Kaiser Health Tracking Poll: June 2014
Jul 01, 2014 - The Henry J. Kaiser Family Foundation
Liz Hamel and
Jamie Firth and
Mollyann Brodie
As many employers begin to expand their wellness program offerings under
new guidelines set forth by the Affordable Care Act (ACA), the latest Kaiser
Health Tracking Poll finds that while the public is amenable to the idea of
wellness programs in general, they do not think itfs appropriate for employers
to charge workers higher health insurance premiums if they donft participate in
these programs. Further, an even larger share of the public is opposed to the
idea of employers tying workersf health insurance premiums to their ability to
meet certain health goals. About half of working-age people with
employer-provided health insurance say their employer offers some type of
wellness program, and most of those who are offered (three in ten of all those
with employer coverage) say they participate.
Public opinion on the ACA overall holds steady this month, with 39
percent of the public having a favorable view and 45 percent an unfavorable one.
Compared with earlier polls, somewhat fewer now say their impression of the law
is based mostly on what theyfve heard in the media, while more say they are
basing their opinion on their own experience or that of their family and
friends. A majority continues to say the law hasnft had much impact to date for
their own families, and four in ten say they donft have enough information to
understand how the law will impact them. Among those who are currently
uninsured, the share who feel they donft have enough information rises to six in
ten.
Most Say Itfs Appropriate For Employers To Offer Wellness Programs, But Not
To Tie Premiums To Participation Or Health Outcomes
The ACA builds on existing policies to encourage employers to begin offering
wellness programs to their workers or expand their existing programs. Guidelines
released jointly by the Departments of Health and Human Services, Labor and
Treasury
include rules for both gparticipatoryh wellness programs, which may provide
financial incentives for employees to engage in healthy behavior but are not
tied to an individualfs health status, as well as ghealth-contingenth or
goutcome-basedh wellness programs, which require individuals to meet specific
health goals in order to obtain a financial reward. The latest Kaiser Health
Tracking Poll finds that while the large majority (76 percent) of the public
thinks it is appropriate for employers to offer wellness programs that promote
healthy behaviors, most (62 percent) believe it is not appropriate for
employers to require workers to pay more for their health insurance premiums if
they donft participate. On the question of outcome-based programs, an even
larger share (74 percent) say it is not appropriate for employers to charge
workers higher premiums if they are unable to meet certain health goals.
Opinions are similar among those who get their health insurance from an
employer; 80 percent say it is appropriate for employers to offer participatory
wellness programs, but majorities say it is not appropriate for them to charge
workers higher premiums if they donft participate (62 percent) or if they are
unable to meet certain health goals (75 percent).
Figure 1
The survey also tested whether arguments for and against outcome-based
wellness programs have an impact on the publicfs view, and found that responses
were similar with and without arguments. After hearing both an argument in favor
of these programs (gworkers who are unhealthy drive up health care costs and are
more likely to be absent from workh) and against them (git is an invasion of
workerfs privacy and may unfairly penalize some people who are unable to meet
health goalsh), seven in ten (70 percent) say it is not appropriate for
employers to have these types of programs, including 75 percent of those with
employer-sponsored coverage.
Figure 2
Among working-age adults who get their insurance through an employer, about
half (48 percent) say their employer offers some type of wellness program,
including 27 percent who say their employer offers a participatory program, 2
percent who say their employer offers an outcome-based program, and 16 percent
who say they offer both types of programs.
Among the 48 percent who say their employer offers either type of program, just
over six in ten (63 percent, or 30 percent of all those ages 18-64 with employer
coverage) say they participate. Reported participation rates are somewhat higher
among women than men (73 percent versus 54 percent among those whose employer
offers a program).
Figure 3
Public Opinion On ACA Holds Steady
Overall public opinion of the ACA remains about the same as it has for the
last several months, with a somewhat higher share expressing an unfavorable view
of the law (45 percent) than a favorable one (39 percent). Views continue to be
polarized by political party, with a large majority of Democrats having a
favorable view (66 percent), a large majority of Republicans unfavorable (74
percent), and independents somewhere in the middle but more negative than
positive (31 percent favorable, 53 percent unfavorable).
Figure 4
A plurality of the public (37 percent) says their impression of the law is
based mainly on what theyfve seen and heard on television, radio, and
newspapers, though this share has declined somewhat from earlier tracking polls
in February 2014 and February 2013, when more than four in ten said their
impression was based mostly on the media. There has also been a corresponding
increase in the share who say their impression is based mainly on their own
experience (26 percent this month) or what theyfve learned from friends and
family (22 percent). For the first time in Kaiser tracking, the combined share
basing their impression on their own experience or that of family and friends
(48 percent) is larger than the share who report basing their view mostly on the
media (37 percent). At least two possible factors may be playing a part in this
change over time. As implementation proceeds, more people may be having direct
experience with the law themselves or through their loved ones. Itfs also
possible that as coverage of the law has been out of the media spotlight for the
last few months, fewer people are hearing about it in the news, resulting in a
declining share who report taking cues from the media.
Figure 5
The survey also finds that while a majority (53 percent) say the law hasnft
made much difference for their own families, this share has declined from 62
percent in January, perhaps another indication that more people are starting to
see the law having a direct or indirect impact on them and their families. The
share who feel the law has left their family better off increased from 12
percent in January to 18 percent this month, but remains smaller than the 26
percent who say the law has left their families worse off. Similarly, when asked
how they feel the law is impacting the country as a whole, a third say the
country is better off – up 6 percentage points since January, but still trailing
behind the 40 percent who feel the country is worse off as a result of the
law.
Figure 6
A large portion of the public remains unclear on the lawfs personal impact.
Overall, four in ten (40 percent) say they donft have enough information to know
how the law will impact them and their family, rising to 62 percent among those
who are uninsured.
When it comes to the impact of the law on different groups, the public is
most likely to believe the uninsured are better off under the ACA (43 percent),
while the perceived impact on those with private health coverage is more mixed.
The public is somewhat more likely to perceive a negative rather than a positive
impact on people who get coverage through an employer, with 31 percent saying
this group is worse off, 26 percent saying theyfre better off, and about a third
(35 percent) saying the law hasnft made much difference for them. When asked
about people who buy their own health insurance, a somewhat higher share of the
public says this group is worse off rather than better (37 percent versus 31
percent), while one in five (20 percent) say it hasnft made much difference. A
recent Kaiser Family Foundation survey of people who purchase their own coverage
found a somewhat more positive assessment among this group: 34 percent said they
had benefited under the ACA, while 29 percent said they had been negatively
impacted.
Figure 7