Obamacare's next threat: Inertia among the uninsured
There's knowing what you have to do and then there's actually doing it. And the results of a new survey suggest the health-care reform law may be falling short on both accounts among the uninsured—the group Obamacare is designed to help the most.
The findings of the survey by the Transamerica Center for Health Studies suggest that Obamacare's goal of providing affordable health insurance to millions of Americans faces widespread inertia.
Although more of the survey's respondents knew about components of the law compared with a prior survey over the summer, not many of those polled are enrolling for coverage via the Obamacare exchanges even if they know that the law mandates nearly all people must have insurance by 2014.
"More Americans are informed and prepared for the March 31, 2014, mandatory health coverage date, but a significant number have yet to actually sign up for health insurance in the exchanges or the traditional insurance market," said Hector De La Torre, executive director of the center, whose online poll of 1,000 adults under the age of 64 was conducted last month by Harris Interactive.
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"The uninsured continue to be the least active, which could be because they feel the least prepared and also are the least satisfied with the health-care system," said De La Torre, whose center is a division of the Transamerica Institute, a nonprofit foundation focused on research and education about health and retirement issues facing the public. "With the deadline to purchase coverage approaching, the great unknown is what the uninsured will do."
The questions surrounding what uninsured people will do are crucial because that is the group the new, government-run Obamacare exchanges were specifically designed to target. And those exchanges are the only place that tax subsidies are available to offset the cost of coverage for people whose incomes qualify them.
Most Americans are unlikely to use the exchanges, since they already have insurance through either their employer, Medicare, Medicaid or military health coverage.
Despite that, the uninsured on average were much less aware of the exchanges such as federally run HealthCare.gov and the state marketplaces than the overall population, the survey found. A total of 31 percent of the uninsured survey participants said they hadn't even heard about the Obamacare exchanges. That compares to just 15 percent of the general population who were in the dark about them.
And a mere 10 percent of the uninsured plan to buy health coverage through one of the exchanges, the survey found.
Still, there is growing awareness about other elements of the Affordable Care Act. The general population has, in recent months, described themselves as better prepared for the potential impact of the new law, the poll found, with about 72 percent saying they are "very" or "somewhat" prepared to deal with the ACA's requirement that nearly all people have some form of health insurance by 2014 for face a tax penalty, the so-called individual mandate.
Those numbers represent statistically significant improvements from when the same survey was first conducted in July. In that earlier poll, 63 percent said they were "very" or "somewhat" ready to comply with the individual mandate.
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Among respondents who are currently uninsured, there was also an increased level of preparedness for the ACA—but far below the levels seen in the general population.
In July, just 30 percent of the uninsured said they were "very" or "somewhat" prepared to comply with Obamacare's individual mandate. That number jumped slightly to 35 percent in the new poll—but was still nearly 40 percentage points below the level of preparedness seen in the general population.
And 55 percent of the uninsured said they are "not sure" what they will do in the face of the individual mandate obligating them to obtain health insurance.
Just 6 percent of the general population said they plan to buy health insurance through the Obamacare exchange, but only 2 percent had actually enrolled.
That relatively low level of sign-ups among survey respondents mirrors what the Obamacare exchanges have seen to date since their Oct. 1 launch. So far, more than 330,000 are believed to be enrolled nationally on the exchanges, but that is well below the 1.2 million people federal officials originally projected would be enrolled by the end of November.
Officials now are hoping that enrollment dramatically increase in December, when a key deadline will occur. To have coverage that begins by Jan. 1, people will have to pick a plan on the exchanges by Dec. 23, and make a premium payment for that plan by Dec. 31.
Health insurance experts have repeatedly warned of the potential negative fallout of so-called adverse selection in plans sold through the Obamacare exchanges.
If too many older people, and those with pre-existing medical conditions sign up after years of being denied affordable coverage because of their health status, they could swamp the insurers with demands for benefits payouts, if those insurers don't get younger, healthier people who currently lack health insurance to enroll in their plans.
—By CNBC's Dan Mangan. Follow him on Twitter @_DanMangan.