On the Eve of Open Enrollment, Few Americans Aware of Exchanges


Despite all the headlines, Congressional bickering and historic Supreme Court ruling, only one in four Americans are aware that the Affordable Care Act’s health-insurance exchanges go live Tuesday. What’s more, that number increases among those the law is intentionally designed to help.

A new survey from the Commonwealth Fund reports that 76% of respondents are aware of the individual mandate requirement and penalty, but only 25% know about the law’s subsidies to lower monthly premiums.

The survey was conducted between July and September of 2013, 6,132 adults ages 19-to-64.

Only 32% of people without coverage during the past year are aware of the exchanges, compared to 43% of those with coverage. Nearly the same amount of people without insurance (31%) were aware of available subsidies, compared to 43% of Americans who had coverage for the past year.

Nearly one-third (32%) of adults with incomes under 250 % of the federal poverty level ($28,725 for individuals and $58,875 for a family of four) were aware of subsidies, compared to 47% of those with higher incomes. Subsidies are available for those making up to 400% of the federal poverty level, which is about $45,000 for an individual and $94,000 for a family of four.

Sara Collins, vice president for Health Care Coverage and Access and lead author of the Commonwealth survey, says the results are a direct reflection of the confusion and controversy over the law.

“The marketplaces haven’t opened yet either,” Collins says. “So there hasn’t been anything to buy on them. I think once these are up and open tomorrow, people will go and find out what they are eligible for and they can buy a plan.”

Once people were made aware of the marketplaces, 61% of those who were potentially eligible for coverage through these exchanges because they were uninsured at the time or had purchased an individual insurance plan, said they were somewhat or very likely to shop for coverage on them.

Young adults, however, were less likely to say they would use these exchanges, with only 55% of those eligible for coverage between the ages of 19-to-29 said they would do so, compared to 65% of those between 30 and 49-years-old.

Collins says the majority of Americans are aware they have to have coverage in some form, but are less clear on what they need to do to obtain coverage. The survey also found that 68% of people said they are somewhat or strongly in favor of making Medicaid available to residents in their state.

The survey found 91% of uninsured Democrats, 78% of uninsured Independents, and 73%of uninsured Republicans strongly or somewhat favor their state expanding Medicaid. However, the vast majority of those surveyed (85%) were unsure of whether their state decided to expand its Medicaid offerings.

“This reflects there is a lot of need for insurance nationwide,” Collins says. “And people who are low-income, uninsured, regardless of party affiliation, they have strong support to expanding [Medicaid] in their states.”