Filling the need for trusted information on national health issues…

The Kaiser Family Foundation (KFF) Survey of Non-Group Health Insurance Enrollees is the third in a series of surveys examining the views and experiences of people who purchase their own health insurance, including those whose coverage was purchased through a state or federal Health Insurance Marketplace and those who bought coverage outside the Marketplaces. The survey was designed and analyzed by researchers at KFF. Social Science Research Solutions (SSRS) collaborated with KFF researchers on sample design and weighting, and supervised the fieldwork. KFF paid for all costs associated with the survey.

The survey was conducted by telephone from February 9 through March 26, 2016 among a random sample of 786 adult U.S. residents who purchase their own insurance. Computer-assisted telephone interviews conducted by landline (293) and cell phone (493 including 302 who had no landline telephone) were carried out in English and Spanish by SSRS. Respondents were considered eligible for the survey if they met the following criteria:

  • Between the ages of 18-64
  • Currently covered by health insurance that they purchase themselves or purchased insurance that would begin in the next month
  • Not covered by health insurance through an employer, COBRA, Medicare, Medicaid, a parent’s plan, or the U.S. military or VA
  • If a small business owner, the health insurance they purchase is only for themselves and/or their family, and does not cover non-related employees of their business

Because the study targeted a low-incidence population, the sample was designed to increase efficiency in reaching this group, and consisted of three parts: (1) respondents reached through random digit dialing (RDD) landline and cell phone (N=142); (2) respondents reached by re-contacting those who indicated in a previous RDD survey that they either purchased their own insurance or were uninsured (N=234); (3) respondents reached as part of the SSRS Omnibus survey (N=410), a weekly, nationally representative RDD landline and cell phone survey. All RDD landline and cell phone samples were generated by Marketing Systems Group.

A multi-stage weighting process was applied to ensure an accurate representation of the national population of non-group enrollees ages 18-64. The first stage of weighting involved corrections for sample design, including accounting for the likelihood of non-response for the re-contact sample, number of eligible household members for those reached via landline, and a correction to account for the fact that respondents with both a landline and cell phone have a higher probability of selection. In the second weighting stage, demographic adjustments were applied to account for systematic non-response along known population parameters. No reliable administrative data were available for creating demographic weighting parameters for this group, since the most recent Census figures could not account for the changing demographics of non-group insurance enrollees brought about by the ACA. Therefore, demographic benchmarks were derived by compiling a sample of all respondents ages 18-64 interviewed on the SSRS Omnibus survey during the field period (N=7,601) and weighting this sample to match the national 18-64 year-old population based on the 2015 U.S. Census Current Population Survey March Supplement parameters for age, gender, education, race/ethnicity, region, population density, marital status, and phone use. This sample was then filtered to include respondents qualifying for the current survey, and the weighted demographics of this group were used as post-stratification weighting parameters for the standard RDD and omnibus samples (including gender, age, education, race/ethnicity, marital status, income, and population density). A final adjustment was made to the full sample to control for previous insurance status (estimated based on the combined RDD and omnibus samples), to address the possibility that the criteria used in selecting the prescreened sample could affect the estimates for previous insurance status.

Weighting adjustments had a minor impact on the overall demographic distribution of the sample, with the biggest adjustments being made based on age (this is common in all telephone surveys, as younger respondents are the most difficult to reach and convince to participate). Weighted and unweighted demographics of the final sample are shown in the table below.

Unweighted

% of total

Weighted

% of total

Age 18-24 7% 12%
25-29 8 11
30-39 13 16
40-49 16 21
50-64 56 40
Refused * *
Gender Male 48 49
Female 52 51
Education Less than high school graduate 4 6
High school graduate 20 26
Some college 27 28
Graduated college 31 25
Graduate school or more 16 13
Technical school/other 1 1
Refused * *
Race/Ethnicity White, non-Hispanic 74 67
Black, non-Hispanic 7 9
Hispanic 8 11
Other/Mixed 8 10
Refused 3 3
Self-reported health status Excellent 22 23
Very good 32 32
Good 29 27
Fair 13 14
Poor 4 5

All statistical tests of significance account for the effect of weighting. The margin of sampling error (MOSE) including the design effect is plus or minus 4 percentage points for results based on the total sample. Unweighted Ns and MOSE for key subgroups are shown in the table below. For other subgroups the margin of sampling error may be higher.

Group N (unweighted) MOSE
Total non-group enrollees 786 ±4 percentage points
ACA-compliant plans 671 ±5 percentage points
Marketplace plans 512 ±5 percentage points

 

Findings

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.