Affordable Health Care

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1 Affordable Health Care Health Insurance Awareness Focus Groups Pamela Gallion, M.Ed., MBA Bridget Kelly, MA 2/11/ P a g e

2 TABLE OF CONTENTS PURCHASING HEALTH INSURANCE:... 3 UNDERSTANDING HEALTH INSURANCE... 3 AWARENESS OF HEALTH INSURANCE EXCHANGE... 4 HEALTH INSURANCE EXCHANGE DEFINED... 5 NAMING HEALTH INSURANCE EXCHANGE... 7 NAME PREFERENCES... 7 STYLE AND TONE OF MESSAGES TAG LINES HEALTH INSURANCE DEMOGRAPHICS METHODOLOGY APPENDIX A: ENGLISH MODERATOR S DISCUSSION GUIDE APPENDIX B: SPANISH MODERATOR S DISCUSSION GUIDE APPENDIX C: TELEPHONE RECRUITING SCRIPT P a g e

3 Focus Group Results Health Insurance: Paradise Campus January 30 and 31, 2013 Moderator (English), Pamela Gallion, Director, Cannon Survey Center Moderator (Spanish) Maria Garcia, Cannon Survey Center Note Taker: Tiffany Brazier, Cannon Survey Center I. Purchasing Health Insurance: English: Cost was the first item that was discussed in both of the English groups. The discussion was centered on the high cost of health insurance. Words such as way too expensive, outrageous, ridiculous, and extreme were used to define the cost of health insurance. Participants indicated that when they have shopped for health insurance they have done so online. The internet was used to shop for the best price. Price emerged as the most important variable in the shopping experience. Price was mentioned more often than any specific kind of coverage. More than one respondent indicated that he/she had been offered insurance through their place of employment but declined due to cost, while one Culinary worker reported that due to limited working hours monthly premiums would be $ Deductibles: Participants who have found health insurance with low monthly premiums have also declined to purchase because of deductibles that were termed extreme ($2000). Spanish: Some participants indicated that they had been offered health insurance through their jobs, while several others had not shopped for insurance. Those who indicated having health insurance coverage further stated that they do not utilize the coverage that they have, or that the quality of coverage is not good. Expense of the coverage was also cited as a problem in acquiring health insurance. II. Understanding Health Insurance 3 P a g e English: The general tone indicated an understanding that health insurance is important, especially when there are families and children involved. However, the cost of insurance overrides the ability to obtain coverage. One individual shared a story of a $16,000 emergency room visit. One participant was very informed about the Health Insurance Exchange and the Affordable Health Care Act. She brought along a binder of information that included the amount of the monthly premium ($289) for her income bracket and how that premium is affected by her pre-existing illness (high blood pressure), the cost of the deductible ($2000), and the fact that there are no marriage or family packages. The pricing unit is by individual only.

4 One respondent compared mandated health care insurance to car insurance: You know how they snuck that car insurance on us? This is the really big thing for me You know how they snuck in that car insurance and it had to be mandatory and then you found out that if your insurance lapsed that when you went to the DMV that you had to pay that $250 Well, they have a $750 penalty And then next year, it goes up $95 more and then the year after that (2015) it goes up $350. And, guess where they can take it from? Your income taxes. We were discussing that on the way down here There s going to be a segment of people that s going to fall through the cracks that makes too much to get on Medicare, but you don t make enough to get this package. Spanish: Participants generally agreed that having health insurance is very important, as costs without insurance are high and medical needs and accidents are unpredictable. One respondent likened it to car insurance in terms of standard necessity. Another respondent indicated that they would travel to Mexico for treatment if they were to become ill without coverage. A couple of respondents indicated that without insurance, health problems often get put off until the problem is very serious and hospitalization is needed. III. Awareness of Health Insurance Exchange English: Most of the respondents were generally aware of affordable health care; they knew that everybody would get health care. They indicated that a health care exchange is a free market kind of health coverage where prices should be fairly competitive. Others indicated that there is information available but at this point they have described the details they have been able to find as vague. There was discussion around employers cutting hours to less than 29 hours so that the employee would be responsible for his/her own health care. Several participants had never heard of the term health insurance exchange, but they were in the minority for both groups. Spanish: Most of the respondents were generally aware of affordable health care; they knew that everybody would get health care. Respondents had heard about it through the news, tax preparation, word of mouth, and on TV. One respondent indicated hearing a message that everyone will have insurance by 2014, and another indicated that they heard coverage would be free of cost. Some respondents 4 P a g e

5 indicated that they know there will be changes, but they don t actually know what those changes will be and whether the changes will be good or bad or more expensive than current options. Participants had not heard of the term health insurance exchange. When asked to interpret what, if anything, the term could mean, respondents used words like something is going to change, more accessible, more economical, lower, something better, exchange of money, or exchange health insurance with money. Generally, the group felt that this was a positive and necessary notion, stating that the Hispanic community is underserved medically due to lack of coverage or cost. IV: Health Insurance Exchange Defined One way to think of a health insurance exchange is a one-stop marketplace where you can go to purchase health insurance. At this marketplace all of the eligible health care plans will be authorized by the government to assure their quality. In October 2013, Nevadans can begin to enroll into Nevada s health insurance exchange and coverage can begin as early as January 1, The exchange will provide information on and access to health insurance for all Nevadans and is committed to creating an easy way to decide upon and purchase health insurance. This marketplace will be accessible on an Internet site or at locations around the state where you can go for assistance to help you shop for and purchase health insurance. A. Participant definition of Health Insurance Exchange English: One of the initial thoughts that came to mind when asked what this definition of health insurance exchange means was insurance broker, which was viewed as a negative thing. Others likened it to health plans where you must see providers within the network. There was some concern that providers that pay more will have their companies pop up first in an internet search and this was not viewed as a good thing by participants; to them it indicated that the company had more money than others and they, the health consumer, would ultimately pay for that location. Most understood the concept that a health insurance exchange is a place to shop for different health care plans. One respondent said, It s an alternative to see if there is a better carrier out there for a less rate than what you re paying. Another said, You d have alternatives versus the employer telling you you re taking this or that or that s the road. Spanish: One participant indicated that they would explain it as exchanging their current policy for another one with better benefits, while others understood there to be a selection of the coverage they need most. Others agreed. A couple of respondents used the term opportunity to buy health insurance. 5 P a g e

6 B. Words and phrases that are important to describing a Health Care Exchange English: In order to describe a health care exchange people need to understand the concepts of marketplace, options/choices, affordability, accessibility, and mandatory. There was some distrust of the government and the concept of mandatory requirement. They see it as something being forced upon them, and not in a positive way.... I think if it s the government it s a box, it s got its limitations, but you re free to choose whatever you want to choose as long as it s in that box. What do you call that box? An option box Controlled Government option box Another respondent said, It makes you look at it in a negative, instead of in a positive because it feels like it s imposed on us already, but now it s mandatory and you can t feel nothing but a negative. Other specific words that the groups thought were important in understanding a health care exchange were network, savings, opportunity and key clients. When expanding, trying to define a health insurance exchange with a phrase rather than a word, the following were provided: Spanish: Know your options Variations of complete health care Realizable and affordable Learn your options Planning for the future (although this choice made some think of financial planning) Planning for a healthier future Affordable healthcare for everyone In order to describe a health care exchange, the words saving, information, benefit, benefits of quality, and quality family were used. Words or phrases associated with a place to shop for affordable health insurance included in the same work, more convenient, affordable insurance, and insurance benefits. These phrases were perceived as good because they attract people or draw attention, encourage people to get the insurance, are easy to understand, and imply accessibility to all people. Messages concerning accessibility to all and a place to get information were emphasized by 6 P a g e

7 multiple participants. One respondent indicated that the words and phrases used should be easy to understand, and suggested that perhaps affordable was a more familiar word than accessible. They went on to suggest, We have insurance for the best of the economy. V. Naming Health Insurance Exchange English: Before any of the KPS3 name options were presented, respondents were given the opportunity to come up with a name for the health insurance exchange. The following names were suggested: Health Care Insurance Mall Silver State Health Silver State Guarantee Insurance Nevada Family Health Insurance Plan Nevada Employees Group Health Plan Nevada Federal Health Care Systems Network Budget Nevada Health Insurance Affordable Health Insurance of Nevada Spanish: Before any of the KPS3 name options were presented, respondents were given the opportunity to come up with a name for the health insurance exchange. The following names were suggested: Nevada Health Insurance for Latinos Latino Health Insurance Accessible for Latinos Easy, Cheap, and Accessible for Latinos Nevada Care Affordable for Everybody Accessible Insurance VI. Name Preferences 7 P a g e English: Participants were asked to respond to 10 suggested names provided by KPS3. Those names were: 1. All in Nevada Name made respondents think of gaming or poker and did not clearly define what a health insurance exchange is. Name not viewed favorably.

8 2. Get Covered Nevada Name made respondents think of auto insurance and was not specific enough to make participants relate the name to health insurance. 3. Nevada Health Link The word link was viewed positively by most, however some thought it had limitations because there are physical locations and this name seemed only to apply to internet options. Another didn t like the word link because it didn t seem complete link indicated a part of something not complete. 4. Nevada Health Hub None of the respondents liked the word hub, it reminded them of a spa or club or bar. One defined it as a place where you just get rerouted. 5. My Health Insurance Link Initial discussion around the word my was positive. One respondent said, That sounds positive. You can go there and more or less ask anything or find anything because it s yours. But names with the word link were only selected once as a first choice and three times as a second choice. Ensuing discussion was around the fact that the word my is too personal. One respondent said, I would be a little frustrated if I went there and it says my and someone couldn t help me. I would be offended. 6. My Health Insurance Nevada Respondents liked this better than My Health Insurance Link. Because it s telling us for the state we re in about our health insurance that we have access to and it s not just computer accessible. It could be phone or places around town you can get access to this information. Participants indicated that the message should be clear and simple; Nevada, Health, and Insurance are the dominant word choices to this point. 7. Nevada Health Benefit Solution - The word solution immediately resonated with participants as a positive word. It has everything Nevada, health, and insurance and it s the solution to your problem. One group was adamant that the word solution should be plural. People are generally confused about the Affordable Health Care Act, having the word solution in the title is viewed as relieving. Three respondents selected this name as their first choice. Those who like the word benefit over insurance think that benefit provides more options, like a website, and information. 8. Nevada Health Insurance Solution - When this name was brought up participants liked the word insurance better than benefit because a benefit can represent many things. Participants saw this as being more focused. Ten of the 21 respondents selected this name as their first choice. 9. Nevada Health Benefit Source - The word source is not well received, one group suggested changing the word source to resource as an improvement. One, while preferring the word solution, would change the word source to plan. 10. Nevada Health Insurance Connect - The word connect made participants think only of internet options, some males likes this, but for the most part connect did not resonate with the participants. One participant thought it was too similar to Job Connect. 8 P a g e

9 Table 1: English name preferences Participant First Choice Second Choice 1E Nevada Health insurance Solution(s) My Nevada Health Insurance Nevada Exchange 2E My Health Insurance Nevada Nevada Health Benefit Solution(s) 3E Health Insurance Solution(s) of NV Nevada's Health Benefit Resource 4E Nevada Health Insurance Solution(s) Nevada's Health Benefit Resource 5E Nevada Health Insurance Solution(s) Nevada Health Link 6E Nevada Health Insurance Solution My Health Insurance Nevada 7E Nevada Health Benefit Solution Nevada Health Link 8E All in Nevada Nevada's Health Insurance Connect 9E Nevada Health Insurance Solution Nevada Health Benefit Solution 10E Nevada Health Insurance Solution(s) Nevada Health Benefit Solution(s) 11E Nevada Health Insurance Solution(s) Nevada's Health Insurance Connect 12E Nevada Health Link Nevada Health Benefit Solution(s) 13e Nevada Health Benefit Solution Nevada's Health Insurance Connect 14E Healthcare for all Nevadans A brighter healthier future 15E Nevada Health Insurance Solution Nevada's Health Insurance Connect 16E Health Coverage for Every Nevadan Healthcare for all Nevadans 17E Nevada Health Insurance Solution Nevada Health Benefit Solution 18E Nevada Health Benefit Solution Nevada Health Insurance Solution 19E My Health Insurance Nevada My Health Insurance Link 20E Nevada Health Insurance Solution Nevada Health Benefit Solution Spanish: Participants were asked to respond to 10 suggested names provided by KPS3. Those names were: 1. All in Nevada Not specific enough, mixed opinions of like/dislike. 2. Get Covered Nevada Somewhat but still not very specific, mixed views, mostly not favorable. 3. Nevada Health Link Sounds better but doesn t seem complete, mixed views, mostly unfavorable. 4. Nevada Health Hub Very good vs. not focused on Latinos and Health Hub doesn t mean anything to us (mixed views). 5. My Health Insurance Link Viewed as better than Health Hub to communicate clearly. 6. My Health Insurance Nevada Seen as fine and is explanatory of who it s for, inclusive of individuals. Viewed highly favorably among some participants, and perhaps as best in one group. 9 P a g e

10 7. Nevada Health Benefit Solution Too long, the word benefit is confusing. Others say it makes sense. Mixed views between groups. 8. Nevada Health Insurance Solution The word solution is viewed favorably in that it will solve the medical problems that we have really. This was seen as the best option in one group discussion due to better explanation and understanding. 9. Nevada Health Benefit Source Seen as long and less specific. 10. Nevada Health Insurance Connect Seen as saying too much about insurance, and infers cheap insurance and that s it. Also seen as something separate from the actual insurance help that you need. Participants feel that words like link and connection actually give the impression of a disconnect between the person and the insurance. Table 2: Spanish name preferences Participant First Choice Second Choice 1S Solución Seguros Médicos Nevada Solución Seguros Médicos Nevada 2S Mi Seguros Médico Nevada Solución Seguros Médicos Nevada 3S Solución Seguros Médicos Nevada Cubrete Nevada (Get Covered Nevada) 4S Enlace de Seguro Médico Nevada Solución Seguros Médicos Nevada 5S Enlace de Seguro Médico Nevada Enlace de Seguro Médico Nevada 6S Enlace de Seguro Médico Nevada Solución Seguros Médicos Nevada 7S Mi Seguros Médico Nevada Todos en Nevada (All in Nevada) 8S Enlace de Seguro Médico Nevada Enlace Salud Nevada 9S Enlace de Seguro Médico Nevada Enlace Salud Nevada 10S Todos en Nevada (All in Nevada) 11S Mi Seguros Médico Nevada Solución Seguros Médicos Nevada 12S Mi Seguros Médico Nevada Solución Seguros Médicos Nevada 13S Mi Seguros Médico Nevada Fuente Beneficios Médicos Nevada 14S Mi Seguros Médico Nevada Cubrete Nevada (Get Covered Nevada) 15S Mi Seguros Médico Nevada Fuente Beneficios Médicos Nevada 16S Mi Seguros Médico Nevada Enlace de Seguro Médico Nevada VII. Style and Tone of Messages English: 10 P a g e All but one participant felt strongly that the message should NOT be delivered by a doctor or other medical professional. There would be distrust of the message from a doctor, paid professional, or

11 celebrity. Participants also did not favor any kind of mascot or cartoon character. However, one group did have some fun picturing a sick horse cartoon character, playing on the phrase healthy as a horse. This was not offered as a real solution, however. Participants think that the message is best delivered by ordinary people, people like us. One participant thought that using an older spokesperson would be beneficial because they are trustworthy. We d listen better to people like us that are in the problem, instead of people carrying the briefcase. The tone of the message should be serious and formal. The tone should not be light. As one participant put it People who don t have health care, don t think it s funny, you don t want to make light of it... they could take it the wrong way. You want them to take it seriously, so you take it seriously. Spanish: Participants think that the message is best delivered by ordinary people, or people that have benefited from health insurance. There were mixed views on whether a physician or celebrity would be believable and credible. Cartoon characters or mascots were not advised, as they are for children. Another person added that children would not be appropriate. TV ads were viewed as favorable. The style was advised to be serious and informative and well-defined as well as using a common understandable approach. One participant explained that very clear policies and explanations of procedures for using the program would be necessary, giving reference to differences between what you read or hear from customer service on the phone and what you are being told by the pharmacies and providers about payment and card options. The participants unanimously indicated that the tone should be serious and informational, as it is a serious subject, and that a humorous tone would not be well received. VIII. Tag Lines English: Group time was running short and this area was not discussed in depth per client instruction. Table 3: English Tag Line Preferences Tag Line Positive/Negative/ Comments Neutral A brighter, healthier future + Visual, bright, happy, gives hope Centered around health - No ring, weird Don t gamble with your future - Not related to health could be drinking, gambling/casinos, etc. Every Nevadan covered O Sounds like a government program. What is being covered? Every Nevadan insured O Insurance could be any kind, not specific enough 11 P a g e

12 Health coverage for every Nevadan Health insurance for every Nevadan Healthcare for all Nevadans + Specific, says what it is, like word coverage better than insured. O Like every in both groups- shows that family also insured/covered O Table 4: Spanish Tagline Preferences Tagline Positive/Negative/ Comments Neutral A brighter, healthier future + All key words are favorable Centered around health +/- Ok, doesn t explain all Don t gamble with your future - Does not specify- No drinking/drugs? Every Nevadan covered - No comment, just the word no. Every Nevadan insured - Not specific to health. Health coverage for every Nevadan + Ok/fine/yes Health insurance for every +/- Better (description), but too long Nevadan Healthcare for all Nevadans - Too long IX. Health Insurance English: Participants agreed almost unanimously that the term health insurance should be used in a name or tag line. It is direct and simple. It s a very important situation that s going on. And then it wouldn t leave those that are ignorant to (know) what s going on or out of the loop. If it has Health Insurance there is no misleading or misguiding. Spanish: Participants agreed unanimously that the term health insurance should be used in a name or tag line. 12 P a g e

13 Table 5: Focus group demographics- ENGLISH Demographics Demographic Frequency (n) Percentage (%) Age Under Total Range= 23 67; Mean= 38.95; Median= 33 Gender Male Female Total Income Less than $20, $20,000 - $29, $30,000 - $39, $40, Total Range=$17,000 - $50,000; Mean= $25,143; Median= $20, P a g e Table 6: Focus group demographics- SPANISH Demographic Frequency (n) Percentage (%) Age Under Total Range= 21 64; Mean= 38.8; Median= 39 Gender Male Female Total Income Less than $20,

14 $20,000 - $29, $30,000 - $39, $40, Total Range=$17,000 - $39,000; Mean= $26,019; Median= $26,000 Table 7: Focus group demographics- COMBINED Demographic Frequency (n) Percentage (%) Age Under Total Range= 21 67; Mean= 38.9; Median= 36 Gender Male Female Total Income Less than $20, $20,000 - $29, $30,000 - $39, $40, Total Range=$17,000 - $50,000; Mean= $25,535; Median= $22, P a g e

15 Methodology Four focus groups about awareness of health insurance and other similar issues were conducted at the Paradise Campus of UNLV on January 30 and 31, Two groups for English speaking participants were conducted on January 30, 2013; these were moderated by Pamela Gallion, who has 17 years of experience conducting focus groups. Two focus groups for Spanish speakers were conducted on January 31, 2013; these were moderated by Maria Garcia who has more than eight years of experience moderating and translating research projects in Southern Nevada. Participants were recruited in two ways. First, flyers were distributed at locations that included locations on the UNLV campus, a community multicultural center, Nevada Job Connect, Medicaid/WIC Office, and the Urban League. In addition, a list of 250 phone number listings with Spanish surnames was purchased from Survey Sampling International (Shelton, CT). SSI has been providing scientific survey samples for research for over 30 years. Four respondents for the Spanish groups were recruited via telephone from this list. The remaining participants were recruited via flyer. All respondents were screened for income level, gender, and age. 15 P a g e

16 APPENDIX A: English Moderator s Discussion Guide Prepared for Focus Group Discussions Conducted by the Cannon Survey Center Date January 30 and 31, 2013 Location Paradise Campus of the University of Las Vegas PARTICIPANT WELCOME: I would like to welcome you and thank you for coming to this focus group. Each of you has been selected to participate because your thoughts and opinions are important to us. We are here today to talk about health insurance. I want to assure you that this is not a test. There are no right or wrong answers, just your points of view on health insurance and purchasing health insurance. Just pretend you are sitting around a table talking with friends or family about the topics we are going to discuss. This session is being audio taped, and notes will be taken as we talk. Your name will not be identified or made public in any way. When we finish with our discussion, each of you will receive a Walmart gift card as our thank you for your time this afternoon (evening). INTRODUCTIONS and WARM UP QUESTION: With that said, let s introduce ourselves. Please say what area of the valley you live in and what kind of work you do. I will go first... (introduce me and respond to icebreaker) MAIN QUESTIONS: A. First, let s talk briefly about health insurance and purchasing health insurance. a. Have you ever shopped for health insurance coverage? Where and how? How was the experience for you? b. What is the importance of health insurance coverage? To you? If you have a family, to your family? B. Understanding of health insurance exchange a. Have you heard or read much about the changes that are coming in the health care system that are required by national law? 16 P a g e

17 b. What have you heard or read? c. Where have you seen or heard about the information on the changes coming to health care? d. What have you heard about what is going to happen in Nevada relating to this federal law? C. Awareness of health insurance exchange a. Are you aware that within the next year it will be possible for everyone to obtain health care insurance at affordable prices through a state government run program that is part of the new federally required change in the health care system? b. What have you heard or read? c. Where have you seen information about this program? D. Has anyone ever heard of the term health insurance exchange? a. What is the first thing that you think of when you hear the term, health insurance exchange? b. What does the term mean to you personally, if anything? E. Explanation of exchange (hand out information card and read) One way to think of a health insurance exchange is as a one-stop marketplace where you can go to purchase health insurance. At this marketplace, all of the eligible health insurance plans will be authorized by the government to assure their quality. In October 2013, Nevadans can begin to enroll into Nevada s health insurance exchange and coverage can begin as early as January 1, The exchange will provide information on and access to health insurance for all Nevadans and is committed to creating an easy way to decide upon and purchase health insurance. This marketplace will be accessible on an Internet site or at locations around the state where you can go for assistance to help you shop for and purchase health insurance. a. Given what I ve just said, if you were going to explain in simple terms what a health insurance exchange is to your friends or family members, what would you say to them? Great, this is a good discussion. 17 P a g e

18 F. Now let s take the concept of describing a health insurance exchange and break it down into specific words and phrases. a. What words and phrases do you think are the most important in describing a health care exchange in a way that is understandable to as many people as possible? b. What words or phrases do you most associate with a place to shop for affordable health insurance plan options? c. Why these words/phrases? G. Now that we have talked about the words and phrases that you think are important in describing a health care exchange, can you think of any words or phrases that you would not use to describe a health care exchange maybe because they are too hard to explain or for someone to understand? a. What are they and why? H. If you were going to name this health exchange in Nevada, what would you call it? Why? I. Thank you very much for your responses so far. Now I am going to read some specific names that might be used to call this health insurance marketplace or exchange In Nevada. Of these, which do you feel best describes what this health exchange concept will do for Nevadans? (list positive and negative reactions and ask them to choose their top two name based on the names effectiveness) All In Nevada Get Covered Nevada Nevada Health Link Nevada HealthHub My Health Insurance Link My Health Insurance Nevada Nevada Health Benefit Solution Nevada Health Insurance Solution Nevada s Health Benefit Source 18 P a g e

19 Nevada s Health Insurance Connect J. Let s talk now about the tone or style of the messages or advertising that could be used to explain this marketplace to the people of Nevada. a. What kind of people do you think you would be most effective in convincing you and others to purchase health insurance (i.e. doctors, nurses, cartoon characters, insurance salesperson, a mascot, ordinary people like your friends and neighbors, sports stars, people who have benefited from insurance)? b. If you were going to choose how the advertising came across, which would be most convincing and appropriate to explain the importance of insurance and how to use the exchange? Serious and Informational? Humorous and clever? Other? c. Why did you answer as you did? K. Tag Line Questions (write tag line on display board an hand out cards for each) a. Given what you now know about a health insurance marketplace or exchange, please tell us which of these descriptive phrases helps explain the concept (these would be used next to the name of the exchange to help further describe what an exchange does and its importance to Nevadans). A brighter, healthier future Centered around health Don t gamble with your future Every Nevadan covered Every Nevadan insured Health coverage for every Nevadan Health insurance for every Nevadan Healthcare for all Nevadans Helping Nevadans get health coverage Helping Nevadans secure health insurance Insuring health for every Nevadan My choice, my health, my future Nevada s affordable health insurance source 19 P a g e

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