Many Don't Understand Obamacare or Health Insurance, Survey Finds
'Navigators' can help walk people through enrollment process, experts say
By Amy Norton
MONDAY, March 24, 2014 (HealthDay News) -- As the deadline looms for Americans to enroll in "Obamacare" this year, a new study finds that many people -- especially the uninsured and those with lower incomes -- know little about the new health care law, known as the Affordable Care Act.
Most significantly, researchers found, Americans show little understanding of the cornerstone of the reform -- the online marketplaces, or "exchanges," that have been set up to help people shop for an insurance plan, and find out if they're eligible for Medicaid or subsidies to help pay for their health insurance.
Overall, half of the 6,000 U.S. adults surveyed did not even know what an exchange was, and among the uninsured, a full 64 percent didn't know. In addition, over 40 percent of survey respondents did not know what an insurance deductible was, including nearly 60 percent of the uninsured.
Experts were concerned by the findings, reported in the March 24 online edition of the Proceedings of the National Academy of Sciences. But they were not shocked.
"No, this doesn't surprise me at all," said Dr. Kavita Patel, a fellow at the Washington, D.C.-based Brookings Institution.
Low "health literacy" -- people's understanding of health information and ability to use it -- is a well-known problem, and not limited to health care reform, noted Patel, who was not involved in the study.
To be fair, the new report is based on a survey done in August and September of last year -- before the state and federal exchanges were up and running, and before the troubled federal website was grabbing headlines everywhere.
By now, Americans may know more, according to Silvia Barcellos, an economist at the University of Southern California who led the study.
She said she and her colleagues are planning a follow-up survey in April to see if there has been a change.
Regardless, Barcellos said, the current findings are worrisome, especially the lack of awareness among the uninsured.
"These are the people everyone is counting on to enroll," she noted.
And the problems go beyond awareness of the exchanges. "Many people lack a basic understanding of how health insurance works," Barcellos said.
March 31 is the deadline for enrolling for insurance coverage for 2014 under the Affordable Care Act.
Of all survey respondents, 42 percent did not know what an insurance deductible was -- including 58 percent of the uninsured.
The same was true for 30 percent to 45 percent of those living between 100 percent and 400 percent of the federal poverty level. Many of those Americans are eligible for tax credits to help pay for insurance bought through the exchanges. They are another group that stands to benefit the most from the Affordable Care Act.
But if uninsured and lower-income people don't understand how health insurance works, Barcellos said, "how can you expect them to make informed decisions when they choose a plan?"
Sharon Long, of the Urban Institute's Health Policy Center in Washington, D.C., agreed.
"Health insurance is complicated, and we're talking about people who may never have had it in the past," said Long, who was not involved in the study. "It's ironic that we're asking people without that experience to make good choices."
Brookings' Patel pointed out that this problem was anticipated. Federal and state governments have so-called navigator programs to help applicants get through the enrollment process. Those navigators include individuals and groups -- from nonprofits to hospitals to church groups -- who are trained and certified (and paid) by the government.
"The role of the navigators is important," study author Barcellos said. But, she added, people also need to know the programs exist.
There are other potential ways to make the exchanges more user-friendly, according to Barcellos. One step, she said, could be to redesign the exchange websites to "nudge" people to the best plans -- by highlighting certain economical and better-quality plans on the first page of the site.
Barcellos said research has shown that when people have too many choices -- especially complex ones -- their tendency is to opt for whatever seems easiest.
"Or," she said, "they may make no choice at all."
The Kaiser Family Foundation offers help in understanding Obamacare.
SOURCES: Silvia Helena Barcellos, Ph.D., research scientist, University of Southern California Center for Economic and Social Research, Playa Vista, Calif.; Kavita Patel, M.D., managing director, clinical transformation and delivery, Brookings Institution, Washington, D.C.; Sharon Long, Ph.D., senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; March 24, 2014, Proceedings of the National Academy of Sciences, online
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