Explore the Findings
Concern for Prices
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.
Eighty-five percent of people with ESI are concerned about the prices that hospitals, doctors, and other medical providers charge for health care services. This is followed by 75 percent of people with ESI concerned about the prices of prescription drugs, and 72 percent who are concerned about the amount that employees have to pay for health insurance. Although still a majority, only 52 percent are concerned about the amount employees have to pay; see Figure 1.
The survey explained that the prices that hospitals, doctors, and other medical providers charge have been increasing for many years and asked people with ESI why they think that has been happening. The most commonly cited reasons are medications and supplies becoming more expensive, more bureaucracy and administrative costs, hospitals making larger profits, and hospital executives getting paid more; see Figure 2.
Impact of Rising Prices
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.
When asked to identify the two biggest reasons why employees have been paying more for health insurance over the years, 47 percent of people with ESI indicated hospitals, doctors, and other medical providers charging higher prices for medical services. The next commonly cited reasons are insurance companies charging higher prices to administer claims (40 percent), pharmaceutical companies charging higher prices (31 percent) and inflation (29 percent); see Figure 3.
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.
Employers have consistently paid most of the costs of insurance premiums for covered workers. But only 39 percent of people with ESI are aware that employers pay most of the costs for employees’ health insurance coverage. Twenty-eight percent believe that employees themselves pay most of the costs, 17 percent say that employers and employees pay about the same amount, and 16 percent say they do not know.
By law, health insurance companies are required to spend at least 80 percent of the money they take in from premiums on health care costs and quality improvement. They can spend no more than 20 percent of premium dollars on administrative, overhead, and marketing costs. Yet nearly half of people with ESI (48 percent) believe that health insurance companies keep most of the money that employers and employees pay in premiums. Only 24 percent think most of that money goes to hospitals, doctors, and other medical providers for health care services, 11 percent believe it goes to pharmaceutical companies for prescription drugs, and 17 percent don’t know where most of the money goes.
Only one third of people with ESI think employer-based insurance works pretty well. Nearly everyone else believes it needs improvement.
Thirty-one percent of people with ESI believe that employer-sponsored insurance needs major improvements, while another 34 percent believe it needs minor improvements. Only 30 percent of people with ESI believe it works pretty well. Among people with ESI who think employer-sponsored insurance needs major improvements, 94 percent are concerned about the prices that hospitals, doctors, and other medical providers charge for health care services. In contrast, among those who think employer-sponsored insurance works pretty well, fewer (83 percent) are concerned about provider prices; see Figure 4.
Support for Regulatory Policy
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.
When asked how to address increasing prices charged by hospitals, doctors, and other medical providers, support is strongest (89 percent) for requiring providers to fully disclose their prices. However, a large majority (79 percent) support limiting how much hospitals, doctors, and other medical providers can charge for health care services, and 81 percent support limiting how much providers can increase their prices each year. Support is similarly strong (80 percent) for preventing hospitals from charging higher prices than independent doctors’ practices when they provide the same medical services; see Figure 5.
By contrast, a modest 55 percent majority supports insurance plans only covering high-quality, reasonably priced hospitals, doctors, and other medical providers. Framing this option in negative terms—that is, insurance plans no longer covering low-quality, over-priced providers—yields a similar level of support (57 percent); see Figure 5.
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.
Just under half of people with ESI support preventing hospitals from buying independent doctors’ practices or preventing hospitals from buying or merging with other hospitals. But only about one-quarter of people with ESI oppose preventing these types of mergers and acquisitions, while about one-quarter of them say they do not know whether they support or oppose them; see Figure 6.
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.
Compared to the eight in ten people with ESI who support limiting providers’ prices, a less robust majority supports government regulation of the prices charged by hospitals, doctors, and other medical providers, more generally. Support for government regulation of providers’ prices is stronger among Democrats than among Independents or Republicans with ESI; see Figure 7.
Among people with ESI, those who think employer-sponsored insurance needs to be improved are supportive of government price regulation.
Those who say ESI needs major or minor improvements are more likely to support government regulation of the prices charged by hospitals, doctors and other medical providers, than those who say it works pretty well. Specifically, 73 percent of those who say that ESI needs major improvement support government regulation, while only 51 percent of those who believe ESI works pretty well support government regulation of prices; see Figure 8.
Implications of 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.
Two-thirds of people with ESI are concerned that if the government regulated the prices charged by hospitals, doctors, and other medical providers, providers would find loopholes to avoid it. About as many are concerned that providers would pressure the government to keep prices high. Six in ten people with ESI are concerned that government regulation would not go far enough in lowering providers’ prices; see Figure 9.
People with ESI who are more concerned that providers would find loopholes to avoid regulation, that providers would pressure the government to keep prices high, or that government regulation would not go far enough are more likely to support government price regulation than people who are less concerned about those issues.
However, about six in ten people with ESI are concerned that the government would be too incompetent to enforce regulation of providers’ prices; see Figure 9. People with ESI who are more concerned that the government would be too incompetent to enforce regulation are less likely to support it.
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.
Six in ten people with ESI are concerned that patients would get lower-quality health care if prices are set too low, and just slightly fewer are concerned that providers would have to crowd more patients into their schedules if prices are set too low; see Figure 10. People with ESI who are more concerned about quality and access are less likely to support price regulation compared to people who do not express those concerns.
About half of people with ESI are concerned that doctors and nurses would quit their jobs if prices are set too low. And half are concerned that some providers would go out of business if prices are set too low; see Figure 10. People who are more concerned about these issues are less likely to support government price regulation.
About half of people with ESI are concerned that government price regulation would unintentionally harm rural communities, including modestly more residents of rural areas (56 percent) compared to urban (44 percent) or suburban (49 percent) areas. People with ESI who are more concerned about impacts on rural communities are less likely to support price regulation. Communities are classified as urban, suburban, or rural based on standard rural-urban commuting area codes.
About four in ten people with ESI are concerned that government price regulation would unintentionally harm communities of color; see Figure 10. This concern is stronger among Black Americans (59 percent) and Latino Americans (49 percent) with ESI than among their Asian American (42 percent) or white American (39 percent) peers. However, among people with ESI overall, concern about impacts on communities of color has no net bearing on support for price regulation.
People with ESI are least concerned that price regulation would violate America’s free market system.
Only 41 percent of people with ESI say they are very or somewhat concerned that government price regulation would violate America’s free market system. This includes a 58 percent majority of Republicans compared to 41 percent of Independents and 26 percent of Democrats. People with ESI who are more concerned that price regulation would violate free market principles are less likely to support it; see Figure 11.
Employers and Regulation
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.
Just over half of people with ESI (55 percent) trust that the employer or union that provides their insurance is trying to make health care more affordable for people like them. Fewer trust any of the other entities that this survey asked about to make health care more affordable. For example, only about one-third trust government agencies and only 19 percent trust elected officials to do so; see Figure 12.
Yet when asked who should be primarily responsible for addressing the increasing prices charged by hospitals, doctors, and other medical providers, 43 percent of people with ESI say a government entity, specifically 26 percent who indicate that government agencies that administer health programs should be responsible, and 17 percent say that elected officials should be primarily responsible. Very few think that employers who provide health insurance or parents and families should be primarily responsible for addressing providers’ increasing prices; see Figure 13.
Eight in ten people with ESI support employers pressuring providers to charge more reasonable prices. Two-thirds support employers advocating for price regulation.
About eight in ten people with ESI support employers working together to pressure providers to charge reasonable prices. A similar share supports employers speaking up publicly about the increasing prices charged by hospitals, doctors, and other medical providers; see Figure 14.
A 68 percent majority of people with ESI supports employers advocating for government regulation of providers’ prices; see Figure 14. This includes 78 percent of Democrats compared to 64 percent of Independents and 56 percent of Republicans.
People with ESI who attribute increasing premiums to providers charging higher prices are especially supportive of employers advocating for regulation.
As discussed in Finding 2, a plurality of people with ESI (47 percent) think that premiums for employer-sponsored insurance are increasing due to hospitals, doctors, and other medical providers charging higher prices. People who attribute increasing premiums to providers charging higher prices are more likely to support employers advocating for government price regulation; see Figure 15.
About half of people with ESI say they do not know what prevents employers from advocating for price regulation.
About half of people with ESI say they do not know what may prevent the purchaser of their health insurance from advocating for government price regulation. For example, about half say they do not know whether the purchaser of their coverage does not advocate for price regulation because they would be harmed by, are opposed to it, are unconcerned about it, or lack the time or skills to advocate; see Figure 16.
