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Cost, Not Indifference, Could Be Obstacle to Health Law Coverage Gains

By John Reichard, CQ HealthBeat Editor

May 29, 2014 -- New research on the early consumer experience with the health law's insurance exchanges sends a mixed message about the new marketplaces. Many buyers are pleased with their new coverage but concerns about coverage costs are keeping many of the uninsured from opting in.

However, the research also suggests at least the possibility that once their gaps in knowledge about the health law are filled, more uninsured people, especially younger ones, could sign up for coverage in 2015.

Two surveys looked into the insurance buying experience. One was released last week by Enroll America, a nonprofit formed to boost enrollment under the health law (PL 111-148, PL 111-152). The other was released by the Deloitte Center for Health Solutions, a consulting firm.

The Enroll America survey found that 41 percent were either very happy (20 percent) or somewhat happy (21 percent) with their new coverage. By comparison, 11 percent were either somewhat unhappy (7 percent) or very unhappy (4 percent). About half either had no particular reaction to their new coverage or said it was too soon to tell.

Funded by the Robert Wood Johnson Foundation and the California Endowment, the poll surveyed 671 newly enrolled individuals and 853 who remained uninsured. It was conducted by the PerryUndem research firm from April 10 to April 28.

Asked what best describes what it feels like to have health insurance, 47 percent said "relieved" while 12 percent said "financially stressed."

The survey also found that 74 percent of those who had signed up for a private plan were either very confident (40 percent) or somewhat confident (34 percent) that they would be able to afford their insurance premiums each month.

Of those who had enrolled in a private plan or in Medicaid, 56 percent said they felt they would have enough "doctors and providers" to pick from while 13 percent said no. Thirty-eight percent said they had tried to see a doctor with their new insurance. Thirty six percent said they had tried to get prescriptions filled.

Asked if they experienced problems with their new insurance, 9 percent said yes. Forty-two percent said no, and 49 percent said they hadn't tried to use their benefits.

Cathy Hope of the Georgetown University Center for Children and Families noted that only half of the Medicaid enrollees surveyed thought they would qualify for the program when they began looking for coverage. Since Medicaid costs little or nothing out of pocket, that suggests a significant number of people who thinks coverage is unaffordable might decide otherwise if they learn they qualify for the entitlement program.

"The survey also reaffirmed what children's health care advocates know, securing coverage for family members is a major motivating factor for those signing up for coverage," she added. "Also, mothers played an important role in young adult enrollment with 19 percent of those between ages 18 and 29 saying mom 'helped them enroll.'"

Deloitte, which said its survey was self-funded, focused specifically on the so-called young invincibles. All of the participants were uninsured when open enrollment began Oct. 1 under the health law. About half of them then obtained coverage.

Deloitte said it polled 500 randomly selected young adults of ages 19-34, 253 uninsured and 247 newly insured. Of the newly insured group, 111 got coverage on exchanges, 50 through Medicaid and 86 through other insurance. The survey took place from April 9 through April 23.

Among those who remained uninsured, 66 percent said they couldn't afford it and 46 percent said they do not see its value. The young adults who went on to get coverage saw it value, with 67 percent saying they got it for greater future protection against medical bills and 60 percent to have peace of mind they would have access to coverage when they need it.

Those polled "don't know what they don't know," a Deloitte summary stated. "There is still a lack of awareness around elements of the Affordable Care Act intended to make coverage more affordable." Seven out of 10 knew about insurance exchanges, the mandate that they must have coverage and the March 31 deadline to sign up.

But 47 percent were unaware that some state Medicaid programs now let in more people to get coverage, 45 percent that low income Americans can get subsidies to buy coverage, and 40 percent that young adults can stay on their parents' coverage until age 26.

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