SPG synthesis report - State Coverage Initiatives

their medical needs. States found that the uninsured receive care through many
different sources, including hospital emergency rooms, safety net providers such as
federally qualified health centers, pay out of pocket for private providers when
possible and at the risk of incurring substantial debt, or go without care.
� Maryland noted that its uninsured residents receive care through many different
mechanisms and paid for by many different sources, including state funded
programs, grant funded programs, and philanthropic efforts.
� West Virginia’s focus groups also revealed that the uninsured met their needs in
a variety of ways. Some uninsured individuals treat themselves with over-thecounter
medications, seeking care only when their condition deteriorates. Others
seek care knowing that they will either get a reduced rate or work out a payment
arrangement with the provider.
• Employer decision-making and incentives. Through focus groups and other
qualitative approaches, such as key stakeholder interviews, states made a concerted
effort to gather information on employer decision-making on health care coverage. In
addition to cost serving as the primary deterrent in an employer’s decision not to
provide coverage, states uncovered a great deal of confusion amongst employers—
especially small businesses. Delaware found a “strikingly high level of
misunderstanding and confusion” among small businesses on the topic of health
insurance coverage. These findings led the state to beef up its plans to disseminate
educational materials to the employer community.
� Delaware undertook both an employer survey and employer focus groups; the
state reported that “cost, or perception of cost, is the single determinant of a
business’s decision to offer or not offer health insurance benefits.” 29
� Similarly, Florida found that “price” was the number one reason that employers
either did not offer health insurance or discontinued coverage.
� Maryland’s focus groups revealed that many small employers are particularly
prone to not offering coverage if they have a high employee turnover or employ
greater numbers of workers from the retail industries; “trade” businesses such as
beauty salons, travel agencies, florists, and auto shops were also found to be less
likely to offer coverage.
� In New Hampshire, employer focus group participants described cost as a major
barrier that affected their decision whether to offer health insurance. These
employers believed that competition, and the hope for a resultant reduction in
premiums, would be the only way to encourage more employers to offer
coverage.
� In North Carolina, focus groups revealed that employers viewed health
insurance as an important benefit to recruit and retain staff. At the same time,
employers reported that they were cutting back on dependent coverage in
response to rising premiums.
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