New KFF/Los Angeles Times Survey Highlights the Financial Challenges Facing People with Employer Health Benefits

A new KFF/Los Angeles Times survey of Americans with employer health benefits finds that although most are largely satisfied with their employer plan, many report financial challenges related to their health care costs, particularly among those facing high deductibles or suffering from chronic health conditions.

The survey captures the experiences of the roughly 156 million Americans who get their health coverage through their employers, rather than through the individual market or government programs such as Medicare and Medicaid.

Overall 40% of those with employer coverage report problems paying medical bills or difficulty affording their premiums, deductibles, cost sharing or an unexpected bill in the past year. Half (51%) say they or someone in their family have skipped or postponed needed care or medication or relied on home remedies instead of seeking care because of the cost.

These problems occur more frequently as a plan’s annual deductible rises, with the greatest challenges occurring among the one in five (21%) Americans with employer coverage who face the highest deductibles – at least $3,000 for an individual or at least $5,000 for a family.

Similar challenges face the roughly half (54%) of people with employer coverage who say someone in their family is being treated for a chronic condition such as diabetes, heart disease, cancer, high blood pressure, asthma or a serious mental illness. For example:

• About half of those with the highest deductibles and of those with chronic health conditions (49% of each group) had difficulty affording health care or insurance costs in the past year.
• Most of those with the highest deductibles (62%) or chronic health conditions (60%) say they or a family member skipped or postponed care or medication in the past year because of cost.
• More than half (56%) of those with the highest deductibles say they do not have readily available savings to cover their deductible.
• People whose family includes someone with a chronic health condition are more than twice as likely as others with employer coverage to have made various financial sacrifices to pay their health care or insurance costs, such as increasing credit card debt (28% v. 12%), using up all or most of their savings (26% v. 11%) or taking on an extra job or working more hours (19% v. 8%).

The survey also probes the experiences of people with plans tied to tax-preferred Health Savings Accounts (HSAs), how people with employer coverage make health insurance decisions, and their perceptions about the health care system. The Los Angeles Times is featuring findings in a series of articles on high deductible plans. A KFF report provides the full detailed findings.

Overall most people are happy with their employer coverage, with nearly seven in 10 (68%) giving their plan an “A” or “B” grade. Similar shares say they are grateful (72%) and content (69%) with their plan, while far fewer say they feel frustrated (26%), confused (23%) or angry (14%). Views are more negative among those with the highest deductibles.

The survey finds a big shift since 2003 in the importance of low costs for people with employer coverage. When asked about the most important feature in a health plan, six in 10 (59%) cite cost-related features such as low premiums, deductibles or cost sharing, while a quarter (26%) cite coverage concerns such as a wide range of benefits or a wide choice of doctors or hospitals. Those priorities are roughly the mirror image of the results of 2003 KFF survey, in which 60% cited coverage issues and 33% citing cost-related features.

Other findings include:

• Fewer than a third (31%) of those with high deductible plans linked to a HSA report having at least $2,000 in their accounts. Two-thirds (68%) say they view their HSA mostly as a way to pay for current medical bills, compared to a third (32%) who see it as a way to save for the future.
• When asked about tradeoffs people would be willing to make in exchange for a lower premium, a large majority (85%) say they would participate in an employer’s wellness program. Fewer say they would accept a more restricted list of doctors and hospitals (49%), pay more for brand-name drugs (39%) or pay a significantly higher deductible (23%).

The survey was conducted from Sept. 25 through Oct. 9, 2018 among a probability-based sample of 1,407 adults ages 18-64 who reported having health insurance from their own or a spouse’s employer or union. Interviews were administered online and by telephone in English and Spanish using NORC’s AmeriSpeak panel. The margin of sampling error is plus or minus 3 percentage points for the full sample. Teams from the Kaiser Family Foundation and The Los Angeles Times worked together to develop the questionnaire and analyze the data. Each organization is solely responsible for its content.