Expense

Employees are covered under spouse's large organization plans

Covered under a program through retirement from previous company.

Cost (14 respondents)

Cost of coverage. High turnover.

Cost and number of employees interested. Most are still on their parents' policy or have other jobs with insurance.

Can't afford the high cost

Can't afford it. Four women employees-spouses have coverage.

Can not find affordable insurance. We get personal insurance and pay ridiculously high premiums. I know that health insurance costs have kept some people from stating their own business.

Because of age we find it impossible to get individual coverage and is too small for group.

All employees are part time

I am still covered by COBRA

Q6. What are the primary reasons your company does not currently offer health insurance to its employees?

Base: Do not currently offer health insurance

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Of the companies offering insurance most full time Of the companies offering insurance most full time employees are covered, yet part-timers, especially contract employees are covered, yet part-timers, especially contract and those working less than 20 hours a week are not.and those working less than 20 hours a week are not.

Employees Eligible for Insurance

5%

4%

36%

95%

96%

28%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Contractemployees

Part time - Lessthan 20 hours

Part time - Over 20hours

Full time

Salariedemployees

% of Respondents

All Eligible for Insurance

Some Eligible for Insurance

Q7. Which of the following groups of employees are eligible for the company’s health plan?

Base: Offer health insurance

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An average of 16% of employees who have insurance available to them through their companies choose not to take the

insurance.

Q9. What percentage of the employees WHO ARE ELIGIBLE TO PARTICIPATE in your health insurance plan choose NOT to participate?

Base: Offer health insurance

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Although being covered by a spouse’s plan is a primary Although being covered by a spouse’s plan is a primary reason for not participating, costs emerge.reason for not participating, costs emerge.

Reasons for not Participating in Insurance Plan

3%

3%

7%

9%

18%

22%

27%

36%

82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Don't want to have to go through the physical orapplication process

Employees are afraid of disclosing confidentialinformation

Don't think they will get sick

Don't think insurance is important to them

Our employees are seasonal or part time

Covered under another employer's plan

Would prefer to have higher wages

Cannot afford to pay their part of the premium

Covered under a spouse's plan

% of "Primary" or "Signif icant" Reason

Q17. What are the primary reasons employees at your company choose not to participate in your health insurance plan?

Base: Offer health insurance

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Having insurance is important to employees and helps Having insurance is important to employees and helps companies attract qualified employees.companies attract qualified employees.

Importance of Health Insurance

45%

39%

9%

4% 4%

0%

10%

20%

30%

40%

50%

60%

Critical VeryImportant

Somew hatImportant

Not VeryImportant

Not at AllImportant

Q23. How important is it to your employees that you offer health insurance?

Impact of Insurance on Attracting Employees

48%

36%

15%

1% 1%0%

10%

20%

30%

40%

50%

60%

Critical VeryImportant

Somew hatImportant

Not VeryImportant

Not at AllImportant

Q24. What impact does not offering health insurance to employees have on a company’s ability to attract qualified employees?

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Most companies provide insurance because it is “the right Most companies provide insurance because it is “the right thing to do” and to aid in recruiting and retention.thing to do” and to aid in recruiting and retention.

Reasons Companies Provide Health Plans

17%

20%

31%

34%

49%

70%

65%

77%

84%

37%

42%

49%

46%

33%

20%

27%

17%

11%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

One or more of my employees have health problems

It is tax deductible

It reduces absenteeism by keeping employees healthy

It increases productivity by keeping employees healthy

Competitors offer it

It increases loyalty and decreases turnover

Employees demand or expect it

It helps with employee recruitment

It is the right thing to do

% of Respondents

Major Reason

Minor Reason

Q10. How important is each of the following for providing health plans for your company?

Base: Offer health insurance

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Companies are paying an average of $470 per month for Companies are paying an average of $470 per month for employees’ insurance.employees’ insurance.

Cost of Insurance per Employee

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$0 $100 $200 $300 $400 $500 $600 $700 $800 $900 $1,000 $1,100 $1,200 $1,300 $1,400 $1,500

About how much does your company pay each month for health insurance per covered employee?

The median amount companies pay per employee for insurance is $350 per month. The average

amount is $470.

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The cost of health insurance is going up dramatically, with The cost of health insurance is going up dramatically, with no change in sight.no change in sight.

Average Cost of Insurance per Employee

$358

$470

$620

$0

$100

$200

$300

$400

$500

$600

$700

Two years ago Currently Two years from now

Q12. About how much does your company pay each month for health insurance per covered employee?

Q13, About how much did your company pay each month fore health insurance per covered employee two years ago?

Q14. About how much, at current coverage levels, do you believe you will be paying for health insurance per covered employee two years form now?

Increase of 31%

Increase of 32%

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Companies are taking relatively drastic measures to manage the costs Companies are taking relatively drastic measures to manage the costs of health care insurance. of health care insurance.

Almost half of companies say they have switched companies in the last two years. No one says they dropped coverage completely.

Measures Taken in the Last Two Years

0%

4%

10%

32%

45%

46%

47%

52%

0% 10% 20% 30% 40% 50% 60%

Dropped insurance coverage completely for allemployees

Dropped insurance coverage for some groups ofemployees

Limited where employees can go for care

Cut back on the scope of benefits covered

Switched to a new health insurance company

Increased employees' co-payments

Increased the total amount employees are requiredto pay for insurance

Increased employees' deductibles

% of Respondents

Q11. In the last two years, has your company changed any of the following items related to its health insurance benefits offered to employees?

Base: Offer health insurance

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The reactions to increasing costs are different depending The reactions to increasing costs are different depending on the size of the company.on the size of the company.

Smaller companies are more likely to switch insurers, while larger companies are increasing employees’ share of the cost and limiting where they can go.

Total 10 or less 11 to 25 26 to 100More than

100

Increased employees' deductibles 52% 57% 48% 56% 49%

Increased the total amount employees are required to pay for insurance

47% 30% 26% 58% 80%

Increased employees' co-payments 46% 39% 37% 54% 59%

Switched to a new health insurance company 45% 53% 39% 46% 41%

Cut back on the scope of benefits covered 32% 26% 35% 35% 35%

Limited where employees can go for care 10% 6% 7% 12% 18%

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While 88% would reduce coverage if costs increased 50%, While 88% would reduce coverage if costs increased 50%, only 4% say they would drop coverage for employees only 4% say they would drop coverage for employees completely.completely.

Coverage Reductions as Prices Increase

20%

75%

90%

0%

1%

4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Increase 10% Increase 25% Increase 50%

Drop coverage

Reduce coverage

Q12. How would your business change its insurance coverage if costs increase in the next two years?

Base: Offer health insurance

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Employers are positioned to shift costs to employees and continue to Employers are positioned to shift costs to employees and continue to shop around for the most economical policies.shop around for the most economical policies.

Steps to Address Changes (Verbatims)

4

4

5

9

11

21

22

0 5 10 15 20 25

Start Medical SavingsPlans

Explore group plans

Encourage legislation

Limit or decreasecoverage

Encourage employeewellness/prevention

Shop around for betterpolicies

Shift costs to employees

Number of Verbatim Comments

Q16. What steps, if any, will your company take in the next few years to address the changes in the provision of insurance and healthcare coverage? (Open-ended question)

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Shift Costs to Employees• Company may co-insure.

• Continue to 'cost shift' to employee

• Drive more of the costs to employees

• Employee will pay more of cost

• Employee will pay more of cost

• Employees may be asked to share in cost.

• Encourage employees to buy own and company will reimburse

• If rates increase too much, we will seek contributions from our employees to offset the costs. As well as searching for other health care providers.

• Increase employee contribution for dependent coverage

• Increase employee share of cost

• It is a certainty that we will make plan changes this year due to increased cost. All options (except dropping coverage) are currently on the table ). Cost will go up for employees.

• Move from 100% company pay to an employee partial pay

• Possible require employees to pay a small portion of the premium

• Require employees to pay more for healthcare insurance

• Require employees to pay more of the premium.

• Transfer cost increases onto employees (partial or total)

• We are currently looking at employees paying a percentage.

• We will have no choice but to look at raising deductibles and/or asking employees to pay some of the costs

• Deductible increases

• Deductibles will be raised. each renewal increases in copays and premiums will be communicated to the employees.

• Increase deductible and co-pay

• Discussions for increases due to the trends have taken place. At Increase deductibles. Consider MSA plan.

Actions to Address Changes - VerbatimsActions to Address Changes - Verbatims

Explore Group PlansIf possible, small business needs to be able to buy at same price as large corporations, and they need all employees to be eligible at same price, only factor being age of employee. If someone had this...I would change

Look at options of pooling resources with other companies to get costs down.

Search for networking with other small firms to increase buying power. Search for insurance consultants/brokers who offer better coverage and lower cost.

We would like to be able to join a larger group through an organization like a business alliance or co-operative or have the chamber organize a program for small business

Q16. What steps, if any, will your company take in the next few y3ears to address the changes in the provision of insurance and healthcare coverage?

Consider Medical Savings Plan• Consider MSA plan.

• Try to convert employees to MSA type plans.

• We have started looking at other alternatives such as the MSA accounts and wish we could find an insurance company whose premiums for amounts the MSA would not cover would be competitive enough for us to use this method. We are also going to be required

• We recently switched to an MSA plan for health insurance.

Limit/Decrease Coverage• We will probably have to limit who qualifies for coverage.

• As employer, cap our spending to $200 per month per employee

• Charge $200 co-pays for non-emergency ER visits; join prescription co-op; etc.

• Consider becoming self-insured raise, deductibles and co-payments, limit prescription plans

• Defer elective procedures

• If necessary, we will drop all coverages

• Look at catastrophic coverage and self insure underneath that

• Only insure salaried full-time employees with a high deductible (basically major medical). If they want more, they will have to pay the difference. As the owner, I carry a separate individual policy which is much less expensive than the group policy, s

• We have just, for the first time in 14 years, had to severely reduce our coverage to maintain a 100% payment for employees. In order to meet their needs, we've added a buy-up option that will cost even the employees, additional money to maintain coverage

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Actions to Address Changes - Verbatims Actions to Address Changes - Verbatims (Continued)

Shop Around/Evaluate Needs• Look at different coverages and plans and try to accommodate as many

benefits as allowed by our budget

• Look at plan designs to be more cost effective

• Look for alternative coverages

• Look into MSA plans and other option to reduce expenditures

• More cafeteria plan approach.

• Put it out to bid each year.

• React to actual conditions by either searching out different providers and/or changing the type of coverage.

• Rebid insurance nearly every year

• Research all possible areas of insurance coverage to provide adequate coverage at reasonable rates

• Self insure to a certain level

• Shop around for best coverage

• Shop around more

• Shop carriers, change carriers to maintain or decrease company costs

• Shop for best buy each year

• Shop insurance coverage, re-evaluate coverage levels

• Shop Rates

• Try to shop the insurance with other carriers - or look into individual coverage with a company reimbursement to employee

• We currently are covered under Greenville County's Insurance Plan. If costs continue to rise, we may need to look at other options, such as the State Heath Plan.

• We will look at other health care plans. Right now we pay 100% of the coverage for healthcare coverage for our employees. We will be looking into splitting the cost with the employee in the near future.

• We will monitor the market and look for competitive service.

• Will continue to monitor other options available

Encourage Wellness/Preventive Care• Disease management and wellness plans

• Emphasize wellness, preventative care, case management and education

• Encourage employees to stay fit and eat healthy, along with providing screening for cancer etc.

• Encourage healthier lifestyles.

• Help educate employees on how to become smart shoppers of health care services and prescription drugs. Considering providing flu shots and other preventative options.

• Make employees more aware of generic drugs, less costly procedures, etc.

• Offer more information on healthy living, bring in screening services to raise awareness.

• Offering more 'creative' ways to keep our staff insured but to get them to make wiser decisions about health care costs

• We put in place two Nurse Practitioners‘

• Wellness and shopping for best product

• Wellness initiatives focused on diabetics and those with coronary artery disease

Encourage Legislation• Actively lobby Congress for the passage of the AHP legislation, which is exactly

what the groups behind this survey should be doing. Also encourage state representative to pass similar legislation to enable the small employer to pool resources

• Any changes made will depend on changes in costs and/or changes in law

• Apply pressure to legislators

• Stay abreast of issues and changes. Petition lawmakers, if necessary.

• I don't know, but something has got to change or we will have Government Healthcare. If that’s true Hillary was right when she tried to push changes in the early 90's. That’s scary to think about.

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Companies believe it is important to offer a series of Companies believe it is important to offer a series of benefits, including some preventive care measures.benefits, including some preventive care measures.

Importance of Insurance Benefits

2%

8%

12%

14%

24%

29%

36%

53%

61%

71%

72%

73%

73%

80%

81%

81%

85%

88%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cosmetic surgery

Alternative medicine

Chiropractic services

Emergency room care for non-serious problems

Provision of eyeglasses and contact lenses

Alcohol and drug abuse treatment

Restorative dental care

Preventive dental care

Childbirth for spouses

Preventive care check-ups to primary care physicians

Maternity care and childbirth

Prescription drugs for all drugs

Prenatal care for normal births

X-rays or MRIs

Visits to specialist physicians such as cardiologists

Prescription drugs for generic drugs

Sick Visits to primary care physicians

Emergency room care for serious problems

% of Respondents saying "Critical" or "Important"

Q19. How important is it for a company to offer these benefits to employees?

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Local businesses believe the primary responsibility for the uninsured Local businesses believe the primary responsibility for the uninsured lies with the uninsured and their families; with some help from national lies with the uninsured and their families; with some help from national and state governments.and state governments.

Uninsured Responsibility

2%

5%

3%

6%

6%

12%

17%

31%

8%

16%

18%

16%

28%

25%

31%

31%

0% 10% 20% 30% 40% 50% 60% 70%

Local Government

Local Employers

Local Hospitals

Insurance Companies

South Carolina StateGovernment

The Federal Government

The Families of theUninsured

The Person who isUninsured

% of Respondents

Q20. In your opinion, how much responsibility do the following groups have for taking care of the needs of those without insurance in Greenville?

62%

48%

37%

34%

22%

21%

21%

10%

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Businesses believe the greatest cost of uninsurance is to the hospitals Businesses believe the greatest cost of uninsurance is to the hospitals for indigent care. They believe taxpayers are paying some of the costs.for indigent care. They believe taxpayers are paying some of the costs.

Impact of Uninsurance

14%

17%

49%

47%

48%

22%

28%

28%

36%

36%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cost to businesses inabsenteeism

Cost to businesses in lostproductivity

Cost to individuals withoutinsurance

Cost to taxpayers whoeventually pay for care

Cost to hospitals forindigent care

% of Respondents

Significant Impact

Some Impact

Q25. It is estimated that about 10% of Greenvillians do not currently have health insurance. What impact does not having insurance have on each of the following?

84%

83%

77%

45%

36%

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Sample DescriptorsSample DescriptorsNumber of Employees

31%

16%

21%

13%

19%

44%

15% 15%

11%

8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Five or less Six to ten 11 to 25 26 to 100 101 or more

Perc

en

t o

f R

esp

on

den

ts

Respondents

Sample

Q2. How many employees does your company employ?

Company Annual Revenue

7%8%

13%

19%

25%

23%

5%

0%

5%

10%

15%

20%

25%

30%

Lessthan

$100K

$100Kto

$250K

$250Kto

$500K

$500Kto $1

Million

$1mmto

$5mm

$5mmor more

Refused

Perc

en

t o

f R

esp

on

den

ts

Q30. For fiscal year 2002, what was your company’s annual gross revenue?