Kaiser Family Foundation /
LA Times Survey Of Adults With
Employer-Sponsored Health Insurance
Prepared by:
Liz Hamel
Cailey Muñana
Mollyann Brodie
May 2019
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance
Table of Contents
Executive Summary ...................................................................................................................................... 1
Section 1: Profile of adults with employer-sponsored health insurance and overall views of coverage....... 3
Section 2: Affordability of health care and insurance .................................................................................... 7
Section 3: The experiences of those with high deductibles and those with chronic conditions .................. 13
Section 4: Health insurance decision-making and trade-offs ...................................................................... 18
Section 5: Views and experiences related to Health Savings Accounts ..................................................... 22
Section 6: Cost-conscious health care shopping behaviors ....................................................................... 24
Section 7: Perceptions of health system winners, losers, and who’s to blame .......................................... 27
Methods ....................................................................................................................................................... 31
Endnotes ..................................................................................................................................................... 33
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 1
Executive Summary
Since the passage of the Affordable Care Act (ACA) in 2010, much attention has been paid to the parts of
the U.S. health insurance landscape that were most directly impacted by the law, including the individual
insurance market and expanded Medicaid programs in some states. Yet, the number of people covered
by employer-sponsored health insurance in the U.S. far exceeds the number covered in the individual
market or by any government program. In 2017, about 156 million people had employer-based coverage,
representing almost half the total U.S. population and 60 percent of non-elderly adults.
1
Surveys of
employers point to the growing cost burden of health insurance for this population. Between 2008 and
2018, premiums for employer-sponsored insurance plans increased 55 percent, twice as fast as workers’
earnings (26 percent). In addition, workers are finding themselves on the hook for bigger deductibles
before their insurance will kick in. Over the same time period (2008-2018), the average health insurance
deductible for covered workers increased by 212 percent.
2
Against this backdrop, the Kaiser Family Foundation partnered with the Los Angeles Times to conduct a
representative survey of adults with employer-sponsored health insurance.
3
Some key themes from the
survey are summarized here, and a full report of the findings follows.
Overall, the survey finds that most people with employer-sponsored insurance (ESI) are generally
satisfied with their health plans, and large shares say they feel “grateful” and “content” about their
insurance while fewer say they are “angry” or “frustrated.” However, insurance does not offer iron-clad
protection against health care affordability challenges. Four in ten report that their family has had either
problems paying medical bills or difficulty affording premiums or out-of-pocket medical costs, and about
half say someone in their household skipped or postponed some type of medical care or prescription
drugs in the past year because of the cost. Seventeen percent say they’ve had to make what they feel are
difficult sacrifices in order to pay health care or insurance costs; for some, the sacrifices they report
making are extreme.
The experiences and attitudes of people with employer coverage differ vastly depending on whether they
are in a higher or lower deductible plan. The higher the deductible, the more likely an individual is to have
negative views of their health plan, and the more likely they are to experience problems affording care or
to put off care due to cost. One reason people with higher deductibles are having trouble affording care is
that many of them do not have enough savings to cover the full amount of their deductible. Among those
in the plans with the highest deductibles (at least $3,000 for an individual or $5,000 for a family), over half
say the amount of savings they could easily access in the short term is less than the amount of their
deductible.
Another group that is particularly vulnerable to health care affordability issues are those with chronic
conditions. Just over half (54 percent) of those with employer-sponsored coverage say that someone
covered by their plan has a chronic condition such as hypertension, asthma, a serious mental health
condition, or diabetes. About half of this group reports that their family has had problems paying medical
bills or difficulty affording premiums or out-of-pocket costs, compared to about three in ten of those in
families without a chronic condition. The combination of a chronic condition and a high deductible leads to
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 2
even higher rates of problems and worries. For example, three-quarters of those in the highest deductible
plans who say someone on in their family has a chronic condition say that a family member in their
household has skipped or delayed some type of medical care or prescription drugs for cost reasons in the
past year.
The survey also finds that cost has taken on greater importance in health insurance decision-making over
the last decade and a half. When asked to choose the most important feature in a health plan, about six
in ten people with employer coverage choose cost-related factors (low premiums, deductibles, or co-
pays), while about a quarter choose coverage-related factors (choice of providers or range of covered
benefits). These shares are essentially the opposite of what they were in 2003, when one-third chose
cost-related factors and six in ten chose range of benefits or choice of providers. Similarly, among those
whose employer offered a choice of plans, the share who say they picked their plan based on the cost
increased from 21 percent in 2003 to 36 percent in the current survey.
Seven in ten people with employer coverage report engaging in some type of cost-conscious health care
shopping behavior in the past 12 months, the most common of which is asking for a generic instead of a
brand-name drug (47 percent). Less common behaviors are those that might actually lead to lower prices
on services, including shopping around at different providers to find the best price for a medical service
(17 percent) and trying to negotiate with a provider for a lower price (9 percent). One selling point of high
deductible health plans is that they may incentivize enrollees to engage in more cost-conscious
behaviors, including price-based shopping. The survey finds mixed evidence that this is the case; while
the lowest rate of reporting these behaviors occurs among those in plans with no deductible, with a few
exceptions, those in high deductible plans are not significantly more likely than those in lower deductible
plans to report engaging in price-based shopping. In addition, those in high deductible plans paired with a
health savings account (HSA plans) are not significantly more likely than those in plans with similar
deductible levels to report shopping for lower-priced health care services. Overall, those enrolled in HSA
plans – who make up 18 percent of adults with employer coverage – are more likely to view them as a
way to pay for current medical bills than as a way to save money for the future.
Confusion and lack of access to cost information can also be a barrier for individuals to engaging in cost-
conscious health care behaviors. Two-thirds say it is difficult to find out how much medical treatments and
procedures provided by different doctors and hospitals would cost them, and over four in ten say they
have had difficulty understanding how much they will have to pay out of their own pocket when they use
care.
Finally, while most people with employer insurance feel that the cost of health care for people like them is
too high, more say the current U.S. health insurance system works well for people with employer
coverage than say it works well for people on Medicare or Medicaid or those who purchase their own
insurance. Asked who is to blame for high costs, majorities point the finger at pharmaceutical and
insurance companies, while fewer see hospitals, doctors, or employers as deserving of blame.
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 3
Section 1: Profile of adults with employer-sponsored
health insurance and overall views of coverage
Sixty percent of adults ages 18-64 in the United States have health insurance coverage through an
employer or union. Census data show that, compared to the general population, these adults have higher
incomes and education levels and are more likely to be White or Asian and less likely to be Black or
Hispanic.
4
The survey finds that most people with employer-sponsored health coverage (73 percent) say they pay at
least part of their premium for their insurance, while 16 percent say their employer pays the whole thing.
When asked about their annual deductible for medical care, 15 percent say they have no deductible and
44 percent report a deductible of less than $1,500 for an individual or less than $3,000 for a family
(defined for the purposes of this report as “lower deductible”). Four in ten (41 percent) report having plans
with higher deductible amounts, including 20 percent with deductibles between $1,500 and $2,999 for an
individual or between $3,000 and $4,999 for a family (“higher deductible”) and 21 percent with deductibles
of at least $3,000 for an individual or $5,000 for a family (“highest deductible”). About one in six (18
percent) report having a higher or highest deductible plan paired with a health savings account (HSA).
Nearly two-thirds (64 percent) of people with employer coverage say their insurance covers other family
members in addition to themselves, while 36 percent report having single coverage. While nearly nine in
ten (88 percent) describe their own health status as “excellent,” “very good,” or “good,” just over half (54
percent) say that they or another family member covered by their plan has a chronic condition, the most
common being hypertension or high blood pressure (30 percent), a serious mental health condition (15
percent), asthma or other breathing problems (14 percent), and diabetes (11 percent).
Figure 1
Four In Ten Adults With Employer-Sponsored Insurance Report
Having High Deductible Plans
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
No
deductible
15%
Lower
deductible
44%
Higher
deductible
20%
Highest
deductible
21%
AMONG ADULTS WITH EMPLOYER-SPONSORED HEALTH INSURANCE: Percent who say their annual
deductible is:
<$1500
individual;
<$3000
family
$1500-$2999
individual;
$3000-$4999
family
$3000+
individual;
$5000+
family
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 4
Overall, most people with employer coverage report being happy with their insurance. Nearly seven in ten
(68 percent) give their health plan a grade of “A” or “B,” and large shares say the words “grateful” (72
percent) and “content” (69 percent) describe the way they feel about their insurance, while far fewer
identify with words like “frustrated” (26 percent), “confused” (23 percent), or “angry” (14 percent). More
than half (58 percent) say they think their employer is offering them the best health insurance they can
afford. However, a substantial share – 42 percent – believe their employer could be providing something
better.
It’s notable that these views differ greatly depending on the deductible level of an individual’s plan. For
example, among those in the highest deductible plans, over half (55 percent) give their plan a grade of
“C” or below, and half (51 percent) say their employer could be providing something better. While positive
emotions still outweigh negative emotions for this group, the gap is much narrower, with 58 percent
saying they feel “grateful,” and 50 percent “content,” while four in ten say they feel “frustrated,” 34 percent
“confused,” and 23 percent “angry.”
Figure 2
Half Of Those With Employer-Sponsored Insurance Say They Or
A Family Member Has At Least One Chronic Condition
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
30%
15%
14%
11%
16%
54%
Hypertension or high blood pressure
A serious mental health illness such as depression
Asthma or other breathing problems
Diabetes
Heart disease
Cancer
Any other chronic condition
Percent who say they or a family member is currently receiving treatment for the following chronic health
conditions:
Yes to any of the above
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 5
Figure 3
Most Give Plans Passing Grades, But Less So For Those With
High Deductibles
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they would give their health insurance plan the following grades:
25%
45%
28%
18%
12%
43%
41%
45%
49%
34%
25%
11%
23%
25%
39%
5%
2%
3%
6%
13%
1%
2%
<1%
2%
3%
Total
No deductible
Lower deductible
Higher deductible
Highest deductible
A, excellent B, good C, average D, poor F, failing
Figure 4
58%
65%
60%
57%
49%
42%
35%
39%
43%
51%
Total
No deductible
Lower deductible
Higher deductible
Highest deductible
…are offering you the best health insurance they can afford
…could be providing something better
Most Say Employer Is Offering Best Insurance They Can, But
Those With Highest Deductibles More Split
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Given what you know about your employer’s current financial situation, do you think they…?
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 6
In addition, while most people in plans with no or lower deductibles say their health insurance has “stayed
about the same” in the past 5 years, four in ten (39 percent) of those in higher deductible plans and half of
those in the highest deductible plans say their insurance has “gotten worse.”
Figure 5
Positive Emotions Towards Health Plans Outweigh Negatives,
But Less So For Those With High Deductibles
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say each of the following describes how they feel about their health insurance:
72%
69%
78%
77%
68%
66%
58%
50%
Grateful
Content
Total No/Lower deductible Higher deductible Highest deductible
26%
23%
14%
18%
20%
10%
32%
21%
20%
40%
34%
23%
Frustrated
Confused
Angry
Figure 6
Those In High Deductible Plans More Likely To Say Insurance
Has Gotten Worse In Past 5 Years
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Over the past 5 years, would you say that your health insurance has…?
12%
13%
15%
15%
52%
67%
57%
44%
41%
31%
16%
24%
39%
50%
Total
No deductible
Lower deductible
Higher deductible
Highest deductible
…gotten better …stayed about the same …gotten worse
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 7
Section 2: Affordability of health care and insurance
While many employers pay for a large share of covered workers’ health insurance premiums, the survey
finds that employer-sponsored health insurance does not offer iron-clad protection against health care
affordability challenges. Four in ten adults with employer coverage say that in the past year they had
problems paying medical bills or difficulty affording their premium, deductible, co-pays, or an unexpected
medical bill for themselves or a family member. When this group is asked to say which has been the
biggest problem for their family, medical bills they had to pay before meeting their deductible (31 percent)
and unexpected medical bills (23 percent) top the list, while fewer say the biggest burden is their
prescription drug costs (11 percent), medical visit co-pays (10 percent), or health insurance premiums (8
percent).
Figure 7
27%
25%
20%
14%
13%
40%
Problems paying/inability to pay medical bills
…medical bills before meeting deductible
…unexpected medical bills*
…co-pays for prescription drugs
…co-pays for doctor visits
…monthly health insurance premium
Four In Ten People With Employer Coverage Report Difficulty
Affording Some Type Of Health Care Or Insurance Cost
NOTE: *Unexpected medical bills include bills people thought would be covered, but the insurance company did not pay or paid less than expected.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they or a family member experienced each of the following in the past 12 months:
Yes to any affordability problem
Difficulty affording…
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 8
Among the 40 percent who report problems affording some type of health care cost in the past year,
many report making various sacrifices in order to pay these costs. Two-thirds of this group (representing
about a quarter of all adults with ESI) say they put off vacations or major household purchases or cut
back spending on food, clothing, or basic household items. About half (one in five among the total) say
they increased their credit card debt or used up all or most of their savings to pay for health care. One-
third (14 percent of total) say they took on an extra job or worked more hours and a quarter (10 percent of
total) reporting borrowing money from friends or family or taking money out of a long-term savings
account. Smaller shares say they took out a loan, sought the aid of a charity or non-profit, changed their
living situation, or used the internet to raise funds to pay for medical care.
Figure 8
31%
23%
16%
11%
10%
8%
Medical bills before meeting their deductible
Unexpected medical bills*
Other types of medical bills
Co-pays for prescription drugs
Co-pays for doctor visits
Monthly health insurance premium
Deductibles And Surprise Medical Bills Top List Of Most Difficult
Affordability Problems
NOTE: *Unexpected medical bills include bills people thought would be covered, but the insurance company did not pay or paid less than expected.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 40% WHO REPORT ANY HEALTH CARE AFFORDABILITY PROBLEMS: Percent who say
each of the following was the biggest problem for them and their family:
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 9
In addition, 41 percent of those who had difficulty affording health care costs (17 percent of all adults with
employer-sponsored insurance) say they feel they have had to make a difficult sacrifice in order to pay
health care or insurance costs in the past 12 months. When asked to describe in their own words the
most difficult sacrifice they have made, responses ranged from cancelled vacations, to skipped meals, to
increased debt, to forgoing needed medical care.
Figure 9
66%
65%
50%
46%
34%
25%
24%
13%
12%
12%
5%
Put off vacations or major purchases
Cut spending on food, clothes, household items
Increased their credit card debt
Used up all or most of their savings
Taken an extra job or worked more hours
Borrowed money from friends or family
Taken money out of long-term savings
Taken out a loan
Sought aid of a charity or non-profit
Changed their living situation
Used the internet to raise funds
Those With Employer Coverage Who Have Problems Affording
Health Care Report Many Sacrifices To Pay Bills
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who report doing each in the past 12 months in order to pay for health care or insurance costs:
Percentage among the 40% who
report affordability problems
26%
26%
20%
19%
14%
10%
10%
5%
5%
5%
2%
Percentage among
all adults with ESI
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 10
Table 1: In Their Own Words: Difficult Sacrifices To Afford Health Care
Question: What is the most difficult sacrifice you’ve made in order to pay health care or health insurance
costs in the past 12 months?
Category
Percentage among
those who made a
difficult sacrifice
Percentage
among all
adults with ESI
Open-ended responses
Cut back on extras
(vacation, eating out,
entertainment)
17%
3%
“Not being able to have extra money to do
leisure/recreational things I would like. Have
to focus money on ‘needs’ not ‘wants.’”
“Cancelled 25th wedding anniversary
plans/vacation”
Cut back on food/eat
less
12
2
“Having trouble affording food for my kid and
myself”
“Me not eating so my kids can”
“Ate like a bird sometimes”
Skipping/being late on
other bills
10
2
“I missed several car payments”
“Picking which bill to pay and not to pay”
Taking money out of
savings/not able to
save
10
2
“Take money out of my 401k and personal
savings account”
“Not being able to save/put away money”
Cut back in general
7
1
“Cutting our budget everywhere”
“Cut back on everything”
Increasing credit
card/other debt
7
1
“Raising my credit card debt so much. Now
with interest I only have to pay more.”
“Taking out more debt to pay down a medical
bill”
Increasing work
hours/going back to
work
7
1
“I had to work 3 jobs at once. 1 full time and 2
part time jobs. Working from 4:30AM until
11pm”
Skipping
care/medication
7
1
“Allowing my health to deteriorate because
it's too expensive to keep up with the cost of
care”
“Not getting the medical treatment I need. I
need two surgeries and cannot afford them at
this time.”
Cut back on clothing,
children’s items
6
1
“Not getting gifts for my grandchildren,
birthdays and holidays”
“Cut back on purchases for our children, such
as clothes”
Unpaid medical bills can also lead to longer-term financial effects for some people. About one in five (19
percent) say that someone in their household has been contacted by a collection agency in the past 12
months because of medical bills, and 9 percent say they have at some point declared personal
bankruptcy because of medical bills (including 2 percent who say they did so in the past 12 months).
In addition to making sacrifices to afford care, about half (51 percent) of adults with employer health
coverage report that they or someone in their household has skipped or delayed some type of medical
care or prescription drugs in the past 12 months because of the cost. This includes about a third each
who report relying on home remedies or over-the-counter drugs instead of going to see a doctor (35
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 11
percent) or putting off or postponing needed care (33 percent), about a quarter (24 percent) who report
not getting a recommended medical test or treatment, and about one in five (18 percent) who report not
filling a prescription, cutting pills in half, or skipping doses of medicine because of the cost.
Both difficulty affording health care expenses and forgoing or delaying care due to cost are more
commonly reported among certain groups, including those with lower incomes, those in higher deductible
plans, and those who say someone covered by their plan has a chronic health condition. For example,
while 40 percent of all adults with employer coverage say they’ve had problems paying medical bills or
difficulty affording health care or insurance costs for themselves or their family in the past year, the shares
are higher among those with annual household incomes below $40,000 (65 percent), those who say
someone covered by their plan has a chronic condition (49 percent), and those in the highest deductible
plans (49 percent). Similarly, while about half overall report that someone in their household skipped or
postponed some type of health care in the past year because of the cost, the share rises to around six in
ten among those with the lowest incomes, the highest deductibles, or a chronic condition.
Figure 10
35%
33%
24%
18%
51%
Relied on home remedies or over-the-counter
drugs instead of going to see a doctor
Put off or postponed getting health care they
needed
Not gotten a medical test or treatment that was
recommended by a doctor
Not filled a prescription, cut pills in half, or skipped
doses of medicine
Yes to any of the above
Half Of Those With ESI Say Someone In Family Skipped Or
Postponed Needed Care Or Rx Because Of The Cost
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they or another family member living in their household have done each of the following
in the past 12 months because of the cost:
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 12
Figure 11
40%
49%
41%
40%
27%
65%
51%
32%
49%
29%
Total
Highest deductible
Higher deductible
Lower deductible
No deductible
Household income: less than $40,000
Household income: $40,000-<$75,000
Household income: $75,000 or more
Someone covered by plan has any chronic condition
No one covered by plan has chronic condition
Lower Incomes, Higher Deductibles, And Chronic Conditions
Associated With Health Care Affordability Challenges
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they have had difficulty affording health care/insurance or problems paying medical
bills in the past 12 months:
Figure 12
Lower Incomes, High Deductibles, And Chronic Conditions
Associated With Skipping Or Postponing Care Due To Cost
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they or a family member have skipped or postponed getting health care or prescription
drugs in the past 12 months because of the cost:
51%
62%
60%
45%
40%
62%
57%
47%
60%
40%
Total
Highest deductible
Higher deductible
Lower deductible
No deductible
Household income: Less than $40,000
Household income: $40,000-<$75,000
Household income: $75,000 or more
Someone covered by plan has any chronic condition
No one covered by plan has chronic condition
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 13
Section 3: The experiences of those with high
deductibles and those with chronic conditions
As noted above, people with employer sponsored health plans that have high deductibles are more likely
to report problems affording health care, and more likely to postpone or forgo health care services for cost
reasons. One contributing factor may be the fact that many people in higher deductible plans do not have
enough savings to cover the full amount of their deductible. When asked how much they have in savings
that could easily be accessed in the short term, three in ten (31 percent) of those in higher deductible
plans and more than half (56 percent) of those in the highest deductible plans name an amount that is
less than the amount of their deductible.
In addition, most people enrolled in plans with high deductibles say they would not be able to pay a bill
equal to the full amount of their deductible without going into debt. When asked how they would pay an
unexpected medical bill equal to the amount of their deductible, one-third of those in plans with high
deductibles say they would either pay the bill at the time of service or put it on a credit card and pay it off
at their next statement. About half say they would go into some type of debt to pay the bill, either by
putting it on a credit card and paying it off over time (27 percent), setting up a payment plan with the
provider (17 percent), or borrowing money from a bank, payday lender, or friends and family (5 percent).
One in six (16 percent) say they would not be able to pay such a bill at all.
Those in high deductible plans who have lower incomes are even less likely to say they could afford such
a bill. Among those in high deductible plans who have annual household incomes of $40,000 or less, one-
third (32 percent) say they would not be able to pay a bill in the full amount of their deductible at all, while
just 14 percent say they would pay it off right away or at the next credit card statement.
Figure 13
Over Half Of Those In Highest Deductible Plans Report
Personal Savings Less Than Amount Of Their Deductible
NOTE: Based on those in plans with deductibles of at least $1,500 for an individual or at least $3,000 for a family.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
53%
65%
42%
44%
31%
56%
Total
Higher deductible
Highest deductible
Savings at least the amount of deductible Savings less than the amount of deductible
AMONG THE 41% IN HIGHER OR HIGHEST DEDUCTIBLE PLANS: About how much would you say
you currently have in savings that could be easily accessed in the short term?
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 14
Another group that is particularly vulnerable to health care affordability issues are people with chronic
conditions. Those who say someone covered by their plan has a chronic health condition (a group that
makes up 54 percent of people with employer plans) are about twice as likely as others to report
problems paying medical bills (36 percent versus 16 percent). They are also much more likely to say
Figure 14
Two-Thirds In Higher Or Highest Deductible Plans Could Not
Pay A Bill Equal To Deductible Without Going Into Debt
NOTE: Based on those in plans with deductibles of at least $1,500 for an individual or at least $3,000 for a family.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 41% IN HIGHER OR HIGHEST DEDUCTIBLE PLANS: Suppose you had an unexpected
medical bill that was equal to the full amount of your deductible. Based on your current financial situation,
how would you pay the bill?
33%
27%
17%
5%
16%
Pay in full at time of service/next statement
Put on a credit card and pay off over time
Set up payment plan with provider (Vol.)
Borrow money to pay bill
Wouldn't be able to pay the bill at all
Total who would
not be able to
pay bill without
borrowing/going
into debt:
66%
Figure 15
One-Third Of Those With Low Incomes And High Deductibles
Would Not Be Able To Pay Bill Equal To Deductible
NOTE: Based on those in plans with deductibles of at least $1,500 for an individual or at least $3,000 for a family.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 41% IN HIGHER OR HIGHEST DEDUCTIBLE PLANS: Suppose you had an unexpected
medical bill that was equal to the full amount of your deductible. Based on your current financial situation,
how would you pay the bill?
14%
23%
21%
8%
32%
19%
25%
26%
7%
24%
41%
28%
14%
5%
12%
Pay in full at time of service/next statement
Put on a credit card and pay off over time
Set up payment plan with provider (Vol.)
Borrow money to pay bill
Wouldn't be able to pay the bill at all
Less than $40,000
$40,000-<$75,000
$75,000 or more
Household Income
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 15
they’ve had difficulty affording medical bills before meeting their deductible, unexpected medical bills, co-
pays, and monthly health insurance premiums.
Drilling down into the consequences of these affordability problems reveals more about the financial
burden of health care on families with chronic conditions. Overall, more than one-third of those with a
chronic condition in the family say they put off vacations or major household purchases (36 percent) or
cut back spending on food, clothing, or basic household items (35 percent) in order to pay for health care
and insurance costs. Nearly three in ten (28 percent) say they increased their credit card debt, about a
quarter (26 percent) say they used up all or most of their savings, and one in five (19 percent) say they
took on an extra job or worked more hours in order to pay for health care. Other consequences, such as
borrowing money, seeking charity aid, or changing living situation were less common, but still occurred at
about twice the rate among people in families with a chronic condition compared to those without such a
condition.
Figure 16
36%
32%
27%
18%
17%
11%
49%
Problems paying/inability to pay medical bills
…medical bills before meeting deductible
…unexpected medical bills*
…co-pays for prescription drugs
…co-pays for doctor visits
…monthly health insurance premium
NOTE: *Unexpected medical bills include bills people thought would be covered, but the insurance company did not pay or paid less than expected.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Those In Families With A Chronic Health Condition More Likely
To Experience Problems Affording Health Care
16%
17%
11%
10%
8%
6%
29%
Someone covered by plan
has any chronic condition
No one covered by plan
has chronic condition
Difficulty affording…
Yes to any affordability problem
Percent who say they experienced each of the following in the past 12 months:
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 16
Those with chronic conditions are also more likely to report forgoing or delaying health care because of
the cost, and this is particularly true for those in plans with high deductibles. For example, 42 percent of
those who say someone covered by their plan has a chronic condition say there was a time in the past
year when they or another family member put off or postponed getting health care they needed,
compared with 23 percent of those without a chronic condition. Among those with chronic conditions who
are in the highest deductible plans, the share rises to 60 percent. Similarly, three in ten (31 percent) of
those in families with a chronic condition say they skipped a doctor-recommended test or medical
treatment in the past year for cost reasons, twice the share as among those with no chronic condition,
and rising to 44 percent among those with chronic conditions in the highest deductible plans. Overall, 60
percent of all those with a family chronic condition say someone in their household skipped or postponed
some type of care or medicine for cost reasons, rising to 75 percent among those in the highest
deductible plans.
Figure 17
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Those In Families With Chronic Health Conditions More Likely To
Report Financial Impacts Of Health Care Affordability Problems
Someone covered
by plan has any
chronic condition
No one covered
by plan has
chronic condition
36%
35%
28%
26%
19%
14%
13%
7%
7%
7%
Put off vacations or major purchases
Cut back spending on food, clothes, household items
Increased their credit card debt
Used up all or most of their savings
Taken an extra job or worked more hours
Borrowed money from friends or family
Taken money out of long-term savings
Taken out a loan
Sought the aid of a charity or non-profit
Changed their living situation
Used the internet to raise funds
Percent who report doing each in the past 12 months in
order to pay for health care or insurance costs:
15%
16%
12%
11%
6%
3%
3%
3%
2%
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 17
Table 2: Skipping And Postponing Needed Care Because Of Cost, By Family Chronic Condition
And Health Plan Deductible Level
Percent who say they
or a family member did
the following in the
past 12 months…
No chronic
condition in
family
Any family member covered by plan has chronic condition
Total
No/Lower
Deductible
Higher
Deductible
Highest
Deductible
Put off or postponed
getting health care they
needed
23%
42%
34%
49%
60%
Relied on home
remedies or OTC drugs
instead of going to see a
doctor
28
41
33
46
58
Have not gotten a
medical test or treatment
recommended by a
doctor
15
31
24
35
44
Not filled a prescription,
cut pills in half, or
skipped doses of a
medicine
12
23
19
23
35
Yes to any
40
60
52
69
75
The combination of a chronic condition and a high deductible can also lead families to worry about
affording health care in the future. For example, among those with a chronic condition in the family, about
half of those in the highest deductible plans say they are not confident in their ability to pay for the usual
medical costs they and their family require, and almost two-thirds are not confident they could pay for a
major illness.
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 18
Section 4: Health insurance decision-making and trade-
offs
The survey finds that at the same time premiums and deductibles have been rising for people with
employer-sponsored coverage, cost has taken on greater importance in health insurance decision-making
compared to previous years. For example, when asked to choose the most important feature in a health
plan, one quarter cite a low monthly premium, 18 percent choose a low deductible, and 16 percent cite
low co-pays, amounting to six in ten (59 percent) choosing a cost-related factor. About a quarter (26
percent) choose coverage-related factors including having a wide range of benefits (17 percent) or a wide
choice of doctors and hospitals (10 percent). These shares are essentially reversed from a KFF survey
conducted in 2003, when one-third of people with employer coverage chose cost-related factors as the
most important feature in a health plan and six in ten chose a wide range of benefits or choice of
providers.
Figure 18
72%
80%
71%
52%
28%
20%
29%
48%
Total
No/Lower deductible
Higher deductible
Highest deductible
Confident Not confident
58%
68%
55%
34%
42%
32%
45%
64%
Among Those With High Deductibles And Chronic Conditions,
Large Shares Are Not Confident About Affording Major Illness
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
…the usual medical costs that you require …a major illness
AMONG THOSE WHO SAY SOMEONE COVERED BY THEIR PLAN HAS A CHRONIC CONDITION:
How confident are you that you have enough money or health insurance to pay for …?
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 19
Another trend point shows a similar pattern. Among those whose employer offered a choice of plans, the
share who say they picked their plan based on the cost increased 15 percentage points, from 21 percent
in 2003 to 36 percent in the current survey.
Figure 19
10%
17%
16%
18%
25%
11%
6%
16%
33%
27%
Cost Factors Rated More Important Now Than In 2003, Benefits
And Provider Choice Less Important
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018); KFF Health Insurance Survey
(Apr. 30-Jul. 20, 2003). See topline for full question wording.
Percent who say each of the following is the most important feature to them and their family in a health
insurance plan:
2018
2003
NET
coverage-
related
26%
NET
cost-
related
59%
NET
cost-
related
33%
NET
coverage-
related
60%
Low monthly premium
Low annual
deductible
Low co-pays
Wide range of
benefits
Wide choice of
doctors
and hospitals
Figure 20
Compared To 2003, Cost Now Rated More Important, Choice
Of Providers Less Important In Plan Choice
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018); KFF Health Insurance Survey
(Apr. 30-Jul. 20, 2003). See topline for full question wording.
AMONG THOSE WHO HAD A CHOICE OF MORE THAN ONE INSURANCE PLAN: Percent who say each
is the main reason they picked their plan versus the other choices offered:
36%
21%
20%
38%
30%
25%
6%
5%
9%
8%
2018
2003
Cost of plan Choice of providers Range of benefits Easy to understand Other reason
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 20
When asked about trade-offs between premiums and out-of-pocket costs, people with ESI are pretty
evenly divided between saying they would prefer a plan with a relatively low monthly premium and higher
out-of-pocket costs (52 percent) or one with a relatively high monthly premium and lower out-of-pocket
costs (47 percent). However, those with higher household incomes lean towards lower premiums and
higher out-of-pocket costs, while those with lower incomes lean in the opposite direction.
Despite this increased emphasis on cost, there is no great enthusiasm among people with employer
plans for several trade-offs that might lower insurance premiums. About three-quarters say they would not
be willing to pay a significantly higher deductible in exchange for a lower premium (perhaps because
deductibles have risen so much already), and six in ten say they would not be willing to pay more for
brand name prescription drugs. However, about half say they would be willing to accept a more restricted
list of providers in exchange for lower premiums, and a large majority (85 percent) say they’d be willing to
participate in a wellness program.
Figure 21
Preference Split Between Plans With Higher Or Lower Premium,
Out-Of-Pocket Costs
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
52%
40%
47%
55%
47%
58%
51%
44%
Total
Household income: less than $40,000
Household income: $40,000-<$75,000
Household income: $75,000 or more
…relatively LOW monthly premium and HIGHER out-of-pocket costs when you use care
…relatively HIGH monthly premium and LOWER out-of-pocket costs when you use care
If offered a choice between the following two health insurance plans, which would you prefer? A plan with…
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 21
Figure 22
Most Willing To Participate In Wellness Program To Lower
Premium, One In Four Willing To Pay Higher Deductible
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
85%
49%
39%
23%
14%
50%
60%
76%
Participate in a wellness program that promotes
healthy behaviors
Accept a more restricted list of participating doctors
and hospitals
Pay more for brand name prescription drugs
Pay a significantly higher deductible before coverage
kicks in
Yes, willing No, not willing
AMONG THOSE WHO PAY AT LEAST PART OF THEIR HEALTH INSURANCE PREMIUM: If it would
lower your health insurance premiums, would you be willing to do each of the following, or not?
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 22
Section 5: Views and experiences related to Health
Savings Accounts
Just under one in five (18 percent) of all adults with employer coverage report being in a high deductible
health plan paired with a Health Savings Account (HSA). Most of these people report making relatively
modest contributions and having relatively modest savings in their HSA, particularly if they have lower
incomes. For example, about half (47 percent) of people with an HSA plan say they have contributed less
than $1,000 to their account in the past 12 months, and just 11 percent say they’ve contributed $5,000 or
more. Among those with household incomes under $75,000 a year, 72 percent say they contributed less
than $1,000 and just 3 percent put in at least $5,000.
Few seem to be able to save much money in these accounts over time. Overall, about three in ten (31
percent) say they have at least $2,000 saved in their HSA account, including 17 percent who have at
least $5,000. Among those with incomes under $75,000, fewer – 22 percent – report having at least
$2,000 saved, including one in ten (11 percent) who have at least $5,000.
Figure 23
Those With Higher Incomes And Highest Deductibles Report
Greater HSA Contributions
NOTE: Deductible definitions (higher, highest) for individual: $1500-$2999, $3000+; for family: $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 18% WHO HAVE A HIGH DEDUCTIBLE PLAN WITH HSA: About how much have you or
your spouse contributed to this Health Savings Account in the past 12 months?
11%
7%
15%
3%
14%
28%
25%
31%
15%
33%
13%
11%
15%
7%
15%
20%
24%
17%
26%
18%
17%
21%
14%
31%
12%
9%
13%
5%
15%
7%
Total
Higher deductible
Highest deductible
Household income: less than $75,000
Household income: $75,000 or more
$5,000+ $2,000-$4,999 $1,000-$1,999 $500-$999 $1-499 $0
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 23
The survey finds that individuals with HSA plans are more likely to view them as a way to pay for current
medical bills (68 percent) than as a way to save money for the future (32 percent). This also bears out in
their self-reported behaviors: while seven in ten (72 percent) say they have used their HSA to pay
medical bills in the past 12 months, far fewer – 21 percent – say they use their HSA to invest in stocks,
bonds, or mutual funds.
Figure 24
Few Of Those With HSA Plans Report Having At Least $5,000
Saved In HSA Account
NOTE: Deductible definitions (higher, highest) for individual: $1500-$2999, $3000+; for family: $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 18% WHO HAVE A HIGH DEDUCTIBLE PLAN WITH HSA: About how much money do you
currently have saved in this account?
6%
6%
2%
7%
11%
13%
10%
9%
12%
14%
14%
14%
11%
15%
21%
18%
23%
13%
24%
42%
47%
37%
58%
36%
5%
3%
7%
4%
5%
Total
Higher deductible
Highest deductible
Household income: less than $75,000
Household income: $75,000 or more
$10,000+ $5,000-$9,999 $2,000-$4,999 $1,000-$1,999 $1-$999 $0
Figure 25
…a way to
pay for
current
medical bills
68%
…a way to
save money
for the
future
32%
HSAs Viewed More As A Way To Pay Medical Bills Rather
Than Save For The Future
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Do you primarily view your Health Savings
Account as…?
AMONG THE 18% WHO HAVE A HIGH DEDUCTIBLE PLAN WITH HSA:
Percent who say they…
72%
21%
…have used their
HSA to pay medical
bills in the past 12
months
…use their HSA to
invest in stocks,
bonds, or mutual
funds
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 24
Section 6: Cost-conscious health care shopping
behaviors
The survey asked about a list of seven different cost-conscious health care shopping behaviors, and finds
that seven in ten people with ESI report engaging in at least one of these behaviors in the past 12
months. The most common of these are asking for a generic instead of a name brand drug (47 percent)
and checking with a provider or health plan beforehand to find out the cost of a procedure (37 percent) or
office visit (36 percent). Less commonly-reported behaviors are those that might actually lead to lower
prices on health care services, including using an online tool to research the cost of different providers
(23 percent), shopping around at different providers to find the best price for a medical service (17
percent), and trying to negotiate with a provider for a lower price (9 percent).
When consumers do try to negotiate prices, they report being successful less than half of the time; of the
9 percent who say they tried to negotiate with a provider, 43 percent say they were able to get a lower
price while 57 percent say they were not.
One selling point of high deductible health plans is that they may incentivize enrollees to engage in more
cost-conscious behaviors, including price-based shopping. The survey finds mixed evidence about
whether this is occurring among people with employer-based coverage. While the lowest rates of
reporting cost-conscious behaviors occur among those in plans with no deductible, those in high
deductible plans are not significantly more likely than those in lower deductible plans to report engaging in
most of the behaviors asked about in the survey. There are two exceptions: those in plans with high
deductibles are more likely than those with lower deductibles to say they’ve asked for a generic rather
Figure 26
Seven In Ten Report Engaging In At Least One Health Care
Shopping Or Cost-Saving Behavior
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they have done each of the following in the past 12 months:
47%
37%
36%
30%
23%
17%
9%
70%
Asked a doctor or pharmacist for a generic drug rather than a
name brand drug in order to save money
Checked with their provider or health plan before a procedure or
hospital stay to find out how much they would have to pay
Checked with their provider or health plan before an office visit to
find out how much they would have to pay
Talked to a provider or their health plan about the cost of a
prescription drug
Used on online tool to research the cost of different health care
providers
Attempted to shop around at different providers to find the best
price for a medical service
Tried to negotiate with a heatlh care provider to get a lower price
before receiving services
Yes to any of the above
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 25
than a name brand drug (55 percent versus 43 percent) and that they’ve used an online tool to compare
the cost of different providers (30 percent versus 22 percent).
Similarly, HSA plans are viewed as a way to give consumers more control over their medical care and to
encourage cost-conscious behaviors. To the extent that the survey finds people in HSA plans are
engaging in more cost-conscious behaviors, it seems to be due to the deductibles associated with these
plans rather than the savings account element, since those in high deductible plans without an HSA are
not significantly more likely than those in HSA plans to report these behaviors.
Table 3: Reports Of Cost-Conscious Health Care Shopping Behaviors, By Health Plan
Deductible Level And Health Savings Account Participation
Percent who say
they did each of
the following in the
past 12 months…
No
deductible
Lower
deductible
Higher/Highest deductible
Total
No HSA
With HSA
Asked a doctor or
pharmacist for a
generic drug to save
money
33%
43%
55%
58%
53%
Checked with a
provider or health
plan before a
procedure or
hospital stay to find
out how much they
have to pay
29
38
39
36
44
Checked with their
provider or health
plan before an office
visit to find out how
much they have to
pay
29
36
40
38
43
Talked to a provider
or health plan about
the cost of a
prescription drug
18
30
33
32
35
Used an online tool
to research the cost
of different health
care providers
9
22
30
29
31
Attempted to shop
around at different
providers to find the
best price
4
17
21
19
25
Tried to negotiate
with a doctor,
hospital, or other
provider to get a
lower price
5
9
11
8
15
Yes to any
52
68
79
77
82
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 26
Confusion and lack of access to cost information can also be a barrier for individuals to engaging in cost-
conscious health care behaviors. Two-thirds of people with employer coverage say it is difficult to find out
how much medical treatments and procedures provided by different doctors and hospitals would cost
them. In addition, four in ten say they have had difficulty understanding what their health plan will cover
(40 percent) and a similar share report difficulty understanding how much they will have to pay out of their
own pocket when they use care (44 percent).
Figure 27
Most Say Cost Information Is Hard To Find, Four In Ten Report
Difficulty Understanding Coverage Or What They’ll Pay
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Percent who say they have ever had the
following problems with their current health
insurance plan:
44%
40%
Difficulty understanding how
much they will have to pay out
of their own pocket when they
use health care
Difficulty understanding what
their plan will and will not
cover
In general, how easy or difficult would you say it is to
find out how much medical treatments and procedures
provided by different doctors or hospitals would cost
you?
Very easy
7%
Somewhat
easy
25%
Somewhat
difficult
40%
Very difficult
27%
DK/Ref.
1%
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 27
Section 7: Perceptions of health system winners, losers,
and who’s to blame
When asked how well the current health insurance system in the United States works for various groups,
fewer than a quarter of people with employer coverage say it works “very well” for any group, with the
exception of wealthy people (70 percent). Still, a large majority believes the system works at least
“somewhat well” for people with employer health coverage (79 percent), somewhat higher than the share
who say the same about people covered by Medicare (65 percent) or Medicaid (63 percent), and
substantially higher than the share saying the system works well for those who buy their own insurance
(45 percent).
While almost two-thirds (65 percent) of people with employer coverage feel the current health insurance
system in the U.S. works at least “somewhat well” for people like them, the percentage varies by income
and deductible level. For example, 80 percent of those in a plan without a deductible say the system
works well for people like them, compared to about half (48 percent) of those in the plans with the highest
deductibles. Similarly, about three-quarters of those with annual household incomes of at least $100,000
feel the system works well for them, compared with half (49 percent) of those with incomes under
$40,000.
Figure 28
More Say Health Insurance System Works Well For Those With
Employer Coverage Than Other Coverage Types
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
How well do you think the current health insurance system in the U.S. works for each of the following?
70%
15%
15%
13%
20%
7%
7%
13%
23%
64%
50%
52%
43%
51%
38%
21%
5%
19%
29%
25%
29%
32%
40%
33%
2%
2%
6%
9%
7%
10%
15%
33%
Wealthy people
People who get health insurance from an employer
People covered by Medicare
People like you
People covered by Medicaid
Middle class people
People why buy their own insurance
Poor people
Very well Somewhat well Not too well Not well at all
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 28
While most feel the system is working well for them, about eight in ten (78 percent) people with employer
coverage say the cost of health care for people like them is too high, with near-universal agreement
across demographic groups. Asked who they blame for the high cost of health care, people mainly point
to two groups that have long been named by the public as culprits of high costs: pharmaceutical and
insurance companies, with about six in ten saying each deserves “a lot of blame.” About three in ten also
place a lot of blame on hospitals (32 percent), the Affordable Care Act (29 percent) and the Trump
Administration’s recent actions on health care (28 percent), while fewer place a lot of blame on doctors
(15 percent). Echoing the finding that a large majority says they feel “grateful” for their employer-provided
health insurance, just 7 percent say employers deserve a lot of blame for the high cost of health care,
while two-thirds say employers deserve “just a little” or “no blame at all.”
Figure 29
49%
60%
56%
74%
49%
40%
44%
25%
Less than $40,000
$40,000-<$75,000
$75,000-<$100,000
$100,000 or more
80%
71%
60%
48%
20%
28%
40%
52%
No deductible
Lower deductible
Higher deductible
Highest deductible
Well Not well
Those With Higher Deductibles, Lower Incomes Less Likely To
Feel U.S. System Works Well For People Like Them
NOTE: Deductible definitions (lower, higher, highest) for individual: <$1500, $1500-$2999, $3000+; for family: <$3000, $3000-$4999, $5000+.
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
By Deductible Level By Household Income
How well do you think the current health insurance system in the U.S. works for people like you?
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 29
Not surprisingly, there are partisan differences in the share who blame the Affordable Care Act (ACA) and
the Trump Administration for the high cost of health care. Among those who feel costs for people like
them are too high, about half (49 percent) of Democrats and just 4 percent of Republicans say the Trump
Administration’s actions on health care deserve a lot of blame, while six in ten Republicans (59 percent)
and just 10 percent of Democrats place a lot of blame on the ACA. Among independents, 27 percent say
the ACA deserves a lot of blame and 21 percent say the same about the Trump Administration’s recent
actions.
Figure 30
Pharma And Health Insurance Companies Receive Most Blame
For High Costs, Employers Less So
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
AMONG THE 78% WHO SAY THE COST OF HEALTH CARE IS TOO HIGH: How much blame do you
think each of the following deserves for the fact that the cost of health care for people like you is too high?
61%
57%
32%
29%
28%
15%
7%
30%
33%
46%
20%
25%
38%
27%
8%
7%
19%
32%
28%
35%
43%
1%
1%
2%
18%
19%
11%
23%
Pharmaceutical companies
Health insurance companies
Hospitals
The 2010 health care law
The Trump Administration's recent
actions on health care
Doctors
Employers
A lot of blame A fair amount of blame Just a little blame No blame at all
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 30
Figure 31
51%
51%
24%
59%
4%
14%
65%
61%
28%
10%
49%
11%
6%
Pharmaceutical companies
Health insurance companies
Hospitals
The 2010 health care law
The Trump Administration
Doctors
Employers
66%
59%
40%
27%
21%
17%
7%
Across Partisans, Large Shares Blame Pharmaceutical And
Health Insurance Companies For High Health Care Costs
SOURCE: KFF/LA Times Survey of Adults with Employer-Sponsored Health Insurance (Sept. 25-Oct. 9, 2018). See topline for full question wording.
Democrats Independents Republicans
AMONG THOSE WHO SAY HEALTH CARE COSTS ARE TOO HIGH: Percent who say each of the following
deserves a lot of blame:
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 31
Methods
The Kaiser Family Foundation/Los Angeles Times Survey of Adults with Employer-Sponsored Health
Insurance is based on interviews with a probability-based sample of 1,407 respondents between the ages
of 18 and 64 who reported having health insurance from an employer or union (excluding those covered
by a parent’s employer). Interviews were administered online and by telephone from September 25
through October 9, 2018 in English and Spanish.
Teams from the Kaiser Family Foundation and The Los Angeles Times worked together to develop the
questionnaire and analyze the data, and both organizations contributed financing for the survey. Each
organization is solely responsible for its content.
NORC at the University of Chicago conducted sampling, interviewing, and tabulation for the survey using
the AmeriSpeak Panel, a representative panel of adults age 18 and over living in the United States.
AmeriSpeak Panel members are recruited through probability sampling methods using the NORC
National Sample Frame, an address-based sampling frame. Panel members who do not have internet
access complete surveys via telephone, and internet users complete surveys via the web (for this survey,
60 respondents completed via phone and 1,347 via web).
5
For this study, panelists with lower incomes
were selected at disproportionately higher rates than those with higher incomes in order to allow for
separate analysis of low-income people with employer-sponsored insurance.
The combined results have been weighted to adjust for the fact that not all survey respondents were
selected with the same probability, to address the implications of sample design, and to account for
systematic nonresponse along known population parameters. The first weighting stage addressed
differences in probability of selection for the AmeriSpeak Panel and accounted for differential
nonresponse to the AmeriSpeak screening interview. At this stage, an adjustment was also made to
account for the oversampling of lower-income panelists and to account for differential nonresponse to the
survey screening interview.
In the second weighting stage, the sample was adjusted to match known demographic distributions of the
U.S. population ages 18-64 with employer-sponsored health insurance using the following parameters:
age, age by sex, age by education, gender by education, education within non-Hispanic whites,
race/ethnicity, Census Division, and household income. Demographic weighting parameters were based
on the U.S. Census Bureau’s March 2018 Annual Social and Economic Supplement of the Current
Population Survey.
The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage
points. All statistical tests of significance account for the effect of weighting. Numbers of respondents and
margins of sampling error for key subgroups are shown in the table below. For results based on other
subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for
other subgroups are available by request. Note that sampling error is only one of many potential sources
of error in this or any other public opinion poll.
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 32
Group
N
(unweighted)
M.O.S.E.
Total adults ages 18-64 with employer-sponsored
insurance
1,407
±3 percentage points
Deductible level
Zero Deductible
189
±9 percentage points
Lower deductible
647
±5 percentage points
Higher deductible
280
±7 percentage points
Highest deductible
284
±7 percentage points
Kaiser Family Foundation public opinion and survey research and NORC at the University of Chicago are
both charter members of the Transparency Initiative of the American Association for Public Opinion
Research.
KFF/LA Times Survey Of Adults With Employer-Sponsored Health Insurance 33
Endnotes
1
State Health Facts. (n.d.). Retrieved April 2019, from https://www.kff.org/state-category/health-coverage-uninsured/
2
Claxton, G., Rae, M., Long, M., Damico, A., Whitmore, H. (2018, October 3). Kaiser Family Foundation 2018
Employer Health Benefits Survey. Retrieved from https://www.kff.org/health-costs/report/2018-employer-health-
benefits-survey/
3
The survey includes adults ages 18-64 who say they get their health insurance from their own or a spouse’s
employer or union. Those ages 65 and older are excluded since they are generally eligible for coverage through
Medicare.
4
State Health Facts. (n.d.). Retrieved April 2019, from https://www.kff.org/state-category/health-coverage-
uninsured/nonelderly-with-employer-coverage/
5
More details on NORC’s AmeriSpeak panel, including sample frame and recruitment methods, can be found at
http://www.norc.org/Research/Capabilities/Pages/amerispeak.aspx.
Filling the need for trusted information on national health issues.
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San Francisco CA 94107
650 854 9400
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This publication is available on the
Kaiser Family Foundation’s website at kff.org.
The Kaiser Family Foundation
is a nonprot organization
based in San Francisco, California.