The Healing American Healthcare Survey

We are dedicated to providing objective analysis of current discussions on healthcare initiatives that impact the health and well-being of Americans today, and in the future. Your responses to this brief survey will ensure that the perspectives of American citizens are represented in our work.

All responses will be kept confidential. Information gathered in this survey will be reported in aggregate form only.

Thank you for participating!

Email address *

Do you have health insurance? *

Employer-based plan

Obamacare plan

Personal private insurance

Parents' insurance plan

Short-term non-Obamacare coverage

Original Medicare

Medicare Advantage

Medicaid

I do not have health insurance

What would make your insurance plan better? (Check all that apply.) *

I am happy with my plan as it is

Lower cost premiums

Lower deductible

Expanded network of providers (doctors, hospitals and pharmacies)

Reduce the cost of my medications

Reduce copays

Eliminate pre-authorizations

Other:

Required

If you DO NOT have health insurance, please tell us why. *

I have health insurance

Health insurance is too expensive

My employer does not provide health insurance

I am not a U.S. citizen

I do not want health insurance at this time

I do not wish to answer this question

Please share with us your age. *

26 or younger

27 to 35

36 to 45

46 to 55

56 to 65

Over 65

I do not wish to answer this question

How would you classify yourself?

African-American

Caucasian

Native American

Hispanic/Latino

Asian-American

Other

I do not wish to answer this question

Clear selection

Please share with us your family income. *

Below $25,000

$25,001 to $50,000

$50,001 to $100,000

$100,001 to $150,000

$150,001 to $200,000

$200,001 to $250,000

$250,000+

I do not wish to answer this question

Would you support a public option for healthcare insurance that is based on Medicare if it was something you could choose? *

Yes

Would you like to receive a copy of the report that is prepared as a result of this survey?

Yes

Clear selection

Never submit passwords through Google Forms.

This form was created inside of silverliningcomm.com.

Forms