CHIS (new) The following questions are on CHIS The data below is from CHIS 2013 (n=20,724).

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1 This document gives a brief overview of questions on CHIS It is split into three sections: (1) new questions on CHIS and (2) new or modified for CHIS 2014 and (3) other questions relevant to healthcare reform CHIS (new) The following questions are on CHIS The data below is from CHIS 2013 (n=20,724). Visits to the medical doctor (ADULT) QA13_J3 About how long has it been since you last saw a doctor or medical provider for a routine check-up? [IF NEEDED: A routine check-up is a visit not for an illness or problem. This visit may include questions about health behaviors such as smoking.] LAST SAW DR FOR ROUTINE CHECK-UP AJ114 Frequency Percent DK REFUSED INAPPLICABLE ONE YEAR AGO OR LESS MORE THAN 1 UP TO 2 YEARS AGO MORE THAN 2 UP TO 5 YEARS AGO MORE THAN 5 YEARS AGO NEVER Delays in care (ADULT) QA13_J25 QA13_J26 During the past 12 months, did you delay or not get any other medical care you felt you needed such as seeing a doctor, a specialist, or other health professional? (This question was not new for , it s included to provide context for the following question.) Did you get the care eventually? GOT DELAYED MEDICAL CARE EVENTUALLY AJ129 Frequency Percent DK INAPPLICABLE YES NO

2 The next questions ask about specialists. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and others who specialize in one area of health care. QA13_J33 In the past12 months, did you or a doctor think you needed to see a medical specialist? [IF NEEDED: Do not include dental visits.] NEED TO SEE MED SPECIALIST PAST 12 MOS AJ136 Frequency Percent DK REFUSED YES NO QA13_J34 During the past 12 months, did you have any trouble finding a medical specialist who would see you? TROUBLE FINDING SPECIALTY DR PAST 12 MOS AJ137 Frequency Percent DK REFUSED INAPPLICABLE YES NO QA13_J35 During the past 12 months, did a medical specialist s office tell you that they would not take you as a new patient? DR NOT ACCEPT R NEW PATIENT PAST 12 MOS AJ138 Frequency Percent DK REFUSED INAPPLICABLE YES NO QA13_J36 During the past 12 months, did a medical specialist s office tell you that they did not take your main health insurance? DR NOT ACCEPT R'S INS PAST 12 MOS AJ139 Frequency Percent NOT ASCERTAINED 1 0 DK REFUSED INAPPLICABLE YES NO

3 QA13_J37 Now think about general doctors. During the past 12 months, did you have any trouble finding a general doctor who would see you? TROUBLE FINDING GENERAL DR PAST 12 MOS AJ133 Frequency Percent DK REFUSED YES NO QA13_J38 During the past 12 months, did a doctor s office tell you that they would not take you as a new patient? DR NOT ACCEPT R NEW PATIENT PAST 12 MOS AJ134 Frequency Percent DK REFUSED YES NO QA13_J39 During the past 12 months, did a doctor s office tell you that they would not take your main health insurance? DR NOT ACCEPT R'S INSR PAST 12 MOS AJ135 Frequency Percent NOT ASCERTAINED DK REFUSED INAPPLICABLE YES NO

4 Dental health (ADULT) QA13_J51 These next questions are about dental health. About how long has it been since you visited a dentist or dental clinic? Include hygienists and all types of dental specialists. HOW LONG SINCE LAST VISIT TO DENTIST AG1 Frequency Percent NOT ASCERTAINED 1 0 DON'T KNOW REFUSED HAS NEVER VISITED MONTHS AGO OR LESS MORE THAN 6 MONTHS UP TO 1 YEAR AGO MORE THAN 1 YEAR UP TO 2 YEARS AGO MORE THAN 2 YEARS UP TO 5 YEARS AGO MORE THAN 5 YEARS AGO QA13_J52 Do you now have any type of insurance that pays for part or all of your dental care? HAVE ANY KIND OF DENTAL INSURANCE AG3 Frequency Percent NOT ASCERTAINED 1 0 DK REFUSED YES NO Dental health (TEEN) QA13_J53 Do you now have any type of insurance that pays for part or all of (TEEN) dental care? TEEN HAS DENTAL INSURANCE MA10 Frequency Percent DK REFUSED INAPPLICABLE YES NO Dental health (CHILD) QC13_B4 Do you now have any type of insurance that pays for part or all of your child s dental care? [IF NEEDED: Include dental insurance, prepaid dental plans such as HMOs, or government plans such as Medi-Cal or Healthy Families]

5 HAS INSURANCE FOR CHILD S DENTAL CARE Frequency Percent DK REFUSED INAPPLICABLE YES NO CHIS 2014 (new or modified) The following questions were either new or modified for CHIS The data below is from CHIS 2014 (n=2,298). Private Coverage (ADULT) The following question was asked to respondents who reported no coverage from Medi-Care, Medi-Cal, Healthy Families, or employer. QA13_H18 Are you covered by a health insurance plan that you purchased directly from an insurance company or HMO, or through Covered California? Modified for CHIS 2014 (Covered CA added) COVERED BY DIRECT PURCHASE INSURANCE AI11 Frequency Percent DK REFUSED INAPPLICABLE YES NO If the respondent answered yes, the respondent was asked how this plan was purchased. QA13_H19 How did you purchase this health insurance directly from an insurance company or HMO, or through Covered California? New for CHIS 2014 PURCHASE INS DIRECT OR THRU COVERED CALI AH104 Frequency Percent DK INAPPLICABLE INSURANCE COMPANY OR HMO COVERED CALIFORNIA OTHER

6 The following question was asked to respondents who have employer-based insurance and work for a company with at least 100 employees. QA13_H22 How did {you/he or she} sign up for this health insurance through an employer, through a union, or through Covered California s SHOP program? CHIS 2014 [IF NEEDED, SAY: SHOP is the Small Business Health Options Program administered by Covered California ] GET INS THRU EMPLOYER,UNION,SHOP PROGRAM AH105 Frequency Percent DK REFUSED INAPPLICABLE EMPLOYER UNION SHOP/COVERED CALIFORNIA OTHER The following question was asked to respondents who reported using Covered California, by either directing purchasing a plan (n=66) or signing up through SHOP (n=8). QA13_H23 Was this a bronze, silver, gold or platinum plan? CHIS 2014 PURCHASE BRONZE,SLIVER,GOLD,PLATINUM PLA AH106 Frequency Percent DK INAPPLICABLE BRONZE SILVER GOLD PLATINUM MEDI-CAL / MEDICAID OTHER QA13_H24 Was there a subsidy or discount on the premium for this plan? CHIS 2014 GET SUBSIDY/DISCOUNT ON PLAN PREMIUM AH107 Frequency Percent DK INAPPLICABLE YES NO The following was asked to respondents who reported signing up though Covered California s SHOP program and have a spouse or partner.

7 QA13_H47 You said you have health insurance through Covered California s SHOP program. Is (SPOUSE/PARTNER) {also} covered by this health insurance? CHIS 2014 SPOUSE COVERED BY INS THRU SHOP PGM AH108 Frequency Percent INAPPLICABLE YES The following was asked to respondents who purchased directly from Covered California and have a spouse or partner. QA13_H50 You said you have a plan you purchased directly from Covered California. Is (SPOUSE/PARTNER) {also} covered by this plan? CHIS 2014 SPOUSE COVERED BY COVERED CALIFORNIA AH109 Frequency Percent INAPPLICABLE YES NO The following was asked to respondents who have insurance and are not covered by Medi-Cal. QA13_H63B Is your health plan a PPO or EPO? CHIS 2014 [IF NEEDED, SAY: EPO stands for Exclusive Provider Organization. With an EPO, you must use the in-network doctors and hospitals, unless it s an emergency and you can access doctors and specialists directly without a referral from your primary care provider.] [IF NEEDED, SAY: PPO stand for Preferred Provider Organization. With a PPO, you can use any doctors and hospitals, but you pay less if you use doctors and hospitals that belong to your plan s network. Also, you can access doctors and specialists directly without a referral from your primary care provider.] [IF R HAS MORE THAN ONE HEALTH PLAN, SAY: Your MAIN health plan. ] IS HEALTH PLAN A PPO OR EPO AH122 Frequency Percent DK INAPPLICABLE YES NO OTHER (DATA TO BE CLEANED)

8 Lack of Coverage and Coverage over past 12 months (ADULT) The following questions were asked to those who had no coverage at the time of the survey, but reported having coverage at some point in the past 12 months. QA13_H83 During that time when you had health insurance, was your insurance Medi-CAL, Healthy Families, a plan you obtained from an employer, a plan you purchased directly from an insurance company, a plan you purchased through Covered California, or some other plan? Modified for CHIS 2014 (Covered CA added) [CODE ALL THAT APPLY] [PROBE: "Any others?"] MOS HAD INSURANCE: MEDI-CAL AI30_1 Frequency Percent INAPPLICABLE YES NO MOS HAD INSURANCE: HEALTHY FAMILIES AI30_2 Frequency Percent INAPPLICABLE YES NO MOS HAD INSURANCE: EMPLOYER/UNION AI30_3 Frequency Percent INAPPLICABLE YES NO MOS HAD INSURANCE: OTHER HEALTH PLAN AI30_4 Frequency Percent INAPPLICABLE YES NO MOS HAD INSURANCE: HEALTHY KIDS AI30_5 Frequency Percent INAPPLICABLE NO 23 1 MOS HAD INSURANCE: PURCHASED DIRECTLY AI30_6 Frequency Percent INAPPLICABLE NO 23 1 MOS HAD INSURANCE: COVERED CALIFORNIA AI30_7 Frequency Percent INAPPLICABLE NO QA13_H84 In the past 12 months, did you try to purchase a health insurance plan directly from an insurance company or HMO, or through Covered California? Modified for CHIS 2014 (Covered CA added) PAST 12 MOS TRY BUY HEALTH PLAN DIRECTLY AH103 Frequency Percent DK REFUSED INAPPLICABLE YES NO

9 QA13_H85 Was that directly from an insurance company or HMO, or through Covered California, or both from an insurance company and through Covered California? CHIS 2014 PURCHASE INS DIRECT OR THRU COVERED CALI AH104 Frequency Percent DK INAPPLICABLE INSURANCE COMPANY OR HMO COVERED CALIFORNIA OTHER The following questions were asked to respondents who reported no coverage or changes in coverage in the past 12 months and who tried purchasing insurance directly from an insurance company or HMO. QA13_H86 {First, think about your experience trying to purchase insurance directly from an insurance company or HMO.} Modified for CHIS 2014 How difficult was it to find a plan with the coverage you needed? Was it FIND PLAN WITH NEEDED COVERAGE AH98 Frequency Percent INAPPLICABLE VERY DIFFICULT SOMEWHAT DIFFICULT NOT TOO DIFFICULT NOT AT ALL DIFFICULT QA13_H87 How difficult was it to find a plan you could afford? Was it AH99 FIND PLAN COULD AFFORD AH99 Frequency Percent INAPPLICABLE VERY DIFFICULT SOMEWHAT DIFFICULT NOT TOO DIFFICULT NOT AT ALL DIFFICULT QA13_H88 Did anyone help you find a health plan? ANYONE HELP R FIND HEALTH PLAN AH100 Frequency Percent INAPPLICABLE YES NO

10 QA13_H89 Who helped you? WHO HELPED R FIND HEALTH PLAN AH101 Frequency Percent INAPPLICABLE BROKER 23 1 FAMILY MEMBER/FRIEND OTHER, SPECIFY The following questions were asked to respondents who reported no coverage or changes in coverage in the past 12 months and who tried purchasing a plan through Covered California. QA13_H90 {Now, think about your experience with Covered California.} How difficult was it to find a plan with the coverage you needed through Covered California? Was it CHIS 2014 FIND PLAN WITH NEEDED COVERAGE-COVRD CA AH111 Frequency Percent DK INAPPLICABLE VERY DIFFICULT SOMEWHAT DIFFICULT NOT TOO DIFFICULT NOT AT ALL DIFFICULT QA13_H91 How difficult was it to find a plan you could afford? Was it CHIS 2014 FIND PLAN COULD AFFORD-COVRD CA AH112 Frequency Percent DK INAPPLICABLE VERY DIFFICULT SOMEWHAT DIFFICULT NOT TOO DIFFICULT NOT AT ALL DIFFICULT 23 1 QA13_H92 Did anyone help you find a health plan? CHIS 2014 ANYONE HELP R FIND HEALTH PLAN-COVRD CA AH113 Frequency Percent DK INAPPLICABLE YES NO

11 QA13_H93 Who helped you? CHIS 2014 WHO HELPED R FIND HEALTH PLAN-COVRD CA AH114 Frequency Percent INAPPLICABLE BROKER FAMILY MEMBER/FRIEND CERTIFIED ENROLLMENT COUNSELOR OTHER, SPECIFY The following question was asked to respondents who tried purchasing insurance directly from an insurance company or HMO or through Covered California. QA13_H94 Did you have all the information you felt you needed to make a good decision on a health plan? CHIS 2014 HAD NEEDED INFO TO PICK HEALTH PLAN AH115 Frequency Percent DK INAPPLICABLE YES NO 23 1 The following question was asked to respondents who reported speaking English less than very well. QA13_H95 Were you able to get information about your health plan options in your language? CHIS 2014 GOT HEALTH PLAN OPTIONS IN OWN LANGUAGE AH116 Frequency Percent INAPPLICABLE YES NO QA13_H96 Was the cost of the plan you selected very important, somewhat important, or not important in choosing your plan? CHIS 2014 COST OF SELECTED PLAN IMPORTANT AH117 Frequency Percent DK INAPPLICABLE VERY IMPORTANT SOMEWHAT IMPORTANT NOT IMPORTANT QA13_H97 Was getting care from a specific doctor very important, somewhat important, or not important in choosing your plan? CHIS 2014

12 CARE FROM SPECIFIC DOCTOR IMPORTANT AH118 Frequency Percent DK INAPPLICABLE VERY IMPORTANT SOMEWHAT IMPORTANT NOT IMPORTANT QA13_H98 Was getting care from a specific hospital very important, somewhat important, or not important in choosing your plan? CHIS 2014 CARE FROM SPECIFIC HOSPITAL IMPORTANT AH119 Frequency Percent DK INAPPLICABLE VERY IMPORTANT SOMEWHAT IMPORTANT NOT IMPORTANT QA13_H99 Was the choice of doctor s in the plan s network very important, somewhat important, or not important in choosing your plan? CHIS 2014 CHOICE OF DOCTORS IMPORTANT AH120 Frequency Percent DK INAPPLICABLE VERY IMPORTANT SOMEWHAT IMPORTANT NOT IMPORTANT QA13_H100 Finally, what was the most important reason you chose your {Bronze/Silver/Gold/Platinum/ } plan? Was it the cost, that you could get care from a specific doctor, that you could go to a certain hospital, the choice of providers in your plan s network, or was it something else? CHIS 2014 MOST IMPORTANT REASON CHOSE PLAN AH121 Frequency Percent DK INAPPLICABLE COST SPECIFIC DOCTOR SPECIFIC HOSPITAL CHOICE OF DOCTORS IN NETWORK OTHER

13 Private Coverage (CHILD) answered by a parent or guardian The following questions were for children who have a health insurance plan or HMO through someone s employment or union. QA13_I6 Is this plan through an employer, through a union, or through Covered California s SHOP program? Modified for CHIS 2014 (Covered CA added) If the plan was through Covered California, the following questions were asked: QA13_I7 QA13_I8 Is (CHILD) covered by a health insurance plan that you purchased directly from an insurance company or HMO, or through Covered California? Modified for CHIS 2014 (Covered CA added) How did you purchase this health insurance directly from an insurance company or HMO, or through Covered California? CHIS 2014 QA13_I9 Was this a bronze, silver, gold or platinum plan? CHIS 2014 The following was asked if the child had non-medi-cal health coverage. QA13_I22B Is (CHILD) s health plan a PPO or EPO? CHIS 2014 [IF NEEDED, SAY: EPO stands for Exclusive Provider Organization. With an EPO, you must use the in-network doctors and hospitals, unless it s an emergency and you can access doctors and specialists directly without a referral from your primary care provider.] [IF NEEDED, SAY: PPO stand for Preferred Provider Organization. With a PPO, you can use any doctors and hospitals, but you pay less if you use doctors and hospitals that belong to your plan s network. Also, you can access doctors and specialists directly without a referral from your primary care provider.] [IF R HAS MORE THAN ONE HEALTH PLAN, SAY: Your MAIN health plan. ] The following question was asked to children who did not have coverage at the time of the survey, but reported some type of coverage in the past 12 months. QA13_I34 During that time when (CHILD) had health insurance, was {his/her} insurance Medi-CAL, Healthy Families, a plan you obtained through an employer, a plan you purchased directly from an insurance company, a plan you purchased through Covered California, or some other plan? Modified for CHIS 2014 (Insurance company and Covered CA added) The following question was asked for children who reported not having the same coverage for all of the past 12 months. QA13_I37 Was this other health insurance Medi-CAL, Healthy Families, a plan you obtained from an employer, a plan you purchased directly from an insurance company, a plan you purchased through Covered California, or some other plan? Modified for CHIS 2014 (Insurance company and Covered CA added) [CODE ALL THAT APPLY] [PROBE: "Any others?" Private Coverage (TEEN) answered by a parent or guardian The following question was asked for teens who had a health insurance plan or HMO through someone else s employment or union. QA13_I47 Is this plan through an employer, through a union, or through Covered California s SHOP program? CHIS 2014

14 The following question was asked for teens who had an insurance plan purchased directly from an insurance company or HMO. QA13_I49 How did you purchase this health insurance directly from an insurance company or HMO, or through Covered California? CHIS 2014 The following question was asked for teens who had an insurance plan purchased directly through Covered California. QA13_I50 Was this a bronze, silver, gold or platinum plan? CHIS 2014 QA13_I51 Was there a subsidy or discount on the premium for this plan? CHIS 2014 The following was asked for teens who had coverage that was not Medi-Cal. QA13_I62B Is (TEEN) s health plan a PPO or EPO? CHIS 2014 [IF NEEDED, SAY: EPO stands for Exclusive Provider Organization. With an EPO, you must use the in-network doctors and hospitals, unless it s an emergency and you can access doctors and specialists directly without a referral from your primary care provider.] [IF NEEDED, SAY: PPO stand for Preferred Provider Organization. With a PPO, you can use any doctors and hospitals, but you pay less if you use doctors and hospitals that belong to your plan s network. Also, you can access doctors and specialists directly without a referral from your primary care provider.] [IF R HAS MORE THAN ONE HEALTH PLAN, SAY: Your MAIN health plan. ] QA13_I74 During that time when (TEEN) had health insurance, was {his/her} insurance Medi-CAL, Healthy Families, a plan you obtained through an employer, a plan you purchased directly from an insurance company, a plan you purchased through Covered California, or some other plan? Modified for CHIS 2014 (Insurance company and Covered CA added) [CODE ALL THAT APPLY.][PROBE: "Any others?"] The following questions were asked for teens who had no coverage at the time of the survey or had changes in coverage in the past 12 months. QA13_I81 QA13_I82 In the past 12 months, did you try to purchase a health insurance plan directly from an insurance company or HMO, or through Covered California? CHIS 2014 Was that directly from an insurance company or HMO, or through Covered California, or both from an insurance company and through Covered California? CHIS 2014 The following questions were asked for teens who had no coverage at the time of the survey or had changes in coverage in the past 12 months and tried to purchase insurance directly through an insurance company or HMO. QA13_I83 {First, think about your experience trying to purchase insurance directly from an insurance company or HMO.} How difficult was it to find a plan with the coverage you needed? Was it CHIS 2014 QA13_I84 How difficult was it to find a plan you could afford? Was it CHIS 2014 QA13_I85 Did anyone help you find a health plan? CHIS 2014 QA13_I86 Who helped you? CHIS 2014 The following questions were asked for teens who had no coverage at the time of the survey or had changes in coverage in the past 12 months and tried to purchase insurance directly through Covered California.

15 QA13_ I87 {Now, think about your experience with Covered California.} How difficult was it to find a plan with the coverage you needed through Covered California? Was it CHIS 2014 QA13_I88 How difficult was it to find a plan you could afford? Was it CHIS 2014 QA13_I89 Did anyone help you find a health plan? CHIS 2014 QA13_I90 Who helped you? CHIS 2014 QA13_I91 Did you have all the information you felt you needed to make a good decision on a health plan? CHIS 2014 QA13_I92 Were you able to get information about your health plan options in your language? CHIS 2014 QA13_I93 QA13_I94 QA13_I95 QA13_I96 QA13_I97 Was the cost of the plan you selected very important, somewhat important, or not important in choosing your plan? CHIS 2014 Was getting care from a specific doctor very important, somewhat important, or not important in choosing your plan? CHIS 2014 Was getting care from a specific hospital very important, somewhat important, or not important in choosing your plan? CHIS 2014 Was the choice of doctor s in the plan s network very important, somewhat important, or not important in choosing your plan? CHIS 2014 Finally, what was the most important reason you chose your {Bronze/Silver/Gold/Platinum/ } plan? Was it the cost, that you could get care from a specific doctor, that you could go to a certain hospital, the choice of providers in your plan s network, or was it something else? CHIS 2014

16 CHIS Other questions (not new or modified) Reasons for Lack of Coverage QA13_H76 QA13_H77 QA13_H78 What is the ONE MAIN reason why you did not have any health insurance during those months? During the time that you were uninsured, did you try to find health insurance on your own? What is the ONE MAIN reason why you do not have any health insurance? Prescription drug coverage (ADULT, TEEN, CHILD) QA13_H65 {Next, I have some questions about your own main health plan.} Are you covered for your prescription drugs? That is, does some plan pay any part of the cost? Premiums (ADULT, TEEN, CHILD) QA13_H25 Do you pay any or all of the premium or cost for this health plan? Do not include the cost of any co-pays or deductibles you or your family may have had to pay. [IF NEEDED, SAY: "Copays are the partial payments you make for your health care each time you see a doctor or use the health care system, while a health plan pays for your main health care coverage." "A deductible is the amount you pay for medical care before your health plan starts paying." "Premium is the monthly charge for the cost of your health insurance plan."] QA13_H26 Does anyone else, such as an employer, a union, or professional organization pay all or some portion of the premium or cost for this health plan? Timely Appointments (ADULT, TEEN, CHILD) QA13_J9 QA13_J10 In the past 12 months, did you try to get an appointment to see {your/a} doctor or medical provider within two days because you were sick or injured? How often were you able to get an appointment within two days? Would you say (Never, Sometimes, Usually, or Always) High Deductible Health Plans (ADULT, TEEN, CHILD) QA13_H66 Does your health plan have a deductible that is more than $1,000? [IF NEEDED, SAY: A deductible is the amount you have to pay before your plan begins to pay for your medical care. ] QA13_H67 Does your health plan have a deductible that is more than $2,000? QA13_H68 Does your health plan have a deductible for all covered persons that is more than $2,000? QA13_H69 Does your health plan have a deductible for all covered persons that is more than $4,000? Policy holder (ADULT, TEEN, CHILD) QA13_H20 QA13_H21 Was this plan obtained in your own name or in the name of someone else? [IF NEEDED, SAY: Even someone who does not live in this household. ] Is the plan in your {spouse s name,} {partner s name,} {parent s name,} or someone else s name?

17 Changes in usual source of care QA13_J18 QA13_J19 In the past 12 months, did you change where you usually go for health care? Did you have to change because of your health insurance plan?