Obamacare year two: More clueless than ever

Obamacare can't cure ignorance.

An increasing number of uninsured Americans say they don't know how to apply for health insurance—despite the fact that the Obamacare marketplaces have been around and the subject of much publicity for more than a year now.

And, compared with earlier last year, more are saying they aren't sure if the Affordable Care Act mandate that they get insurance or pay a fine applies to them, according to a survey released Wednesday by the Transamerica Center for Health Studies. The survey also found higher levels of resistance to the ACA generally among the uninsured.

Health-care counselors help clients navigate the second round of open enrollment for the Affordable Care Act in Manassas, Va.
Linda Davidson | The Washington Post | Getty Images
Health-care counselors help clients navigate the second round of open enrollment for the Affordable Care Act in Manassas, Va.

The rising level of apparent cluelessness about how insurance and Obamacare works among the uninsured underscores existing concerns among ACA advocates, who have warned that signing up remaining uninsured people will be harder in the second season of Obamacare than in the first.

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The TCHS survey found that nearly 1 in every 5 people—or 19 percent—said, "I did not know how to apply" when asked in November why they didn't obtain Obamacare health coverage last year.

That's more than double the 9 percent who gave that answer when the question was asked in July 2014, three months after the close of the first open enrollment in Obamacare plans.

Ten percent of the respondents who failed to get health insurance last year said in November that it was because "I was not sure the insurance mandate applied to me," according to the survey. That's up from 7 percent who gave that answer last July.

In fact, the insurance mandate applies to nearly all Americans, although some exemptions are available.

The online survey, which was conducted for TCHS by Harris Poll, questioned 1,203 people in November, and was a "pulse check" for an earlier survey in July, which questioned 2,624 people.

TCHS, which conducts analysis and research on national health-care issues, is a division of the nonprofit Transamerica Institute, whose website says it is dedicated to identifying, researching and educating the public about retirement, health coverage and other relevant financial issues facing Americans.

Hardening opinions

The survey found, in another troubling sign for ACA supporters, opposition to Obamacare has hardened among the uninsured.

The TCHS survey found that 24 percent of uninsured respondents said they failed to get health coverage last year because "I don't support the ACA in principle." That's up from 17 percent who gave that same answer last July.

In broader findings, the TCHS survey shows that among uninsured Americans, slightly more than half, 52 percent, reported being completely uninformed or not very informed about Obamacare.

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When asked about that high percentage, TCHS Executive Director Hector De La Torre said, "As millions of Americans have obtained insurance since 2013—many moving from being uninsured to newly insured—the uninsured group is reduced to individuals who have a harder time figuring out the health coverage market and how to access insurance."

"They are less likely to have coverage on the job or are unemployed, they are less educated, and, in many cases, [have] less income," De La Torre said.

A large minority of the uninsured, 38 percent, had not even heard about the Obamacare marketplaces, also known as exchanges, which began selling private individual and family health plans in October 2013.

Those exchanges were created under the ACA for the express purpose of selling insurance to the uninsured, or underinsured.

The exchanges, which include the federally run HealthCare.gov and marketplaces being run by 14 individual states and the District of Columbia, are the only places that people can buy health plans with the use of federal subsidies, which often greatly reduce their cost to customers.

De La Torre said, "Combined with their lack of knowledge of the exchanges and government program options, many are unaware of the low-cost or subsidized, discounted health coverage that is available.

"It is to be expected that as individuals are motivated by medical conditions or affordable health insurance, they will purchase health coverage, which will leave the harder to reach, harder to serve populations. This is the challenge for expanding coverage going forward—educating and assisting the uninsured, many of whom have never had health insurance."

On Wednesday, HealthCare.gov said it had signed up nearly 6.8 million customers for this enrollment season through last Friday, and all 37 states on the exchange have seen enrollment levels that have already surpassed levels at the close of open enrollment last year.

Even among the 62 percent of the uninsured respondents who had heard about those exchanges, only a small number of them, just 3 percent, had either called one of those marketplaces for assistance in signing up for health plans, or had spoken to a so-called navigator, whose job is to help such people, according the TCHS survey.

Support for some provisions

The survey also echoed previous studies in finding widespread support for most parts of the ACA other than the so-called individual mandate to obtain insurance or pay a tax penalty. That penalty, which was up to 1 percent of taxable household income in 2014, has risen to as much as 2 percent of household income or $325 per adult, whichever is higher.

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At least 75 percent of people questioned for the survey said that they strongly or somewhat supported ACA provisions that include allowing everyone eligible to qualify for health insurance regardless of pre-existing conditions, no annual or lifetime limits on health coverage, allowing people under age 26 to remain on their parents' plans, expanding Medicaid to include nearly all poor adults and giving subsidies to people to help them enroll on Obamacare exchanges.

Support was strongest for the barring of limits on health coverage, and for guaranteeing the right to qualify for insurance despite health status.

But just 46 percent of respondents said they strongly or somewhat supported the requirement that most people get insurance or pay a penalty. A total of 34 percent of respondents said they strongly opposed such a mandate.

De La Torre said that despite the mandate's unpopularity, "it will push many of the uninsured to obtain health coverage as it increases year to year."

That penalty is set to increase in 2016 to $695 per adult or 2 ½ percent of household income, whichever is higher. In future years, the flat dollar amount penalty will be indexed to inflation, but the 2 ½ percent figure will remain the same.