Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoons for the latest edition — and read all previous columns here.
The health-care law is supposed to extend health-care benefits to millions of Americans who currently lack coverage. How does that happen when a public is largely unaware of the law — and, when they learn more, still remain deeply skeptical that it will actually help.
These are questions that Michael Perry and Tresa Undem have spent months trying to answer. Working with Enroll America, a nonprofit focused on public outreach for the Affordable Care Act, the two have put together one of the most comprehensive polls about how those most likely to qualify for new programs feel about the expansion of health insurance. The survey covered 1,814 adults who earn less than 400 percent of the federal poverty line, the exact demographic likely to qualify for new benefits.
The results, released last week, suggest both challenges and opportunities for those implementing the insurance expansion. Undem and I spoke Wednesday about some of their most interesting findings.
Forty-four percent of those surveyed said they had shopped for health insurance outside their job and most described it as a stressful, frustrating experience. Seventy-seven percent said it was difficult to find a plan that they could afford, and 70 percent had trouble understanding the details. "I think you're certainly going to face a lot of skepticism from this population," Undem told me.
2. Very few are aware of the new health law provisions...
3. ...and even when they do learn about them, they remain skeptical that insurance will be affordable. This was probably the most interesting finding that Undem shared with me. They found that, when read a brief description of the exchange, 37 percent of those surveyed thought that a health plan would be affordable.
When they gave them an actual price estimate for how much that plan would cost for an individual earning $30,000 — a $210 out-of-pocket premium — those who thought it was affordable dropped to 29 percent. "We said the plan was affordable, and everyone was skeptical," Undem says. "Then we gave them a sample premium and the skepticism got even higher. It's like, oh, I can't afford that."
4. How to temper the skepticism? Talk about how much the plan would cost without subsidies. Undem and Perry tested out a number of other ways to talk about the premiums, ones that would mention how big the subsidies were — and how much the plan would cost without them. They found that each lead to an uptick in survey respondents thinking they could afford coverage.
The most compelling explanation — telling an individual how much they would save annually by using the new subsidies — had 48 percent of respondents agree that the premium amount was "in the affordable range."
5. Will the online marketplaces actually work? The whole idea of the Affordable Care Act is that Americans will use online portals, called exchanges, to purchase insurance coverage. Perhaps surprisingly, Perry and Undem found that many of those they surveyed saw insurance as too important to buy online — it's not like shopping for a birthday present on Amazon.
"I don't know if it's so much the idea of it being online," Undem told me, "But more of that doing this online represents doing this alone. They want somebody who they can hold accountable, somebody who is going to make sure they get coverage."
Seventy-five percent said they would want assistance in person, while just 9 percent would seek support from an online chat function.
6. So where do people want to buy insurance? Maybe at the Medicaid office. Undem saw in the survey results relatively strong interest in seeking coverage at a state Medicaid office, especially among low-income Americans and Latinos.
"Part of it is they already know the Medicaid office," Undem says. "While people do not like sitting in the Medicaid office all day with screaming kids, when they do get in to see someone, they're told 'you did everything correctly, and in two weeks you're going to get a card.' They walk out of there with a sense of security that the application was done right and that they've had all their questions answered."
7. When in doubt, ask mom. Undem thinks that women are going to be especially important in encouraging family members to seek coverage. They found that, for unmarried adults, "mom" would be the family member they would most likely seek advice from.
"For the segment of the uninsured in their early 30s, the mandate is biggest motivator," Undem says of her findings. "They don't think insurance is necessary and they're one of the most skeptical demographics. When we asked about the family member they'd trust, it was the mom, that's where they're going to go. Really engaging women is going to be key to reducing the uninsured."
KLIFF NOTES: Top health policy reads from around the Web.
The robot will see you now. "IBM didn’t build Watson to win game shows. The company is developing Watson to help professionals with complex decision making, like the kind that occurs in oncologists’ offices—and to point out clinical nuances that health professionals might miss on their own." Jonathan Cohn in the Atlantic.
The Virginia legislature is headed to a showdown over the Medicaid expansion. "One day after House and Senate negotiators struck a transportation funding deal, some Democrats were trying to link passage of that plan to the issue of Medicaid expansion. Some House Democrats vowed to vote against the transportation package if the General Assembly does not lay the groundwork this year for expanding Medicaid. They are also threatening to vote against state budget amendments if they do not include a framework for expansion." Laura Vozzella and Frederick Kunkle in The Washington Post.
A do-it-yourself test for...cancer? "Mode Diagnostics Ltd. wants to bring the medical laboratory into your bathroom -- with a mobile phone-size device that can detect signs of cancer right before your eyes. The do-it-yourself test market, estimated at $2 billion to $3 billion globally, is expanding 20 percent a year as new checks for colon and prostate cancer, HIV, chlamydia, stomach ulcer, sperm count and drug abuse take their place on pharmacy shelves alongside standards such as blood-sugar monitors for diabetics and pregnancy tests." Andrea Gerlin and Makiko Kitamura in Bloomberg.