Massachusetts Employers Largely Support Health Care Reform: Few Signs of Crowd-out. Jon Gabel Heidi Whitmore Jeremy Pickreign National Opinion Research Center at the University of Chicago Financial support for this study was from the Blue Cross Blue Shield Massachusetts Foundation and the Robert Wood Johnson Foundation.

Study Objectives Examine Massachusetts employers’ –Attitudes about health care reform –Anticipated responses to health care reform Provide baseline documentation comparing health benefits in Massachusetts with the nation

Methods Survey of about 1,000 randomly selected Massachusetts public and private firms with three or more workers (RWJF/NORC Mass. Employer Benefits Survey). Comparison group is Kaiser Family Foundation/Health Research and Educational Trust (KFF/HRET) national survey. Massachusetts survey includes core questions from KFF/HRET national survey, plus additional questions on employer attitudes about Massachusetts health care reform. National Research LLP conducted telephone interviews with employee benefit managers conducted from February to June 2008 for RWJF/NORC survey. Use of statistical weights –Employer weights –Employee weights

Coverage Estimates Category Firms with 3-50 Workers All Firms MassachusettsUnited StatesMassachusettsUnited States Percentage of employees covered by their employer, firms offering and not- offering health benefits. 47%45%57%59% Percentage of employers offering coverage 70%*57%73%*60% Take-up rate 72%*79%78%*82% Coverage rate 58%*65%61%65% Percentage of workers enrolled in family coverage 41%*34%45%*38% Percentage of firms where same sex couples are eligible for coverage 59%*30%52%*38% Sources: Robert Wood Johnson Foundation/National Opinion Research Center Massachusetts Employer Benefit Survey, 2007; and Henry J. Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey, * Massachusetts estimate is significantly different from United States estimate at p<0.05 level.

Employer Responsibility: Percentage of Firms Agreeing That Employers Bear Some Responsibility for Health Insurance, by Firm Characteristics, 2007 Source: RWJF/NORC Survey of Massachusetts Employers: 2007 * Distributions are significantly different from other firm sizes or offering status at p < 0.05.

Employer Support for Reform Plan’s Requirement to Offer Health Benefits or Pay Fair Share Contribution, and Against Exempting the Smallest Firms, by Firm Size, 2007 Firms agreeing with requirement to offer or pay fair share contribution Firms agreeing that smallest firms (10 or fewer workers) should not be exempted Source: RWJF/NORC Survey of Massachusetts Employers: 2007 * Distributions are significantly different from other firm sizes at p < 0.05.

Little Early Evidence of Crowd-Out among Firms with Workers * Tests found no significant differences between Mass. And USA. Source: RWJF/NORC Survey of Massachusetts Employers, 2007

Summary and Discussion Massachusetts employers hold views generally supportive of the spirit of health care reform. –View employers bearing some responsibility for providing health insurance for workers. –Support “fair share ” provision. –Support expanding requirements to firms with 10 or fewer workers. Little early evidence of crowd-out. Some aspects of health insurance make reform in Massachusetts challenging. –Employee contributions for single coverage are nearly twice the national average, reducing the take-up rate. –Premiums are more expensive than nationally, and increasing more rapidly.

Plan Characteristics Firms with 3-50 WorkersAll Firms MassachusettsUnited StatesMassachusettsUnited States Percentage increase in premiums, %6.8% 7.5%* 6.1% Monthly premium single coverage $426$403$445*$373 Employee contribution single (Percent contribution) $83* (20%) $46 (13%) $105* (24%) $58 (16%) HMO-POS Market Share 85%*49%77%*34% Percentage of workers with deductible 34%*55%19%*59% Sources: Robert Wood Johnson Foundation/National Opinion Research Center Massachusetts Employer Benefit Survey, 2007; and Henry J. Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey, * Massachusetts estimate is significantly different from United States estimate at p<0.05 level.

Employee Responsibility: Percentage of Firms Agreeing That Employees Bear Some Responsibility for Health Insurance, by Firm Characteristics, 2007 Source: RWJF/NORC Survey of Massachusetts Employers: 2007 * Distributions are significantly different from other firm sizes or offering status at p < 0.05.