The following tables present the unadjusted results and. regression results that underlie the results reported in

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1 Sinaiko AD, Ross-Degnan D, Soumerai SB, Lieu T, Galbraith A. The experience of Massachusetts shows that consumers need help in navidgating insurance exchanges. Health Aff (Millwood). 2013;32(1). Technical Appendix The following tables present the unadjusted results and regression results that underlie the results reported in the paper Consumer Experience in a Health Insurance Exchange: Evidence from Massachusetts.

2 Unadjusted, weighted frequencies

4 Logit regression results

Commonwealth Connector Health Insurance Survey Sponsored by the National Institutes of Health This survey is about the experiences of people and their families in Harvard Pilgrim health insurance

Your input will help us to make recommendations to improve health insurance and health care for people throughout the nation.

9 Commonwealth Connector Health Insurance Survey Sponsored by the National Institutes of Health This survey is about the experiences of people and their families in Harvard Pilgrim health insurance plans offered through the Commonwealth Connector. Your opinions are important. Your input will help us to make recommendations to improve health insurance and health care for people throughout the nation. Our records indicate that you have been enrolled in a Harvard Pilgrim health insurance plan from the Commonwealth Connector. We are interested in your experiences in the Harvard Pilgrim Connector plan, as well as the experiences of other family members who may be enrolled in this plan with you. 1. Are you currently enrolled in a Harvard Pilgrim health insurance plan from the Commonwealth Connector? Yes Continue with Question 2 on the next page No What was the main reason you disenrolled from this plan? (check one only) 1 The premium was too expensive 2 The deductibles and/or copays were too high 3 Wanted a better network of health care providers 4 Other insurance coverage became available 5 Employer changed plans or stopped offering coverage 6 Change in employment status 7 Moved out of state 8 Other (specify) Continue with Question 2 on the next page

10 PRIOR TO ENROLLING 2. Just before you enrolled in the Connector plan, what kind of insurance coverage did you have? (check all that apply) Uninsured Insurance from employer or union COBRA A different plan from the Commonwealth Connector Insurance purchased directly from a health plan or broker/agent MassHealth, Medicaid, Commonwealth Care Health Insurance Plan or some other public coverage Insurance through a business or professional association Other (specify) 3. Just before you enrolled in the Connector plan, what kind of insurance coverage did your spouse/partner have? (check all that apply) Not applicable (skip to Question 4) Uninsured Insurance from employer or union COBRA A different plan from the Commonwealth Connector Insurance purchased directly from a health plan or broker/agent MassHealth, Medicaid, Commonwealth Care Health Insurance Plan or some other public coverage Insurance through a business or professional association Other (specify) 4. Just before you enrolled in the Connector plan, what kind of insurance coverage did your children have? (check all that apply) Not applicable (skip to Question 5) Uninsured Insurance from employer or union COBRA A different plan from the Commonwealth Connector Insurance purchased directly from a health plan or broker/agent MassHealth, Medicaid, Commonwealth Care Health Insurance Plan or some other public coverage Insurance through a business or professional association Other (specify)

11 ENROLLING IN THE CONNECTOR PLAN When completing this section, please think about your experiences at the time you were deciding whether to enroll in the Harvard Pilgrim plan from the Commonwealth Connector (referred to below as the Connector plan or your plan ). 5. Were you considering other health plan options outside of the Connector? (check all that apply) Yes, a plan/plans from spouse/partner Yes, a plan/plans available directly from a health insurance plan Yes, a plan/plans available from a broker/agent Yes, COBRA Yes, a plan/plans from another source (specify) No 6. What sources did you use to get information about the Connector health plans? (check all that apply) Internet Print materials Broker/Agent Employer Friend/Family member Physician Social Worker Community service organization The Connector telephone line Other (specify) None

12 ENROLLING IN THE CONNECTOR PLAN 7. How strongly do you agree or disagree with the following statements about the time when you were deciding to enroll in the Connector plan? Strongly Agree Agree Disagree Strongly Disagree a. I would have had an easier time choosing a plan if there were fewer plans to choose from. b. It was hard to understand the information that was available about the different health plans. c. I was satisfied with the affordability of the plan. d. I was satisfied that I found a plan with the type of coverage I needed. e. I was able to get my questions about Connector plans answered. ENROLLIN G IN THE CONNECTOR PLAN 8. Did you have someone help you narrow down your choices to a few plans that were best for you? If yes: Who helped you narrow down your choices? (check all that apply) Broker/Agent Employer Friend/Family member Physician Social Worker Community service organization The Connector telephone line Other (specify) 2 No If no: Did you wish you had someone help you narrow down your choices? 2 No

13 ENROLLING IN THE CONNECTOR PLAN 9. When you were choosing your plan, did you estimate the amount you would have to pay out-of-pocket beyond the monthly premium under the different options available? 1 2 Yes No If yes: Did you compare the total costs among plans, including the estimated out-of-pocket cost and monthly premiums? 2 No 10. Which of the following were reasons you chose your plan? (Check all that apply) Good network of physicians and hospitals Network included a particular doctor Low out-of-pocket costs for services Lower cost of the premium Prior experience with this plan Specific benefits offered by the plan Plan s good reputation, recommended by others Other (specify) 11. Of these, which one was the most important reason you chose your plan? (check one only) 1 Good network of physicians and hospitals 2 Network included a particular doctor 3 Low out-of-pocket costs for services 4 Lower cost of the premium 5 Prior experience with this plan 6 Specific benefits offered by the plan 7 Plan s good reputation, recommended by others 8 Other (specify)

14 YOUR EXPERIENCE IN THE CONNECTOR PLAN When completing this section, please think about your experiences in the Connector plan during the past 12 months. If you are no longer enrolled in the Connector plan from Harvard Pilgrim, please think back to the last 12 months you were enrolled. 12. What is the amount that you pay out-of-pocket for the premium for this plan (not including any amount your employer contributes)? $ Is that payment 1 Weekly 2 Every two weeks 3 Twice a month 4 Monthly 5 Quarterly 6 Yearly 7 Other (specify) 13. Does your employer pay any part of the premium? 2 No 3 No, I am self-employed or the owner of a small business 4 No, I am not currently employed 14. How strongly do you agree or disagree with each of the following statements concerning the Connector plan? a. The plan is easy to understand 1 Strongly Agree 2 Agree 3 Disagree 4 Strongly Disagree b. The plan offers protection in the event of an expensive illness 1 Strongly Agree 2 Agree 3 Disagree 4 Strongly Disagree

15 YOUR EXPERIENCE IN THE CONNECTOR PLAN 15. Did your out-of-pocket costs in the Connector plan end up being as you expected? 2 No, actual costs were higher 3 No, actual costs were lower 16. During the last 12 months, were there times in the Connector plan when you had problems paying or were unable to pay any of your or your family s medical bills? 2 No 17. During the last 12 months in the Connector plan, did you: a. Have to set up a payment plan with a hospital or doctor's office? 2 No b. Have trouble paying for other basic bills like food, heat, or rent because of medical costs for you or a member of your family? 2 No c. Discuss the costs that you would have to pay for your care with your doctor? 2 No 3 Not applicable -- did not go to the doctor in the last 12 months d. Discuss the costs that you would have to pay for your child s health care with your child s doctor? 2 No 3 Not applicable -- no children in plan 4 Not applicable -- child did not go to the doctor in the last 12 months

16 ABOUT YOU AND YOUR FAMILY This next section asks about you and your family. 18. In general, how would you describe your health? 1 Excellent 2 Very good 3 Good 4 Fair 5 Poor 19. Do you or any of the adults in your plan have one of the conditions below, or another chronic condition? (Check all that apply) Abnormal uterine bleeding Arthritis Asthma Benign prostate enlargement Cancer Depression Diabetes Emphysema or lung disease Heart disease Hypertension or high blood pressure Other (write in): No chronic conditions 20. Do any of the children in your plan have one of the conditions below, or another chronic condition? (Check all that apply) No children in the plan (skip to question 22) Asthma Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder (ADHD/ADD) Developmental Delay Diabetes Depression, anxiety, an eating disorder, or other emotional problems Epilepsy or other seizure disorder Other (write in): No chronic conditions 21. Please answer the following question for each child enrolled in the Connector plan with you: In general, how would you describe your child s health? a. Child #1 Excellent Very Good Good Fair Poor b. Child #2 c. Child #3 d. Child #4 e. Child #5

17 ABOUT YOU AND YOUR FAMILY 22. Are you Spanish/Hispanic/Latino? 2 No 23. What is your race? (Check one or more races to indicate what you consider yourself to be.) White Black or African American American Indian or Alaska Native Asian or Pacific Islander Other (specify): 24. What language do you usually speak at home? If you speak more than one, which do you speak most of the time? 1 English 2 Spanish 3 Other (specify): 25. Including you, how many family members live in your household? (write in) 26. In 2009, approximately what was your family s total income from all sources, before taxes? 1 Less than $20,000 6 $60,000 to under $75,000 2 $20,000 to under $30,000 7 $75,000 to under $100,000 3 $30,000 to under $40,000 8 $100,000 to under $125, $40,000 to under $50,000 $125,000 to under $150,000 5 $50,000 to under $60, $150,000 or more 27. What is the highest degree or level of school you completed? 1 8 th grade or less 2 Some high school 3 High school graduate -- high school diploma or equivalent 4 Some college or technical school 5 Bachelor's degree 6 Postgraduate training or degree

19 CLAIMS PERMISSION We would like to obtain information from your family s health plan medical claims data for those members in the Harvard Pilgrim Connector plan. These claims are computerized data from Harvard Pilgrim Health Care that show what services your family has used in the past 12 months. The different types of information we would like to collect are claims for hospitalizations, emergency department visits, and outpatient visits, including diagnoses, and prescription medications. The only people who will have access to claims will be the research team. All identifying information, including your name, address and telephone number, will be removed and your information will be used only to come up with averages. 28. Do we have your permission to obtain information from your family s claims? 1 2 Yes No To thank you for your time, we would like to send you a $30 gift card to your choice of Target or CVS. Please check which one you would like. 1 Target 2 CVS The following information is needed to send you the gift card: Name: Street Address: City: State: Zip Code: THANK YOU! Please return this survey by September 30, 2010 using the envelope provided: Commonwealth Connector Survey [Address]

More Than One-Quarter of Insured Adults Were Underinsured in 2016

Exhibit 1 More Than One-Quarter of Insured Adults Were Underinsured in 216 Percent adults ages 19 64 insured all year who were underinsured* 28 22 23 23 2 12 13 1 23 25 21 212 214 216 * Underinsured defined