Rebecca Silliman and Dickson Su
2024
The care provided by hospitals, physicians, and other clinicians accounts for about half of all health care spending in the United States. The increasing prices charged by hospitals and other health care providers are the greatest drivers of growth in health care spending, contributing to rising insurance premiums for employers who purchase health insurance and growing premiums and cost-sharing for beneficiaries. The strategies available to employers for addressing high prices often involve directing beneficiaries toward high-value providers and shifting more costs to beneficiaries. But employers increasingly believe in the need for policy approaches to address high provider prices.
To equip employers and policymakers with a better understanding of the perspectives of people with employer-sponsored health insurance (ESI) about how to address the prices charged by hospitals, doctors, and other medical providers, Public Agenda, with support from Arnold Ventures, conducted a nationally representative survey of people with ESI.
In brief, the survey finds that a large majority of people with ESI are concerned about higher provider prices. Nearly half believe that higher provider prices are contributing to rising employee premiums, yet most are not aware that employers pay most of the costs for employees’ health insurance coverage. A majority think ESI needs improvement. To address increasing health care providers prices, over three quarters of people with ESI support price transparency and limiting health care providers’ prices and about two thirds support government regulation of providers’ prices in general. However, if the government were to regulate prices, most people with ESI are concerned about various aspects of implementation, including providers finding loopholes to avoid regulation or the government being too incompetent to enforce regulation. Furthermore, their concerns around implementation influence their support for government regulation. People also see a role for employers in addressing high costs. Just over half of people with ESI trust that their employers are trying to make health care more affordable for people like them and two-thirds support employers advocating for government price regulation. People who attribute increasing premiums to providers charging higher prices are especially supportive of employers advocating for regulation.
Findings are based on a nationally representative survey of 2,049 people covered by health insurance provided by their own or a family member’s current or former employer or union in the United States. The survey was designed by Public Agenda and fielded March 22, 2024 to April 9, 2024 by NORC at the University of Chicago. The survey has a margin of error of +/- 2.82 percentage points at the 95 percent confidence interval. Margins of error are greater for subgroups. For details about the methodology, topline with full question wording, and additional regression analyses, see the methodology.
This Public Agenda project is supported by Arnold Ventures.
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Findings in Brief
Most people with ESI are very concerned about prices that providers charge for health care services. A plurality attribute rising prices to more expensive medication and supplies, more administrative costs, and hospitals making larger profits.
- About nine in ten people with ESI are concerned about the prices that providers charge. Far fewer are concerned about the amount that employers have to pay for their employees’ health insurance.
A plurality of people think that higher provider prices explain rising employee premiums. A majority are not aware employers pay the larger share of premiums and a majority believe ESI is in need of improvement.
- Just under five in ten people with ESI think that premiums for employer-sponsored insurance are increasing due to providers charging higher prices.
- Only four in ten people with ESI know that employers pay most of the premiums for employees’ health insurance and half think health insurance companies keep most of the money that they receive in premiums for themselves.
- Only one third of people with ESI think employer-based insurance works pretty well. Nearly everyone else believes it needs improvement.
To address increasing health care provider prices, over three quarters of people with ESI support requiring price transparency and limits on health care providers’ prices. Slightly fewer support government regulation of prices in general.
- Most people with ESI support requiring price transparency and most support limiting health care providers’ prices. Just over half support insurance plans being tailored to only cover high-value providers.
- About half of people with ESI support measures to prevent hospital consolidation, but only about one quarter are opposed to those measures. The rest are unsure.
- A smaller majority of people with ESI support government regulation of providers’ prices in general, including three-quarters of Democrats, almost half of Republicans, and just over half of Independents.
- Among people with ESI, those who think employer-sponsored insurance needs to be improved are supportive of government price regulation.
Most people with ESI are concerned that providers would find ways to avoid government price regulation. Slightly fewer are concerned that regulation would negatively affect patients or health care providers. Their concerns influence their support for government regulation.
- Two-thirds of people with ESI are concerned that if price regulation were instituted, providers would find loopholes to avoid it or pressure the government to keep prices high. However, those who are more concerned about these issues are also more likely to support government regulation.
- Six in ten people with ESI are concerned that price regulation would negatively impact quality of care and access to care. Half are concerned about impacts on hospitals, doctors, and other providers. Around most of these issues, greater concern corresponds with lower support for government regulation.
- People with ESI are least concerned that price regulation would violate America’s free market system.
A plurality of people with ESI believe that the government should be primarily responsible for addressing providers’ prices. Most want employers to advocate for price regulation, especially those who think that hospital prices contribute to rising premiums.
- Although more people with ESI trust that employers rather than government are trying to make health care affordable, more think government entities rather than employers should be primarily responsible for addressing providers’ prices.
- Eight in ten people with ESI support employers pressuring providers to charge more reasonable prices. Two-thirds support employers advocating for price regulation.
- People with ESI who attribute increasing premiums to providers charging higher prices are especially supportive of employers advocating for regulation.
- About half of people with ESI say they do not know what prevents employers from advocating for price regulation.
Authors


David Schleifer, PhD, also contributed to this research.
Funding Partner

Founded in 2010 by Laura and John Arnold, Arnold Ventures is a philanthropy dedicated to improving the lives of all Americans through evidence-based policy solutions that maximize opportunity and minimize injustice. They believe philanthropy is uniquely positioned to take risks and make big bets in ways the public and private sectors are often unable or unwilling to do. Arnold Ventures approaches philanthropy as an engine for innovation that can help catalyze new solutions and advocate for public policies that maximize opportunity and minimize injustice for all.