With just 38 days to go before the opening of Obamacare insurance exchanges, public ignorance about those marketplaces remains sky-high, threatening the very goal of offering affordable health care to the uninsured, several studies show.
And according to a troubling conclusion in at least one study earlier this year, awareness about the new health-care law had declined among some groups more than three years after Obamacare was signed.
But whether knowledge is slipping or stagnantly low, health-care advocates are now in crunch mode as they work to spread the word about exchanges, whose success is dependent on large consumer participation.
Just 22 percent of adults ages 18 to 64 had heard "a lot" or "some" about the insurance exchanges, according to a Kaiser Family Foundation study in June. But 45 percent said they knew "nothing at all about them," according to the study.
Perhaps most alarming is the number of young adults who appear particularly clueless about the Affordable Care Act exchanges that are due to open Oct. 1 and begin coverage on Jan. 1. A whopping 73 percent of adults between the ages of 19 and 29 are unaware of the marketplaces, a separate Commonwealth Fund study this week found.
"If you continue to see that very low level of awareness even as you get toward October, that's a sign that we may not be getting the enrollment, and the exchanges are going to be at a bit of risk from that," said Commonwealth Fund report co- author Sara Collins.
"You want a broad, healthy diverse risk pool in the marketplaces. It's really important that young, healthy people come into the market," said Collins, noting the danger of premium hikes from having a disproportionate number of older, sicker people in insurance plans.
Even if they know about the exchanges, a surprising 68 percent of people with pre-existing health conditions—who potentially have the most to benefit because the law now will bar denial of insurance in such cases—say they are unsure if they will buy the plans there, according to a separate report this month from InsuranceQuotes.com. That same report found that 14 percent of such people with health conditions said they actually would not buy insurance.
(Read more: Health-care changes on the horizon)