Summary of Findings

Over a period of just seven weeks, from Jan. 14-March 3, a total of 26,419 people took the online 2008 Health Care for America Survey sponsored by the AFL-CIO and Working America. Most are insured and employed. Most are college graduates. More than half are union members.

These are the people, it would seem, most likely to have positive experiences with America’s health care system. Instead, their responses tell a sobering story about the breadth of the problems with health care in America. They say our system has fundamental problems that must be fixed.

And they’re ready to vote about it.

The people who took the survey also submitted 7,489 heart-wrenching stories about the effects of this broken health care system on them and their families. You’ll see some of their stories throughout this report.

The demand for change in today’s health care system is based primarily on deep concerns about costs.

• One-third of respondents to the online survey, sponsored by the AFL-CIO and Working America, report skipping medical care because of cost, and a quarter had serious problems paying for the care they needed.
• Ninety-five percent say they are somewhat or very concerned about being able to afford health insurance in the coming years.
• Almost half overall (48 percent) and 60 percent of Latinos say they or a family member has stayed in a job to keep health care benefits when they would have preferred changing jobs.
• Ninety-five percent of respondents say America’s health care system needs fundamental change or to be completely rebuilt.
• Seventy-nine percent say health care is a very important voting issue, and 97 percent say they plan to vote in the November elections.

The failures of America’s health care system, the survey reveals, are a significant factor in broader economic problems facing working families today.

• Eighty-three percent of respondents say their families have just enough to get by or are falling behind.
• And a shocking 84 percent predict the standard of living will be worse for the next generation.

Having insurance coverage is not insulating families from problems, concerns and dissatisfaction with today’s health care system.

• Ninety-six percent of people with insurance say they are somewhat or very concerned about affording coverage in the next few years.
• Seventy-one percent of the insured worry about losing coverage because they may lose or change jobs.
• Almost two-thirds (61 percent) who have employer-provided coverage say their costs have gotten worse.
• Ninety-five percent of people with insurance are dissatisfied with health care costs, and 62 percent of them are dissatisfied with health care quality.
• Ninety-four percent of the insured say the health care system needs fundamental change or to be rebuilt.

But people who lack insurance—and those who have children younger than 18 who are not covered—report particularly troubling problems getting the care they need because of cost.

• In the past year, 76 percent of people who lack insurance themselves and 71 percent of people with uninsured children say someone in their family did not visit a doctor when sick because of cost.
• Sixty-seven percent of the uninsured and 66 percent of those whose children are uninsured report skipping medical treatment or follow-up care recommended by a doctor.
• Fifty-seven percent of the uninsured and 61 percent of people with uninsured children had to choose between paying for medical care or prescriptions and other essential needs (such as the rent or mortgage and utilities).

More than half of survey takers say their health insurance does not cover all the care they need at a price they can afford. Among them, people who buy their own insurance in the private market are more likely than those with employer-provided health care to report that critical needs are not covered or not affordable.

• Fifty-two percent of people who buy private coverage say prescription drugs are not covered or are unaffordable, compared with 44 percent who have employer-provided coverage.
• Forty-one percent who buy private insurance say preventive care and checkups are not covered or affordable, versus 36 percent overall.
  
  

Medicare is not a shield against unaffordable prescription drug prices.

• Fifty-three percent with Medicare, compared with 46 percent overall, say prescription drugs are not covered or affordable.
  
  

Concerns about today’s health care system span all ages, races, education levels and affect the insured as well as the uninsured.

• A third of college graduates say they or a family member skipped recommended medical care because of cost.
• Half of people in insured families say their coverage does not cover all the care they need at a price they can afford.
• People of color, including 75 percent of African Americans and 76 percent of Latinos, are especially likely to voice dissatisfaction with health care quality.
• Large majorities in all age groups—from 74 percent among 18- to 29-year-olds to 80 percent among 50- to 64-year-olds—consider health care a very important voting issue for the 2008 elections.

The 2008 Health Care for America Survey gives voice to working families’ concerns about health care in this critical election year, and the results will be shared with candidates for office across the country at every level. The survey exposes a health care system that costs too much, covers too little, leaves too many behind and is getting worse. The results deliver a mandate for health care reform to everyone who wants the support of working families in this year’s elections.

	The 2008 Health Care in America Survey reveals tragic flaws in America’s health care system—flaws that provide more evidence that our country is headed in the wrong direction. “Our job in 2008 is to elect a president, Congress and leaders at every level who will work to Turn Around America. Health care costs are out of control. We have an economy that does not work for working families. Good jobs are disappearing. Our trade policies are disastrous. Workers are losing their freedom to form unions and bargain to improve their lives. Hard-working people are losing their homes, their home equity and their retirement security. Our schools and roads and bridges are crumbling underneath us. The road to health care reform—and to an economy that works for all—runs through the 2008 elections. We have to help candidates who support real reform become active champions for health care. And we have to expose and hold accountable candidates at all levels who oppose real reform and propose false solutions.” JOHN J. SWEENEY, AFL-CIO PRESIDENT

Kitchen Table Economics

A quick look at the demographics of who took the 2008 Health Care for America Survey makes it clear that these are people who should be experiencing the best of America’s health care system and a secure place in our economy. They should be the foundation of the American Dream.

Seventy percent are employed, and 20 percent are retired. Seventy-seven percent are in insured families. Fifty-seven percent are union members (who, because they can bargain with employers, have better average wages and benefits than their nonunion counterparts) and 18 percent have a union member in the family or household. Fifty-one percent have completed college or postgraduate school, and another 29 percent have attended some college.

Nonetheless, most say they have just enough to get by or are falling behind economically. And a shocking 84 percent project the next generation will face a worse standard of living than we have today.

Nearly half of our respondents (46 percent) say they paid $1,000 to $5,000 out of pocket last year for health care (including premiums, deductibles and prescription costs); another 17 percent spent even more than $5,000.

Out-of-pocket health care costs are big burdens for families.

How much did you and your family spend out of
pocket for health care in the past year?

Nothing	2%
$1–$100	4%
$100–$1,000	30%
$1,000–$5,000	46%
More than $5,000	17%
Not sure/refused	1%

Health Care Today

Dissatisfaction with the cost of health care today is overwhelming, according to our survey, and a majority also lack confidence in health care quality.

Dig a little deeper and it’s easy to see why: More than half (52 percent) say their health insurance does not cover all the care they need at a price they can afford, with prescription drugs topping the unaffordable list. An even larger proportion of medicare beneficiaries (53 percent) say prescription drugs are not covered or not affordable—a telling statement about the failures of the Medicare Part D drug benefit, which blocks the government from negotiating with pharmaceutical companies to lower drug prices, is administered by private insurers and allows seniors to fall into a “donut hole” period when their drug costs are not covered. Preventive care—widely considered a cost-saving approach to health care—is uncovered or unaffordable for more than one-third (36 percent).

People who buy their own insurance in the private market are more likely than those with employer-provided coverage to say important care isn’t covered or affordable—a caution to proponents of pushing people into private insurance.

Health coverage is not meeting the need.

Among people who say their insurance doesn’t cover all the care they need at a price they can afford, what is not covered or not affordable?

	All	Employer-Provided Insurance	Medicare	Provides Own Insurance
Prescription drugs	46%	44%	53%	52%
Specialists	43%	43%	38%	44%
Tests	40%	39%	37%	44%
Preventive care and checkups	36%	33%	37%	41%

These cost obstacles are blocking people from getting at least some of the care they need—especially people who do not have insurance and who have children younger than 18 who lack insurance. One-quarter to one-third of respondents overall say their family has skipped needed care or medicines, had trouble paying bills or run up debt because of costs.

Cost keeps people from getting the care they need.

In the past year, did you or a family member experience any of the following:

	Overall	Uninsured	Have Children Under 18 Who Lack Insurance
Skipped medical test, treatment or follow-up recommended by doctor because of cost	33%	67%	66%
Did not visit doctor when sick because of cost	31%	76%	71%
Did not fill a prescription or skipped doses because of cost	29%	51%	56%
Had to choose between paying for medical care or prescriptions and other essential needs (rent/mortgage, utilities)	24%	57%	61%
Had serious problems paying or were unable to pay medical bills	23%	48%	56%
Ran up credit card or other debt you're still paying off due to medical costs	22%	34%	39%

All in all, 95 percent of respondents to the survey say America’s health care system needs fundamental change or to be completely rebuilt. Seventy-nine percent say health care is a very important voting issue, and 97 percent say they plan to vote in the November elections.

One fact that comes through loud and clear in these survey results is that problems paying for health care are not limited to the uninsured. Even among the insured, 94 percent say today’s health care system needs fundamental change or to be completely rebuilt—and 95 percent are dissatisfied with the cost of health care. Ninety-six percent are somewhat or very concerned about affording health insurance in the next few years, and 71 percent of the insured are concerned about losing health coverage because of losing or changing jobs.

Stories submitted as part of the survey illustrate that people are struggling to pay rising premiums, deductibles and the costs of care that insurers refuse to cover. Others suffer because insurers refuse to cover people with pre-existing conditions.

Altogether, more than three-quarters (77 percent) of our respondents say they and their families have health care coverage, but 16 percent say some members in the household do not. In these households, 23 percent lack health care themselves, and more than half (53 percent) say an adult child is uninsured.

Who’s not insured?

Among households in which someone lacks insurance, who does not have coverage?

Self	23%
Spouse/partner	18%
Children younger than 18	8%
Children ages 18-24	25%
Children 24 and older	34%
Other relatives (parent, sister, brother etc.)	24%
Not sure/refused	2%

Employers provide most insurance—by far.

Do you or your family have health care coverage? If yes:

Coverage provided through employer (yours, spouse's, partner's or parents')	78%
Medicare	20%
Coverage purchased by you or someone in your family	15%
Other	9%
Not sure/refused	3%

But almost two-thirds (61 percent) of respondents with employer-provided coverage say their costs have gotten worse in the past couple of years. (Twenty percent say costs stayed the same, and 2 percent report they improved.)

Health coverage has become a major factor in virtually all union contract bargaining, with increasing employee cost-sharing consuming wage increases and other improvements for which unions are fighting. Union members are acutely aware of these effects: 67 percent of members and 66 percent of people in union households say their costs for employer-provided coverage have gotten worse.

For union and nonunion workers alike, the value of health coverage is tying people to jobs they might otherwise want to leave. Nearly half the respondents in our survey (48 percent) and 60 percent of Latinos say they or a family member has stayed in a job just to hold on to health care benefits.

Health Care in the Future

“Health care reform should control costs and ensure everyone gets health care at least as good as what they have now,” according to 83 percent of respondents. “It should let people choose their own doctor and establish government as a watchdog on quality and costs.”

Conversely, only 13 percent agree with a statement summarizing a “free market” approach to health care: “Health care should be based on the current private insurance market. If we let the market do its job, companies will compete for customers and that will control costs and quality. People who don't have health coverage now should get tax incentives to help them pay for insurance.”

In conflict with their vision for what the health care system ought to be, looking ahead toward health care in the future is a frightening prospect for many who see costs rising out of reach for life-saving treatment and medicines. Ninety-five percent of the people who took the 2008 Health Care for America Survey—and an equal portion of respondents with insurance—are concerned about affording health insurance over the next few years. Nearly three-quarters (72 percent overall and 71 percent among the insured) are concerned about losing health coverage because of losing or changing jobs, including almost half (46 percent overall and 43 percent of the insured) who are very concerned. Forty- to 49-year-olds make up the age group most likely to have this worry, with 81 percent very or somewhat concerned about losing coverage along with a job.

When painting a picture of the health care system they would want to see for the future, respondents see many solutions that will help people like them. They are especially supportive of covering preventive care and establishing a watchdog on drug and insurance companies to reduce costs.

We need preventive care coverage and a watchdog on costs.

Choose whether you think each of the following is a good idea or a bogus solution:

	Good idea	Not a good idea	Not sure
Cover preventive care at little or no cost	93%	5%	2%
Establish a watchdog on drug companies to reduce costs	90%	7%	3%
Set rules and establish a watchdog on insurance companies to reduce costs	87%	9%	4%
Offer choice of health insurance plans at last as generous as members of Congress receive	85%	12%	3%
Use technology to increase efficiency and reduce paperwork	85%	10%	5%
Require employers to provide health care coverage or contribute to its cost	76%	19%	5%

When it comes to the future for our children…

People who responded to the survey are deeply concerned about the future for their children. In addition to worries about health care, they cite the economy, the environment, rising college costs, eroding retirement security and the massive imbalance of wealth and corporate power in America.

But the sense that America’s people and our unions are poised to bring about significant change gives the survey respondents hope for the next generation— as does the intelligence, resourcefulness and decency of their children.

…What concerns you most?

“The fact we’ve bankrupted future generations….The system we have now is brutal and it runs roughshod over our most vulnerable citizens: children, the poor, and the elderly.”

“Losing the middle class.”

“Will our children really be able to live the American Dream?”

“My concerns are greater than my hopes. I see my children struggling to make ends meet every month. I see that struggle becoming even harder when the grandchildren get sick because there is no insurance to cover the health cost. Even the cost of a doctor’s visit and medicine cannot be met without a bill going unpaid or less food on the table. A great education is not worth much if you can’t find a job that will let you pay your bills, put food on the table and furnish you with an affordable health insurance.”

“That it will take a generation or more to undo the damage that seeing health as a commodity has caused.”

…What makes you most hopeful?

“My willingness to fight for that better future.”

“History. When things get bad enough, the people will finally stand up and bring about change. The role of the union will be to direct that change.”

“Electing a president that will watch out for the middle class, which this current status administration has not.”

“People in America always seem to be able to overcome adversity when they work together. Hopefully, we will have better leaders that will be able to recognize what a dynamic country we live in and the strength of the people.”

Turn Around America: Health Care

The results of the 2008 Health Care for America Survey would be depressing were it not for the commitment of working families to become active on health care to help Turn Around America.

Ninety-seven percent of respondents say they are registered to vote, and the same proportion say they plan to vote in November. Across all age groups, large majorities (79 percent overall) consider health care a very important voting issue in the upcoming election.

In addition to voting, survey respondents are willing to take a range of actions to improve health care.

People are ready to act.

What steps would you be willing to take to improve health care?

Sign a petition	90%
Send an e-mail to a friend or elected official	72%
Talk to family/friends about the issue	71%
Write to or visit an elected official	61%
Attend a rally/demonstration	45%
Write a letter to the editor	39%
Actively volunteer for a political party or candidate	31%

By and large, they are at least somewhat informed about the presidential candidates’ health care proposals, with 89 percent saying they have heard some or a lot, while only 10 percent say they have heard nothing. Familiarity with candidates’ health care proposals is shared by all age groups, including 89 percent of 18- to 29-year-olds.

What advice would you like to give to elected officials and candidates about America’s health care system?

When asked what advice they would like to give to elected officials and candidates about America’s health care system, people spoke out strongly for health care that covers everyone and for letting doctors rather than insurance companies make the decisions. They want health care as good as what their elected leaders receive—and for officials to experience or at least understand the system in which the rest of us are living.

“Let’s catch up with the rest of the world and adopt a universal health care plan and insure everyone. Let’s make health care a human right like it should be.”

“Try living for a year as a regular person under the present system.”

“I want the same as you have. Because I am paying for you and your family.”

“Our present health care system is a disgrace. It is a criminal enterprise. You cannot have a for-profit health care system…. Don’t tell us you don’t have the funds for universal health care. If you can spend a trillion dollars on an unproductive and illegal war, you can provide us with universal health care.”

“Americans deserve health care for all. Our elected officials have some of the best health care available, while their constituents suffer. We are in a health care crisis, and the citizens of other countries far surpass us in the quality of care they get.”

About the 2008 Health Care for America Survey

	Working America, community affiliate of the AFL-CIO, combines the strength of union men and women and that of workers without the benefit of a workplace union. The result is a force of 10.5 million working people who share common challenges and goals to fight in communities, states and nationally for what really matters—good jobs, affordable health care, world-class education, secure retirements, real homeland security and more. Join now >>
	Peter D. Hart Research Associates tabulated and analyzed the response data for the 2008 Health Care for America Survey.

Soaring health care costs are a major factor in the economic upheaval facing today’s working families. Costs are rising much faster than our wages or inflation, pushing working families into housing problems and bankruptcy, undercutting bargaining and making it impossible for our employers to compete with overseas companies and domestic competitors with low standards.

Largely because of rising costs, 47 million people in this wealthy and powerful country—including 8.7 million children—have no health coverage at all.

In this election year, the AFL-CIO and community affiliate Working America wanted to give voice to working families’ concerns about health care—a voice we could share with candidates running for office at every level in every part of the country.

From Jan. 14 through March 3, 2008, a total of 26,419 people participated in the survey. They submitted 7,489 heart-wrenching stories about their experiences in America’s broken health care system.

The survey was featured on the AFL-CIO website, and Working America, affiliate unions and state and local labor councils linked to the survey as well. Through the Working Families e-Activist Network, the AFL-CIO and 30 partner organizations sent e-mails urging activists to take the survey and encourage their friends and family to take it, too.

Altogether, more than 35 organizations promoted the survey through links and e-mails. These include eight national unions: (AFGE, AFSCME, AFT, BCTGM, IBEW, UAN, UMWA and USW); nine state labor federations (Ariz., Calif., Iowa, Ill., Minn., N.H., N.J., S.D. and Vt.); nine area and local labor councils; the constituency groups Pride at Work and the Coalition of Labor Union Women; and allied organizations including the Alliance for Retired Americans, American Rights at Work, Campaign for America’s Future, Jobs with Justice, Union Privilege, USAction and the Universal Health Care Action Network.

Of the people who took the survey, 57 percent are union members, and 18 percent live in households with a union member. Seventy-seven percent are in insured families— including 83 percent of union members, who are able to bargain for employer-based coverage. Seventy percent are employed, and 20 percent are retired. The largest age group of respondents (49 percent) is 50 to 64 years old. Eighty-six percent are white, and 51 percent have completed college or post-graduate studies.

Here’s a look at them:

Employment

Currently employed	70%
Retired	20%
Not currently employed and not retirement age	9%
Not sure/refused	1%

Age

18-29 years	5%
30-39 years	12%
40-49 years	21%
50-64 years	49%
65 or older	12%
Not sure/refused	1%

Education

Schooling level completed
First-11th grade	1%
High school graduate	11%
Non-college post-high school (technical school etc.)	8%
Some college	29%
College graduate	27%
Post-graduate school	24%

Race/Ethnicity

White/Caucasian, non-Hispanic	86%
African American, non-Hispanic	5%
Hispanic/Latino	4%
Asian Pacific American/East Asian	1%
Native American	1%
Biracial/Multiracial	2%
Not sure/refused	1%

Household

Check all that describe you
Student	7%
Have children younger than 18 living with me	22%
Married	57%
Domestic partner	8%
LGBT	4%
Union member	57%
Someone in my family or household is a union member	18%
Not sure/refused	9%

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Survey Results by State