1) The document summarizes a panelist's presentation on consumer sentiment toward health reform. It discusses the creation of indices to track consumer confidence in health costs over time and reactions to health reform. 2) Three indices were created based on survey data - the Recent Health Cost Barrier Index, Future Health Cost Concern Index, and a composite RWJF Health Care Confidence Index. The future index appears more sensitive to health reform events. 3) While the reform debate has not shifted confidence levels overall, the importance of reform varies by demographics and is seen as very or somewhat important by a majority of respondents from April 2009 to May 2010.

1. Session: Consumer Sentiment Toward Health Reform RoundtablePanelist #1: Health Care Concerns: Rates and Trends During Health Reform Peter Graven SHADAC University of Minnesota AcademyHealth Annual Research Meeting6/28/2010, Boston MA

2. Acknowledgments Funded by a grant from the Robert Wood Johnson Foundation (RWJF) to the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, School of Public Health 2

3. Overview Index calculation Index demographic results Time series tracking Health care reform breakdowns Summary/Discussion 3

4. Index Calculation-Motivation Goal was to produce an index that could be tracked over time measuring an individual’s health care experiences in the recent past and their concerns about the future. Index would provide barometer of health care confidence and help to estimate impacts of changes at national level. Health Care Consumer Confidence Index Recent Health Cost Barrier Index Future Health Cost Concern Index 4

5. Index Calculation- Survey Background Health Care Consumer Confidence Survey (Begun March, 2009) Sponsored by Robert Wood Johnson Foundation (RWJF) and developed with the State Health Access Data Assistance Center (SHADAC): Authored by Brian Quinn, PhD (RWJF); Lynn Blewett, PhD; Kathleen Call, PhD; and Michael Davern, PhD Items added to Surveys of Consumers University of Michigan Survey Research Center in conjunction with Thomson Reuters ~500 monthly respondents, representative of adults 18+ in contiguous US, begun in 1946 50 Core questions in three broad areas: personal finances, business conditions, and buying conditions NOT the same as the Conference Board’s Consumer Confidence Index (~5000 households, begun in1967) 5

6. Index Calculation- Item Selection 9 items chosen from a potential list of 18 Model selection from factor analysis Items targeted current (recent) and expected (future) question framings From the 9 items two factors with eigenvalues >1 conveniently aligned with the current and expected variables. Cronbach’s alpha from the interitem correlations is mid-ranged at 0.85 6

7. Index Calculation- Construction Points Recent Health Cost Barriers (RHCB) Delayed seeing a doctor when it was necessary due to cost Skipped a recommended medical test, treatment, or follow-up due to cost Did not fill a prescription due to cost Have had difficulty paying for medical bills Future Health Cost Concern (FHCC) Worried about losing health insurance coverage (if insured) Worried about not being able to afford treatment for serious illness Worried about not being able to afford all of the routine health care services you Worried about not being able to afford prescription drugs Worried about going bankrupt from not being able to pay medical bills 7 2 1 0 No DK Yes No DK Yes No DK Yes No DK Yes 2 1 0 No DK Yes No DK Yes No DK Yes No DK Yes No DK Yes

8. Index Calculation- Construction Recent Health Cost Barrier Index (RHCBI) Future Health Cost Concern Index (FHCCI) RWJF Health Care Confidence Index (RWJFI) 8

9. Index Calculation- Item validation 9

10. Demographic Results -4/2009-5/2010 10

11. Time Series-Health Indices 11

12. Time Series-Health & Economic Indices 12#

13. Time Series-HCCI Model Results of the Portmanteau Q Test for white noise (P-value percent to reject white noise) Cannot reject null of white noise, however, the future index appears to be responding to health care related events, and more so than recent index 13

14. Time Series-Health Indices 2009 14

15. Time Series-Health Indices 2010 15

16. Health Care Reform 16 Percent of responses by overall health index (April, 2009-May, 2010) * Includes “somewhat important” and “very important”

17. Health Care reform 17 Percent of responses by reform importance (April, 2009-May, 2010)

18. Summary/Discussion Results from an index of individual’s health experience that can be tracked over time Index reflects many of the demographic trends one might expect The future health cost concern index appears sensitive to the national health reform debate Health reform debate has not shifted confidence Benefits/costs may not be incorporated in responses since major impacts occur in 2014 (ie. pre-existing conditions not protected, impacts on quality) 18

19. Contact Information Peter Graven grave165@umn.edu State Health Access Data Assistance Center Health insurance coverage estimates are a click away at www.shadac.org/datacenter 19

20. Extra-Trends of Index Items 20

21. Extra-Trends of Health Reform 21

22. Extra-Reform Importance Change by Demographics

23. Longitudinal Analysis-4/2009-5/2010