Are you or your family members planning on getting health insurance?

Starting in 2014, most Americans will be required to have health insurance or pay a penalty. We want to hear from people who don't have health insurance about what they plan to do.

* indicates required field

First Name *

Last Name *

City

Postal Code *

E-mail *

Phone *

Which of the following describes you and your immediate family?

We all have health insurance.
I am insured, but I have family members who are uninsured.
We are all uninsured.

Please tell us a little about the uninsured members of your family: age, reason for not having insurance, etc.

If you or your family members are uninsured, what are you planning to do about health insurance in 2014?

What else should we know about the decision to get insurance?

Now, a few questions to help us better understand your perspective.

In what year were you born?

What do you do for work?

Your Information

By completing this form, you become part of American Public Media's Public Insight Network (PIN). Minnesota Public Radio, American Public Media and any other PIN newsroom listed on this form may contact you for help with current and future news coverage.

This submission may be shared with journalists at Minnesota Public Radio, American Public Media and other news organizations collaborating on reporting. It will not be used for marketing or fundraising purposes, and we will never quote you without first getting your explicit permission.

If you give us permission to publish your submission, we may edit before sharing it on-air, in print or online. We reserve the right to reuse or republish your submission, or to withhold your submission from publication. You must be 13 years or older to provide a submission.

About the Public Insight Network

Founded in 2003, American Public Media's Public Insight Network is a platform for connecting trusted journalists with knowledgeable sources and for fostering journalistic excellence, innovation and collaboration. Learn more »

Through American Public Media, you may have opportunities to also inform reporting for Marketplace, Marketplace Money, On Being, American RadioWorks and other partner newsrooms.