Member Survey: Healthcare Costs (Coalition)

NJ Public Sector Worker Survey: Healthcare Costs
How concerned are you about the cost of your healthcare?*

Not concerned at allA little concernedConcernedVery concerned
Do rising healthcare premiums and out of pocket costs impact your ability to afford basic needs like groceries, housing, childcare or utilities?*

No impactA little impactSome impactHuge impact
Have you ever considered any of the following due to rising healthcare premiums?

Leaving the public sectorTaking a demotionMoving out of stateWaiving health insurance and being covered under a spouse’s planOther

How worried, if at all, are you about being able to afford each of the following for you and your family?*

	Not at all worried	Somewhat worried	Very worried
The cost of healthcare services
Your monthly healthcare premium
Gasoline and other transportation costs
Your monthly utilities like electricity and heat
Food
Debt
Rent/Mortgage
Childcare

How have rising healthcare premiums impacted you?
Would you be willing to record your story to share with elected officials and the public on why we must reform healthcare?

Yes, in writing to be shared on social media or in a report to elected officialsYes, in a video to be shared on social mediaYes, speaking with press or signing on to an Op-EdMaybe; I'd like to talk some more about itNo, please don't share my story
First Name
Last Name
Your Union
Email (please use your personal email if possible)
example@example.com
Employer
How long have you worked for that employer?
Should be Empty:

NJ Public Sector Worker Survey: Healthcare Costs