The Health and Wealth of a Nation: Employer-Based Health insurance and the Affordable Care Act

Appendix A: The California Health and Employment Surveys

147 Appendix A The California Health and Employment Surveys 148 Maxwell Survey Number___________ SC-1 Health and Employment Survey Hello. My name is and I am calling from the HIRE Center at Cal State, East Bay. The Upjohn Institute has funded us to conduct academic research on benefits offered to workers in California firms. I have just a few questions I would like to ask you. Are you the person with knowledge about benefits and jobs in your firm? (If not, could I talk with someone like the Business Manager or Human Resources Officer that could answer these questions?) The questions will only take about 10 to 15 minutes and all information will be strictly confidential. Do you have some time now to help us out with our research? Your participation is strictly voluntary and you can terminate the survey process at any point. Neither you nor your firm will be identified in any reporting of data. Any responses given will be aggregated for reporting purposes only. TIME: (military) Began: Ended: Date: Surveyor: County: First, I’d like to verify your contact information so we can thank you for participating in our survey. Phone number: NAICS code (if blank ask what firm does): Firm name: Address: Street: City, state, and zip code: Respondent: Position: Screening questions: I’d like to ask you a couple questions to see if you fit into our sampling frame. Sc1: Are you a for-profit or nonprofit company? (Check which.)  For profit  Nonprofit [501(c)(3)]  Government (federal, state, city, county) END SURVEY  Other: (verify eligibility before proceeding) Sc2: How many workers are there at THIS location?  1–4 (END SURVEY)  5–9  10–19  20–50  51–99  100–299  300–499  500–999  1,000+ Sc3: Does your firm operate at more than one location?  Yes  No (Start survey) Sc3A: Are the locations . . . ?  Multinational  National  Regional (western U.S.)  California  Local (northern CA)  Other: Sc3B: Are benefits set at the central location or at your location?  Central location  Respondent location  Respondent location is central  Other (specify): Sc3C: How many workers are at ALL locations? (Count all workers including part-time/full-time, temporary/ permanent, that are paid by the firm.)  1–4 (END SURVEY)  5–9  10–19  20–50  51–99  100–299  300–499  500–999  1000–1999  2000–4999  5000–9999  10,000+ Verify need before proceeding Type firm: (base on who sets benefits)  Small (5–50)  Large (51+) Appendix A 149 Survey Number___________ SC-2 Call Log Date and time: Notes (e.g., reason not surveyed, when to call back) SURVEYOR NOTES: After survey has been disposed of: Circle disposition code 1. Survey complete 2. Refusal 3. Left 15 or more messages 4. Quota met 5. Other, specify: Complete Information about the Respondent and Survey About the: Gender: Perceived accuracy of survey responses: respondent  Male  Female  Accurate  Some inaccuracies (explain) About the survey: Attempts before surveyed: Minutes: Comments: Sign-off initials: Surveyor: Lead surveyor: Field check: Occupational coding: Data entry: 150 Maxwell Survey Number___________ 1 Section A: Benefits. We would like to ask you some questions about the benefits you offer workers beyond those mandated by the government. Please answer yes if your firm offers the benefit or no if it does not. Does your firm offer workers . . . ? 1. Paid vacation  Yes  No  DK 2. Paid holidays  Yes  No  DK 3. Paid sick leave  Yes  No  DK 4. Flexible hours  Yes  No  DK 5. Shift differentials or premium pay (include dangerous, dirty, and hazardous pay)  Yes  No  DK 6. Nonproduction bonuses (e.g., lump-sum payments, referral bonuses)  Yes  No  DK 7. Severance pay (where needed)  Yes  No  DK 8. Supplemental unemployment plans  Yes  No  DK 9. Life insurance  Yes  No  DK 10. Long-term disability insurance  Yes  No  DK 11. Defined benefit retirement  Yes  No  DK 12. Defined contribution retirement  Yes  No  DK 13. Retiree health coverage (including Supplemental Health Insurance)  Yes  No  DK 13a. (If yes) Does the plan cover workers under age 65?  Yes  No  DK 14. Formal job training (e.g., classes)  Yes  No  DK 15. Financial assistance for education  Yes  No  DK 16. Financial assistance for child care  Yes  No  DK 17. Cafeteria plans in benefit selection (aka Section 125 plans)  Yes  No  DK 17a. (If yes) Is health insurance an option under your cafeteria plan?  Yes  No  DK 18. Does your firm offer health benefits?  Yes  No  DK 18a. (If yes...