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0%
 
 
What type of health insurance do you currently have for you and/or your family?
 
No coverage
 
coverage for children only
 
catastrophic coverage only
 
minimal coverage (high copay/deductible)
 
full coverage (low or no copay/deductible)
 
 

What is your main reason for choosing the insurance you currently have?
 
Cost of insurance
 
Healthy lifestyle
 
Annual salary
 
Chose not to have insurance
 
Unsure of different types of insurance
 
 

On a monthly basis, at what cost are you willing to spend for health insurance?
 
$0 to $250
 
$251 to $500
 
$501 to $750
 
$751 to $1000
 
$1001 or more
 
 

A national health insurance, same cost for same coverage, would make you change your thought process about the amount insurance your currently have.
 
Strongly agree
 
Agree
 
Neutral
 
Disagree
 
Strongly disagree
 
 

What is your current household size?
 
1 to 2
 
3 to 5
 
6 to 7
 
8 to 10
 
 

Of your current household, how many have health insurance?
 
0
 
1 to 2
 
3 to 4
 
5 to 6
 
7 to 10
 
 

What is your current household income?
 
$0 to $15,000
 
$15,001 to $30,000
 
$30,001 to $45,000
 
$45,001 to $60,000
 
$60,001 or >
 
 
 
Additional Comments/Suggestions for improvement
   
 
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