Recent focus groups demonstrate the low bar of being satisfied with health insurance

Over the past couple of years, United States of Care has been engaged in an intensive listening initiative to uniquely and deeply understand people’s health care needs in order to achieve more durable, people-centered solutions. We have been excited to share our findings with you over the course of this journey. In November, we published a blog post highlighting the initiative itself, and in December we shared findings from our national survey.

We recently undertook a series of focus groups as the next phase of our research to learn more about people’s needs and their perceptions of the health care system. These consisted of four groups: participants who are Black, low-income, Republican, and have insurance that they are satisfied with. We learned a great deal from these focus groups—learnings that both reinforced our previous research and shed light on some perplexing questions raised by our national survey.

Consistent with our first year of research, we heard over and over again—throughout each group—that cost of care is the primary concern among participants. Notably, we heard that cost has driven many of our participants to skip seeking even routine care. While this was especially prevalent in our low-income group, it was not uncommon across the other groups. In fact, even those who are financially secure expressed exasperation at the cost complexity of the health care system, noting that they often struggle to understand what they will ultimately owe out of pocket. Not knowing what they will owe ahead of time serves as a deterrent for seeking care.

While participants disapproved of the cost of care and complexity of the billing process, they did approve of preserving choice in the health care system. For some this meant being able to keep their insurance if they like it, while for others it meant being able to pick the doctor they wanted to see. The wide selection of providers available in the U.S. was seen as a point of pride, even for those who were more critical of the system due to their own experiences.

Our focus groups also reinforced our previous findings that there is broad support for achieving core improvements to the health care system. Participants responded positively to a hypothetical health care system in which:

• People have the certainty that they can afford their health care.
• People have the security and freedom that dependable health care coverage provides as life changes.
• People can get the personalized care they need, when and how they need it.
• People experience a health care system that’s understandable and easy to navigate.

As participants expressed strong support for the health care system described above, they also expressed hesitancy to the idea of dramatic change. Across demographics, participants expressed preference for targeted fixes to the existing system rather than a complete overhaul. Many participants found a fragile assurance in the current system and were grateful for the most basic levels of care. They were concerned that dramatic changes to the system might put their care at risk and believed that targeted fixes to big problems would lead to quicker and more stable success.

Several findings from our focus groups were illuminating. In our national survey conducted in November 2020, we found that 93% of people said they were “satisfied” with their health insurance, and that 62% of people thought the care they received was “better than average.” These percentages surprised us because they didn’t align with the concerns about coverage and care we had been hearing. Using the focus groups to dig deeper on these questions, we found that participants weren’t defining “satisfied” the same way we were. Instead of understanding “satisfied” to mean that they had no complaints about their individual insurance situation, participants said they were “satisfied” simply because they felt more fortunate than those who didn’t have insurance at all. This is an incredibly important distinction for our work ahead and for the industry as a whole.

We also found that participants’ perception of having “better than average” health care is actually due to the broad awareness of the struggles that those without coverage endure. Simply believing that their coverage might be better than that of others does not mean they think the system is working. One participant, from our focus group of Black Americans, put it succinctly: “Health care works good if you’ve got it, and if you don’t, you’re S.O.L.”

Our research to date has underscored just how much work we have ahead of us to enact solutions centered on people’s needs and build a health care system that works for everyone. We ended our focus groups on a high note—talking about feelings related to the idea of a system that is affordable and fully meets patient needs. As participants reflected on the possibility of achieving core improvements to the system, they spoke of feeling more secure and having a peace of mind that came with a great sense of relief. We discussed various potential solutions that people want to see in place, and in the next phase of our research, we will begin testing those solutions using advanced research tools and tactics. We are excited about this effort and look forward to sharing more as our research unfolds.