Transamerica Institute

Highlights: Americans 2015

Nearly Two out of Three Americans Suffer from a Chronic Health Condition

  • White Americans (67%) are the most likely to report being diagnosed with a chronic health condition
  • African Americans are shown to have the highest rates of high blood pressure and Type 2 Diabetes (24% and 10%, respectively).
  • Asian Americans are generally least likely to report having any chronic health condition (41% have any health condition).

The health insurance landscape is changing with more Americans covered. Individuals reporting being uninsured fell from 21% in 2013 to 11% in 2015.  At the same time, satisfaction with health coverage has increased for many Americans, but not for all.

  • 1 in 3 insured Americans changed or acquired a new health plan in the last year.
  • Satisfaction with the quality of the healthcare system is at its highest since the survey was first conducted with 82% reporting that they are very or somewhat satisfied.
  • The percentage of Americans indicating an increase in the quality of the health insurance plans and healthcare services they have access to has roughly doubled since 2014 (7% vs. 12% and 5% vs. 11%, respectively).
  • Exchange buyers are more likely than those with other types of insurance to say the quality of the health insurance plans they have access to has increased, but are not more likely to say the same about the quality of healthcare service they can access. Half say their coverage has stayed the same, with equal numbers (25%) reporting it is better and worse.

For the majority of Americans, affordability is most important. While the majority of Americans say they can afford routine health expenses, many also report healthcare costs are on the rise.

  • When asked identify characteristics of the healthcare system today are most important, 54% of Americans selected affordability.
  • The percentage of Americans reporting increases in premiums (41% vs. 30%), deductibles (33% vs. 25%) and out-of-pocket expenses (36% vs. 26%) is larger than what was noted in 2014.
  • 82% of Americans say they can afford routine health expenses while nearly one in five Americans (18%) report they are unable to afford routine health expenses.
  • Fewer than half of the Uninsured (46%) reported being able to afford a premium of $100 per month.

Americans also reported being less informed about the ACA than they were in 2013. The Uninsured are least likely to feel informed about the ACA (39%), while 52% of the Newly Insured and 57% of the Continuously insured feel informed

Among those who did not have a prior health insurance policy, about half now receive coverage either through a government-sponsored program or through an Exchange.

While the percentage of those who report being uninsured has fallen, for those who remain uninsured the most common reason they say they do not have coverage is because they are not aware of the mandate (26%). Furthermore, 18% report they do not know how to apply - up from 9% in 2014.

The percentage of Americans overall indicating they will not purchase health insurance in the next year and pay the tax penalty continues to drop (down to 3%).

One in four Americans (28%) says prevention is their top health priority, while another one in four (26%) cite self care as their health priority.

  • One in five (21%) are making health changes, with 15% dealing with a current or past health condition. Seven in ten (71%) of those making health changes have at least one chronic condition that they are managing.

Highlights: Companies 2015

A minority of employed adults (38%) report their employer offers a workplace wellness program, and just over half of those employees participate.

More than four in five (82%) employers offer at least one healthcare plan, and companies of all sizes are offering more healthcare plans across the board.

  • Of companies who say they are at risk for paying a “Cadillac Tax,” for high-end health plans, more than eight in ten (84%) report planning to change their benefits to avoid it.
  • Currently, nearly two in three employers (62%) say they buy a health plan and provide it directly to employees, but one in ten (10%) report they anticipate that they will subsidize employees buying health coverage on private exchanges in the future (compared to 6% currently subsidizing plans).
  • There has been a steady increase in the use of high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs) over the past two years – nearly two in three employers offer one of these types of plans along with a health savings account (HSA).

Over 80% of both employers and employees agree that healthcare benefits are important for attracting/retaining employees and for overall employee job satisfaction, and over 90% of employers and employees say a flexible work/life balance is important for the overall employee experience.

  • However, employers are more likely to think employees are satisfied with the company’s health plan (95% vs. 77%) and other benefits (93% vs. 78%) than employees actually report.
  • Two in five employers (40%) anticipate the quality of health insurance they offer to employees will improve in the next 12 to 36 months, and only 10% expect the quality to decline.

Most employers say they will attempt to keep constant their contribution to the cost of employees’  premiums (57 percent), deductibles (60 percent), and co-pays/coinsurance (58 percent) and three in 10 employers want to maximize their contributions to employees’ premiums  to help manage  health insurance costs.

  • Employers are most likely to be concerned about their company’s ability to manage healthcare costs associated with cancer (71%) drug expenses (69%), as well as diabetes and obesity (68%). Self-insured employers are more likely to report being concerned about healthcare costs compared to companies that purchase or subsidize plans.
  • More than two in five (44%) companies say they anticipate their employees healthcare costs to the company will increase in the next 24 to 36 months.

Sixty-one percent of employers report offering workplace wellness programs for their employees, and half (49 percent) of employers that implemented a wellness program in the last 12 months cite saving money as the motivation.

  • Among companies with workplace wellness programs, 82 percent say their program had a positive impact on workers’ health, 80 percent say it had a positive impact on productivity and performance, and 71 percent say it had a positive impact on healthcare costs.
  • Employers reporting that their health promotion plan has had a positive impact on healthcare costs are more likely than those reporting a neutral or negative impact to say they offer screenings (69% vs. 57%), links to services (53% vs. 39%) and integration of the program into their culture (48% vs. 37%).

Most companies report offering wellness programs that they believe have a positive impact. But while the majority of employers (84%) say their leaders are committed to taking care of the health of their employees, only a third of employees (33%) agree.

  • Three in five (61%) employers report offering wellness programs. But, less than half (45%) of employees with employer coverage say they work for an employer who offers a wellness program.

As for small businesses (companies with less than 50 employees), 55 percent say they are aware of the Small Business Health Options Program (SHOP) Marketplaces, compared to 50 percent last year, and a third say they know how to access SHOP coverage for their employees.

  • Small businesses (companies with less than 50 employees) are more likely to say they believe the ACA has had a negative impact on their business (23 percent of small businesses vs. 11 percent and 10 percent of medium (50 to 499 employees) and large companies (more than 500 employees).

Highlights: Pulse Check Survey 2015

Affordability remains a major factor in the level of or lack of health insurance coverage for Americans.

  • While only 25 percent of uninsured Americans can afford routine health expenses, 90 percent of continuously insured Americans and 61 percent of newly insured Americans are able to afford their routine health expenses.
  • More than half of the general population pay less than $1,000 in insurance premiums annually; 16 percent pay more than $3,000 per year.
  • Eighty percent of uninsured Americans state that they spend less than $500 a year on routine health expenses, compared to 72 percent of the newly insured and 55 percent of the continuously insured who state the same.

While the majority of Americans support most aspects of the ACA, a small majority object to the tax penalty for noncompliance with the individual mandate.

  • More than half (54 percent) of Americans oppose the new law’s requirement to acquire health insurance or pay a tax penalty for opting out.
  • The aspects of the ACA that the general population supports include:
  • Allowing everyone to qualify for health insurance despite any pre-existing conditions (90 percent)
  • The removal of annual or lifetime limits on coverage (89 percent)
  • Providing coverage under a parent’s plan for children up to age 26 (79 percent)
  • Providing eligible individuals and families who earn less than $92,000 a year with government subsidies that lower the cost of health insurance plans (78 percent)

Roughly six in ten of all adults say they are at least somewhat informed about the ACA (58%), and satisfaction with the quality of the health care system overall remains high and unchanged from July 2014 (78%).

While satisfaction remains high overall, only 49% of uninsured Americans are satisfied with quality of health care, compared to 86% of the continuously insured and 77% of the newly insured. 

In terms of specific elements of the health care system, the general population is most satisfied with the focus placed on preventive care (79%) followed by health insurance access for themselves and their families (77%).

Since the introduction of the ACA, more than half of Americans (56 percent) are now more concerned about being able to regain insurance coverage if they were to lose what they have now, and 44 percent are now less concerned.

Nearly one in five Americans said their employers may change insurance plan options in the upcoming year.

  • Half of the general population does not expect their employer to make any changes to their health care benefits.
  • However, 12 percent believe that their employer will reduce or eliminate a company contribution to cover health insurance costs.