94 percent of So. Marylanders are insured, survey says

College of Southern Maryland poll indicates most feel coverage is adequate

Wednesday, June 24, 2009

About 94 percent of Southern Marylanders in a recent College of Southern Maryland survey said they have health insurance and about 83 percent of respondents said their current coverage meets their needs.

Local health care professionals say those numbers are surprising. Respondents might not really understand what adequate health care coverage is, they say, have never experienced an emergency that forced them to analyze their coverage or don't realize how much rising costs play into their quality of care.

The survey, part of an occasional series called the Pulse of Southern Maryland, was conducted by CSM marketing and statistics students by telephone this spring. A total of 397 residents in the region responded. There was a 4.91 percent margin of error.

Over the past eight years, Marylanders have seen their health insurance premiums increase by 64.1 percent while wages during that period only grew by 21.4 percent, according to a statement by Rep. Steny Hoyer (D-Md., 5th). Without reform — a controversial and hot topic on Capitol Hill — the health insurance premiums of Maryland families would increase from 4.7 percent of their income to 9.1 percent by 2016, Hoyer's data shows.

While it appears the majority of Southern Marylanders are adequately insured, in Maryland the number of uninsured people has grown to 769,007 — 13.8 percent of the state's population, according to Hoyer's statement. About $56 billion in uncompensated care for the uninsured is absorbed annually by the health system, driving up the cost of insurance for everyone, Hoyer said.

Jon S. Frank, president and senior adviser of Jon S. Frank and Associates, a benefits consulting firm, wrote in an e-mail that he thought the survey answer was "low," citing a U.S. Census Bureau estimate of 10 to 15 percent uninsured in Southern Maryland. "Maybe things are better than [we] thought?" he wrote in the e-mail.

Southern Marylanders' generally positive view of their health care is juxtaposed by a November Gallup poll that indicated most Americans believed access to care was the most urgent health problem in the country (30 percent), followed by health care and insurance costs (25 percent), obesity (12 percent) and cancer (11 percent). The same poll found that the majority of Americans believed health care coverage in America was only fair (42 percent); 30 percent of people thought it was poor; 22 percent thought it was good, and 4 percent said it was excellent.

"We were surprised to see that 94 percent number [of insured citizens] because that doesn't necessarily track with our experience with the patients that we've seen," said Linda Kandel, director of marketing and planning for Civista Medical Center. "They could have a high co-pay, and say yes, they have insurance [in the survey], but it's limited coverage. Even though many people have insurance, there seems to be more that do not."

Todd Eberly, an assistant professor of political science of St. Mary's College of Maryland who has studied and surveyed public health programs in Maryland, said because about 18 percent of the respondents were 65 or older, the results of the number of insured are skewed because that population is likely to be using Medicare, a federal program financing health care for the elderly.

"It's a little high … I doubt it's 94 percent have coverage. The Medicare folks in there are skewing it a little bit," Eberly said.

Because those surveyed are older than 18, uninsured kids would be excluded from the tally and so the actual number of uninsured could be greater, Eberly said.

Many of those surveyed were 31 to 50 years old (41 percent). These are people generally in the prime of their careers who are most likely to be insured by their employers, Eberly said. About 56 percent of the households surveyed earned $60,000 or more annually.

The majority of insured folks (83 percent) said their coverage meets their needs.

"Most people who have insurance say they are satisfied. That jibes with national surveys. Most people go through the year and have primary care visits or have long-term stays in hospitals … they know it's there whenever they have it. But there's no question in here about cost," Eberly said, such as one asking if families have not visited a primary care doctor or emergency room because of cost?

The majority of respondents — 57 percent — said their health insurance is provided by their employer, and 28 percent said they share responsibility of paying for insurance, and 17 percent they provide insurance for themselves.

"But what preference would they have?" Eberly said of the result. "People are far more supportive of employers providing it than they are of the government providing it. It's what we're comfortable with. There a dozen ways you could have health care other than these three."

Calvert and Charles are more likely to have employer plans but more supportive of universal health care, indicating these residents are more aware of health care's annual rising costs.

More than three-quarters of respondents said their health insurance includes vision coverage or dental coverage or prescription drug coverage.

When asked whether they thought that all employers should provide health care, 71 percent of respondents said yes. About 21 percent said they don't think so, and 8 percent said they had no opinion.

But from the employers' point of view, that's a less attractive proposition, according to Frank.

"We work with employers who now offer coverage; some are tired of carrying the water for others and want more water carriers; some would like to put their buckets down," he wrote in the e-mail.

About half of the respondents said that the government should provide universal health care, and about 31 percent said it should not. About 19 percent had no opinion.

About 39 percent of citizens nationwide believed that the current health system should be replaced, according to a March Gallup poll. About 56 percent said it should say the same, and 5 percent had no opinion. In a November poll, 54 percent of Americans said they believe it's the government's responsibility to provide health care for all.

The favorability of Southern Marylanders to universal health care could be unintentionally biased by the fact that more females answered the survey (69 percent versus about 31 percent of men), Eberly said, though it falls in line with national figures.

"Women and men answer questions on health care differently … it's a sense of family responsibility … women have been more responsive to programs that help people," Eberly said.

About 91 percent of Southern Marylanders said they or a family member had visited a primary health care provider within the last year.

"Well, 90 some percent have health insurance. Well of course you're going to have a skewed perspective [on universal health care] … But even with asking people with health insurance … 50 percent said yes, they believe the government should offer universal health care," said Carol Paris, a Leonardtown psychiatrist who has been an activist for a national health care program. "Do people know what national health insurance is? They don't understand it. I don't think that the people who have insurance realize they can still go bankrupt [from health care costs]. People don't know what they have and that it doesn't cover stuff until they need it."

Younger folks 18 to 30 were more likely to support universal health care and feel employers should provide health care for all employees. Eberly said this is because young people getting out on their own begin to realize how expensive health care really is. About 28 percent of respondents in the 22-30 age group said they did not have health insurance, the highest out of all the age groups.

"You got a generational shift where folks are less apprehensive about the government providing services," Eberly said.

A higher percentage of respondents in the lowest two household income categories, up to $30,000 and $30,000 to $60,000, said they lacked health insurance (18 percent vs. 6 percent overall). These groups also believed more in universal health care (about 70 percent versus 50 percent overall).

Staff writer Joel Davis contributed to this report.