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Survey finds lack of general knowledge about ACA exchanges

Tuesday October 1, 2013
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In a crucial week for the Affordable Care Act, 76% of U.S. adults are aware of the law’s individual mandate, while only four of 10 are aware of the new health insurance marketplaces opening Oct. 1, or the financial assistance that is available to help people with low or moderate incomes pay their health insurance premiums, according to a new Commonwealth Fund survey.

The marketplaces — commonly known as health insurance exchanges — are scheduled to open Oct. 1 regardless of whether the federal government shuts down the same day because of a lack of funding. Republicans and Democrats have been unable to agree on a budget to keep the government running, with Republicans demanding a delay in implementation of the ACA.

The survey also found broad support for expanding Medicaid in all states, with 68% of adults saying they are somewhat or strongly in favor of making Medicaid available to more residents in their state.

The survey, conducted between July and September using a nationally representative sample of 6,132 adults, ages 19 to 64, is part of the Commonwealth Fund’s efforts to track implementation of the health reform law. The survey found that the people most likely to benefit from the health insurance marketplaces and premium subsidies often are least likely to be aware of them.

According to “What Americans Think of the New Insurance Marketplaces and Medicaid Expansion,” a report based on the survey:

• Only 32% of people without health coverage during the past year are aware of the marketplaces, compared with 43% of people with coverage all year;

• 31% percent of people without coverage during the year are aware of the subsidies that are available, compared with 43% of those insured all year;

• 32% of adults with incomes under 250% of the federal poverty level ($28,725 for an individual and $58,875 for a family) are aware of the subsidies, compared with 47% of those with higher incomes;

• Once people are made aware of the marketplaces, 61% of those who are potentially eligible — because they either were uninsured at the time of the survey or had purchased an individual insurance plan — said they are very or somewhat likely to shop for coverage in the marketplaces.

However, only 55% of young adults ages 19 to 29 who are potentially eligible for the coverage options said they are very or somewhat likely to use the marketplaces, compared with 65% of those ages 30 to 49;

• Potentially eligible adults with health problems were slightly more likely to say they would use the marketplaces than adults with no health problems (65% vs. 57%). Nearly equal shares of potentially eligible people who identify themselves as Democrats or Republicans said they are very or somewhat likely to shop in the marketplaces (67% vs. 63%), although Democrats expressed somewhat stronger interest.

“These survey findings demonstrate that people who need the health insurance coverage the marketplaces offer will want to shop for plans and find out if they are eligible for financial help,” Sara Collins, PhD, the study’s lead author and Commonwealth Fund vice president, said in a news release.

“However, more work needs to be done to ensure that people who may be eligible are aware of the marketplaces and the subsidies. State and federal efforts to educate people about the marketplaces during the six-month enrollment period beginning in October need to be intensive enough to help close the information gaps this survey highlights.”

Support for Medicaid expansion

Despite the fact that only 25 states and the District of Columbia have agreed to expand Medicaid under the Affordable Care Act, 68% percent of adults surveyed are somewhat or strongly in favor of making Medicaid available to more residents in their state. The report also finds that:

• 78% percent of people without insurance for a time during the past year and 82% of people earning less than $32,499 a year for a family of four support expanding Medicaid to more people in their state;

• 91% of uninsured Democrats, 78% of uninsured independents and 73% of uninsured Republicans strongly or somewhat favor their state making Medicaid available to more residents;

• 90% of Democrats, 79% of independents and 75% of Republicans making less than $32,499 a year for a family of four are in favor of making Medicaid available to more people;

• While 85% of adults surveyed do not know what their state has decided regarding the Medicaid expansion, among those who do, 68% of those who are aware their state is expanding Medicaid are in favor of that decision. Meanwhile, 38% of adults who know their state is not expanding Medicaid are strongly or somewhat in favor of their state’s decision.

Report: www.commonwealthfund.org/Publications/Issue-Briefs/2013/Sep/Insurance-Marketplaces-and-Medicaid-Expansion.aspx

More on the insurance marketplaces (also known as insurance exchanges): www.healthcare.gov


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