One of the nation’s foremost experts on survey writing compared McKinsey & Company’s controversial health care study to a push poll, calling into further question whether its results can be trusted as even a snapshot of employer sentiment.
“There is no doubt that the answers one would get after priming respondents the way they did would be expected to include more expressed interest in the possibility of not insuring employees than a question asked in a nonprimed context,” said Floyd Fowler, a Senior Research Fellow at the Center for Survey Research at University of Massachusetts, Boston, and author of the book Survey Research Methods.
McKinsey’s study concluded that employers are fairly likely to rescind insurance benefits after the health care law takes full effect in 2014. The firm claims to stand by the result, though it now admits the results of the survey aren’t predictive. However, the results were based on some curious questions, pasted in full below, designed to lead survey-takers to conclusions at odds with the majority of expert analysis.
One question on “workforce strategies” posits:
With healthcare reform, some employers may be interested in offering health insurance to their higher-wage employees, but not to lower-wage employees (who can purchase government subsidized coverage on healthcare exchanges). Here are some additional facts about this option:
* Healthcare reform prohibits employers from discriminating in favor of higher wage employees in
their benefits offering.
* However, there are other workforce strategies your company could pursue to provide different
benefits to your higher vs. lower wage employees.For the next set of questions, assume exchanges are an easy, affordable way for individuals to obtain
health insurance.
It goes on to list a series potential business strategies companies could use to arbitrage the health care law.
“[T]he fact that someone spent time thinking up, then outlining to corporations, ways to circumvent the law in such amazing ways seems like a pretty good story all by itself,” Fowler says. “… What is intriguing to me is whether in fact they may have increased corporation interest in exploring ways to avoid providing insurance to their employees by the act of suggesting these possible approaches. In the political polling world, as you probably know, push polling is used to plant ideas in voters’ heads: If I told you that CANDIDATE A has had two abortions and stopped going to church at an early age, who would you be most likely to vote for: A or B? Such a question will change the distribution of answers, but also may disseminate ideas about candidate A.”
Republicans and foes of the health care law continue to cite the McKinsey study and stand by its results despite McKinsey’s admonition that it’s not intended to be predictive. So the political damage may already be done. But we now have authoritative reason to believe that McKinsey’s result is misleading — not simply an innocent outlier.
41a. Individual health insurance exchanges. Starting in 2014, there will be state-run exchanges for individuals to more readily purchase medical insurance on their own. Here are some additional facts:
* Insurance products will be “guaranteed-issue” (i.e., a person cannot be turned down because of a pre-existing condition)
* Insurance companies cannot charge exorbitant rates because of a person’s health. The only factors they can use to “rate” an individual are age and smoking status.
* Individuals whose employers do not offer health coverage, and who have household incomes below 400% (around $43K for a single person and $88K for a family of 4) of the federal poverty level, will receive government subsidies to offset their healthcare cost. Individuals with incomes above 400% of the FPL will receive no subsidies.
Assume exchanges become an easy, affordable way for individuals to obtain health insurance.If your employees were to obtain insurance on an exchange instead of through your company, here are examples what they would likely pay for basic coverage (based on their annual household incomes):
Given this information, how likely do you think your company would be to discontinue employee health
coverage?Definitely would
Probably would
May or may not
Probably would not
Definitely would not
44. Workforce strategies.
With healthcare reform, some employers may be interested in offering health insurance to their higher-wage employees, but not to lower-wage employees (who can purchase government subsidized coverage on healthcare exchanges). Here are some additional facts about this option:
* Healthcare reform prohibits employers from discriminating in favor of higher wage employees in their benefits offering.* However, there are other workforce strategies your company could pursue to provide different benefits to your higher vs. lower wage employees.
For the next set of questions, assume exchanges are an easy, affordable way for individuals to obtain health insurance. How likely would your company be to consider pursuing each of the following strategies?
[TOP]
Definitely would
Probably would
May or may not
Probably would not
Definitely would not
I don’t know
[SIDE. RANDOMIZE]
Restructuring your company into two companies, one comprised of higher-wage employees who would continue to be offered health insurance, and one comprised of lower-wage employees who would not be offered coverage. (If the “lower-wage company” has more than 50 employees, you would pay a penalty of $2000 per employee in this company, after the first 30 employees.)Shifting your lower-wage workforce toward more part-time workers (work less than an average of 30 hours per week each month). You would not have to offer part-time employees health insurance and would not have to pay any penalties. You would continue offering health insurance to all full-time workers.
Significantly shifting your lower-wage workforce toward outsourced and/or offshore workers. You would not have to offer your outsourced/offshore workforce health insurance and would not have to pay any penalties. You would continue offering health insurance to all full-time workers.
Setting the health coverage premium paid by employees above 9.5% of household income of many/most of your low-wage employees. Because of health reform law, this will enable these low-wage employees to opt-out of your coverage and receive subsidies toward purchase of coverage on an exchange instead. However, you would pay a penalty (the lesser of $3000 times the number of employees who receive subsidies, or $2000 times the number of full time employees after the first 30).
