Survey: Tracks First Month Of HIX Shopping Experience
By Dr. James Palermo // November 5, 2013
HEALTH PLAN AFFORDABILITY MAJOR CONCERN
On October 1, the Affordable Care Act’s (ACA, aka Obamacare) health insurance marketplaces opened for business. The launch of the online health insurance exchange (HIX) has been plagued by multifactorial technical failures that have severely hampered enrollment across the country. The Obama administration claims that the issues that consumers are encountering are being aggressively addressed and should be corrected by the end of November.
COMMONWEALTH FUND SURVEYS HIX SHOPPING EXPERIENCE
To gain some insight into what Americans experienced during the first month of shopping for a health plan on the HIX, the Commonwealth Fund conducted a telephone survey of a nationally representative sample of 682 adults age 19-64, who are either uninsured or purchasing individual coverage on their own and potentially eligible for the law’s new coverage options, whether private plans or expanded Medicaid.
The Commonwealth Fund, a private U.S. foundation whose stated purpose is to “promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable,” has been an advocate of the ACA.
Findings of the Commonwealth Fund ACA Tracking Survey, which was conducted over a nineteen-day period, October 9-27, are as follows:
Q: Are you aware of the HIX marketplace, where people who do not have aﬀordable health insurance through a job can shop and sign up for health insurance?
60 percent said yes, 39 percent said no.
Q: Are you aware that financial assistance for health insurance is available through the ACA?
53 percent were aware, 46 percent were unaware of assistance.
Q: Have you gone to the HIX (on the internet, by mail, on the phone or in person) to shop for health insurance?
82 percent said no, 17 percent said yes.
Q: Were you able to enroll in a health plan?
21 percent said yes, 76 percent said no.
Those who did not enroll were asked:
Q: Why didn’t you enroll in a health plan or Medicaid when you visited the HIX?
Not certain can afford a plan—48 percent
Trying to decide which plan to purchase—46 percent
Deductibles and copays were too high—42 percent
Website failures—37 percent
Information on financial assistance or Medicaid not available—29 percent
Not eligible for financial assistance or Medicaid—28 percent
Desired doctors not available in offered plans—21 percent
Q: How likely are you to go to/go back to the HIX by March 31, 2014 when open enrollment through the HIX ends, to enroll in a health plan or find out if you’re eligible for financial assistance to pay for the plan or for Medicaid?
58 percent said they are likely to shop for coverage, 39 percent said they would not.
Q: How easy or difficult was it to:
Find a plan with the type of coverage needed—56 percent difficult, 38 percent easy
Find an affordable plan—61 percent difficult, 30 percent easy
Compare benefits covered—58 percent difficult, 30 percent easy
Compare premium costs—52 percent difficult, 37 percent easy
Q: Overall, how would you describe your experience in trying to purchase health insurance through the HIX?
Fair or poor—70 percent
Excellent or good—27 percent
IS ‘GLASS HALF FULL OR HALF EMPTY?’
Interpretation of these survey results is very dependent on your perspective related to the ACA. The headline that went out from the Commonwealth Fund e-Alert was: “Survey of Experiences with Marketplaces in October: Americans Needing Coverage Are Determined to Keep Trying,” and the brief overview of results in that email focuses on the 17 percent who visited the HIX (116 out of the 682 survey participants), the “one out of five” (24 total) who were then able to overcome the website disaster and actually enroll in a plan, and the findings that awareness of the HIX was up substantially since last summer.
Granted, the overall numbers in this survey are relatively small and drawing statistically significant conclusions from the findings is a bit suspect. However, just looking at the raw numbers certainly should not instill a great deal of confidence in the hearts of ACA proponents.
60% HAVE ISSUES WITH HIX HEALTH PLAN AFFORDABILITY
Although the number of people aware of the HIX and its potential benefits in October was higher than previous Commonwealth Fund surveys, it is clear that there remains a very substantial segment of those eligible to shop on the HIX who are uninformed.
Only 116 of the 682 eligible survey participants visited the HIX through one or more of the available venues, and only 24 (less than 4 percent of the total surveyed) of those enrolled in a health plan. Surprisingly, at 37 percent, the website debacle was not the most frequent reason why survey participants who went to the HIX did not enroll. Affordability involving premiums, deductibles and copays were primary factors in 40-50 percent of survey participants’ decision not to enroll, and over 60 percent said that it was difficult to find an affordable plan on the HIX.
ACCEPTANCE AND EFFECTIVENESS OF ACA HIX REMAINS TO BE SEEN
It’s been said many times in the past three and a half years that there would be some winners and some losers as Obamacare becomes the “law of the land.”
The disastrous roll out of healthcare.gov, the revelation that millions of Americans are losing health coverage they liked, the questionable HIX “affordability” for shoppers of various demographics, the preponderance of HIX shoppers in many states moving into Medicaid, the limited provider networks in available plans on the HIX, and the overarching question of “who’s paying for this?” continue to plague the ACA.
Fundamentally, the ACA is supposed to insure the uninsured, improve patient care and better manage the health of the American population. Perhaps the glass is half full, and solutions to the many problems that afflict President Obama’s signature healthcare law will be forthcoming in the near future. Until then, as the Commonwealth Fund survey shows, there are some significant challenges to overcome related to the acceptance and effectiveness of the HIX marketplace.