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Most Marketplace Plan Buyers Had Been Uninsured, Study Shows

By Kerry Young, CQ HealthBeat Associate Editor

June 19, 2014 -- The majority of people who bought insurance through health law marketplaces, or exchanges, were previously uninsured, according to a study that honed in on the experiences of people who purchased plans in the individual market.

The study is the first of series planned by the Kaiser Family Foundation designed to answer some common questions about who was enrolling through the marketplaces. These state and federal web-based programs are a defining feature of the implementation of the 2010 health law (PL 111-148, PL 111-152).

"There has been considerable debate about how many people signing up for coverage in the new exchanges were uninsured. Our survey reveals that the majority of people who enrolled in the new exchanges were previously uninsured," said Drew Altman, president and chief executive of the nonprofit foundation in a release.

This survey was conducted from early April to early May, and included a random sample of 742 adults who bought their own insurance.

"This is a market very much in flux, and we will track experiences and perceptions over time as new people enroll and those already in the market gain more experience using their new plans," said Liz Hamel, director of the foundation's Public Opinion and Survey Research in a statement. "While the share of the overall population enrolled in the non-group market is small, their views and experiences will have outsized significance in terms of whether the ACA is viewed as a success or not."

Kaiser said that nearly six in 10 people, or 57 percent, of those who purchased through marketplaces had been uninsured just prior to obtaining coverage. Of this group, most had been without coverage for at least two years.

The Kaiser findings differed from some other estimates. A report from Rand Corp. released in April pegged the previously uninsured population at roughly a third. Looking at results through mid-March, Rand research found that of a total of 3.9 million people enrolled in marketplace plans, only 1.4 million had been previously uninsured. The researchers noted that their "data do not fully capture the surge in enrollment that occurred in late March 2014."

On a recent call with reporters, Larry Levitt, senior vice president of Kaiser, said that the timing of research makes a difference in the results.

"Ours is the most current survey," he said.

Some of the findings in the Kaiser survey were not surprising.

"Those who are most likely to feel they have benefited from the law are people receiving government financial assistance for exchange plan premiums (60 percent benefited), while those most likely to feel they have been negatively affected by the law are people who experienced a plan cancellation in the past year (57 percent negatively affected)," Kaiser reported in a summary of the work.

In general, people buying their own insurance were more likely to have a favorable view of the 2010 law than the public at large, which includes many people who have coverage through their employers. According to the survey, the people buying their own insurance were about evenly split between favorable (47 percent) and unfavorable (43 percent views. Adults nationwide in the same age range have an unfavorable view of the law (46 percent) than a favorable one (38 percent).

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