Why no health insurance? A summary of focus groups with individuals, small-business employers, and health-insurance representatives in Alaska

Objective: To understand perceptions of, and barriers to, health-insurance coverage from specific groups of Alaskans who are likely to have sporadic or no health insurance. These groups included the uninsured and sporadically insured; those employed in specified sectors such as tourism or fishing; members of certain racial, cultural, ethnic, and geographic groups; and small-business employers, who may or may not offer health insurance to employees.

Methodology: Methods to recruit participants included: face-to-face recruitment at shelters and clinics, newspaper ads, fliers, messages sent via e-mail list servers, radio station announcements, and word-of-mouth. A demographic-screening questionnaire was administered by phone prior to the focus groups to select a cross-section of participants willing to share their experiences and opinions related to health insurance. Participants completed an insurance and employment questionnaire prior to the start of the focus group.

Eighty-nine people, ages 18 to 64, participated in the 11 focus groups held with individuals; 73% did not have insurance. Thirty-one participants attended the three focus groups for Alaska Natives and 61% did not have health insurance. Thirty-one small-business employers with 2 to 50 employees participated in four groups; 27% of employers offered insurance to their employees. The final group consisted of eight businesses that sell health-insurance products.

Themes: The role of employer-sponsored health insurance is a key topic in current discussions about health care and the uninsured in the U.S. Only a third of Alaska businesses with fewer than 50 employees offer coverage, compared with 43% nationwide. Alaska has the largest seasonal variation in workers anywhere in the U.S. with the peak in July nearly 25% above winter levels. The workers who fill seasonal jobs are essential to the state's economy. Yet this variation creates difficulties for both employees and employers. Seasonal workers often don't have insurance, or they lose it when the job ends.

Most uninsured Alaskans are working, and many are working for employers who would like, but cannot necessarily afford, to provide insurance coverage. Seasonal variations in employment, fluctuating incomes, and pre-existing health conditions make it nearly impossible for uninsured Alaskans to afford private insurance. They are grateful for public programs that help provide coverage because the choices they have for medical care are limited.