Life Choices Affecting Iowa Health Insurance Coverage

Health Insurance Influences Iowans' Life Choices

Survey results show the increased financial burden of rising health insurance costs has influenced Iowans to change their behaviors as health care consumers. Looking beyond changes related to health care consumption, past research teaches us that individuals make a multitude of life choices based on their health insurance coverage. A June 28, 2004 article in The Los Angeles Times mentions rising concern among those in the health insurance and health insurance policy fields of individuals marrying in order to get health insurance benefits. One of the questions this study seeks to answer is whether the availability of health insurance exerts influence on Iowans' life choices.

Social and family concerns. Within the family unit, some of the most private decisions that can be made focus on what health insurance will cover. In addition, families must sometimes choose between a desire to be a more engaged parent or caregiver and the need to hold a job that offers health insurance benefits.

The decision to start a family. Slightly less than one in four insured Iowans aged 35 or under (23%) say that within the past three or four years health insurance considerations influenced their decision on when or if to have a child (compared to 8% overall). When asked about future childbearing decisions, 31% of those in the prime child-bearing years say health insurance would influence their decisions (13% overall).

Family care giving. The decision for a parent to stay at home and care for children or other family members is a momentous one for families. The consequences are felt not only within the family, but reverberate throughout the economy. Among insured Iowans, 18% say that the ability to maintain health insurance coverage influenced them or a member of their household to keep working instead of staying home to care for children or other family members. In looking to the future, 30% say that decision will be influenced by health insurance coverage concerns, but 38% of those younger than 35 say they will be influenced by coverage concerns.

Nineteen percent (19%) overall and 27% of low income respondents indicate they or a member of their household has maintained full-time employment to stay eligible for insurance coverage when they would have preferred part-time employment to be able to spend time with family or pursue an education. A future decision to work full or part-time will be influenced by insurance eligibility according to 34% of insured respondents and 45% of those younger than 35.

Economic concerns. Going beyond social concerns and into the area of economic behaviors, Iowans are taking health insurance coverage into consideration as they make decisions regarding when to enter and exit the workforce, make personal investments, and whether or not to pursue an entrepreneurial future. The accompanying economic analysis of the survey data presented beginning on p. 14, confirms that the secondary effects of inflation in health care costs are less employment mobility, dampening of entrepreneurial incentives, and stress.

Job mobility. Almost one in four (24%) say they or someone in their household has stayed in a job they did not like in order to maintain coverage. Thirty-five percent (35%) believe they or someone in their household will have to make this compromise in the future. This finding is exaggerated among those with incomes below $30,000, where 33% say they have stayed in a job they dislike to keep coverage (38% in the future).

While overall only 7% say they or a member of their household has taken a less desirable job to obtain or to improve health insurance coverage, the percentage who think they will be faced with that situation in the future climbs to 19%.

Entering the workforce. Twenty-one percent (21%) of low wage earners say they or someone in their household decided to start working in order to get health insurance coverage (as compared to 13% overall).

Retirement. Health insurance considerations exert even greater influence on retirement decisions. Four in ten insured Iowans aged 55 to 64 (41%) say they or someone in their household made the decision of whether or when to retire, based on health insurance coverage (compared to 24% overall). Looking to the future, a majority (50%) of these Iowans say health insurance will influence their retirement decisions (compared to 44% overall).

Entrepreneurship. The desire to maintain health insurance coverage has stopped 14% of insured Iowans from starting their own business; 23% believe they will not be able to start a business in the future because of the need to maintain health insurance coverage.

Insurance. Overall, one quarter of insured Iowans (25%) say they or someone in their household has stayed with an existing policy to avoid problems associated with pre-existing conditions. Among insured low-income Iowans (incomes below $30,000), 42% say the presence of a pre-existing medical condition has caused them or a member of their household to retain an insurance policy.

Thirty-nine percent (39%) of insured Iowans say in the future they may well have to stay in a policy to avoid pre-existing condition issues as compared to 50% of low-income insured Iowans who see this happening to them in the future).

Among low-income Iowans (incomes below $30,000), 42% say the presence of a pre-existing medical condition has caused them or a member of their household to retain an insurance policy (as compared to 50% who see this happening to them in the future).

Investments. When asked if they had decided to forgo making future investments such as starting a child's college fund or a retirement saving account based on health insurance considerations, 25% agreed the situation had happened to them or someone in their household (30% think this will happen to them in the future).

Table 3, below, shows not only the influence of health insurance concerns on past and future life decisions, but also the demographic groups among insured Iowans that are the most likely to be influenced by coverage concerns.

Lower-income insured Iowans are more likely to report that health insurance concerns influence life decisions. Also of note is that in four past life-decision categories and in six future categories, those persons identifying themselves as Democrats are among the groups most likely to say that health insurance concerns influence their decision-making. In no life decision tested do those identifying themselves as Republicans appear among the groups most likely to say health insurance has influenced their decisions.

Table 3. The influence of Health Insurance on Major Life Decisions
	Past Decision %	Key Groups Most Likely Past Decision %	Future Decision %	Key Groups Most Likely Future Decision %
Decided to forgo making an investment in the future, such as starting a college fund for a child or putting money into a retirement savings account	25	33 Rural 30 Age 35-54	30	39 Private Ins. 38 $30-50K 36 Rural
Stayed with the same insurance policy to avoid problems with "pre-existing conditions"	25	42 <$30K 37 Private Ins. 33 <=HS 33 Age 55-64	39	57 Private Ins. 46 <$50K 45 <=HS
Stayed in a job you didn't like in order to keep health insurance	24	36 $30-50K	35	41 $30-50K
Decided whether or when to retire, based on health insurance coverage	24	41 Age 55-64 32 <=HS 30 Boomer	44	51 Boomer 50 $50-70K
Worked full-time so you would qualify for the company health insurance plan when you would have preferred part-time, so you could to go to school, for example, or spend time with family	19	27 <$30K	34	45 Age <35
Decided to continue working instead of staying home to care for children or other family members in order to keep health insurance	18	27 $30-50K	30	38 Age <35 36 $30-50K
Decided not to start a business on your own because of losing health insurance	14		23
Decided to start working in order to get health insurance coverage	13	20 <$50K	21	26 <$50K
Decided whether or when to have a baby, based on health insurance coverage	8	23 Age <35	13	31 Age <35
Switched to a job that was less desirable in order to get health insurance coverage or get better coverage	7	12 <$30K	19	24 <$30K
Decided to get married or stay married to get or keep health insurance	6		9

Interpretation

Health insurance cost and availability affects Iowans' lives, and the influence is growing. The data reveal differences among Iowans, primarily in the demographic categories of age, and income in the extent to which they say health insurance is likely to influence life decisions. Iowans from disparate groups have a common stake in the future of health insurance.