Health Exchange Enrollees Had Mostly Been Uninsured
WASHINGTON — Four in 10 people enrolling in health plans through the new insurance exchanges already had insurance, but six in 10 were previously uninsured, according to a Kaiser Family Foundation survey released Thursday.
Most of the uninsured had been without coverage for two years or more, and 45 percent said they had been without coverage for at least five years, the foundation said in a report about people in the individual insurance market.
A majority of people with new health plans purchased inside and outside the exchanges rated their coverage as excellent or good and said they were generally satisfied. But four in 10 said it was difficult for them to afford their share of the premiums. And six in 10 said they were worried that insurers would raise premiums so much that they could not afford insurance in the future.
Some people who had insurance lost it because their policies did not comply with coverage standards of the Affordable Care Act. But until now, neither the government nor outside experts had reliable estimates of how many people were previously insured.
The survey findings were based on telephone interviews from April 3 to May 11 with a nationally representative random sample of 742 people ages 18 to 64 who bought their own insurance. The margin of sampling error was plus or minus four percentage points for the full sample, and larger for some subgroups.
The survey found that people in the individual insurance market had been affected by the health care law in different ways. Thirty-four percent said they and their families had benefited from it; 62 percent said they had not.
When asked if they had been “negatively affected” by the law, 29 percent said yes and 66 percent said no.
Among those most likely to say they had benefited were people receiving federal subsidies to buy insurance and those who had previously been uninsured. By contrast, people who had coverage canceled in the last 12 months and people who bought unsubsidized insurance outside the exchanges were much more likely to say they had been adversely affected.
The survey found many Americans to be unfamiliar with details of their coverage. Nearly one in five people buying their own insurance said they did not know the amount of their monthly premiums. Almost four in 10 did not know the amount of their annual deductibles.
Moreover, it appears that many people receiving federal aid may be unaware of it.
In the Kaiser survey, 46 percent of people with insurance purchased through the exchanges said they were getting help from the government to pay premiums. That is significantly less than the share reflected in official data. The Obama administration said that 85 percent of people choosing health plans on the federal and state exchanges had been found eligible for federal subsidies.
People in the survey were asked to describe their health status. Liz Hamel, director of survey research at the Kaiser Foundation, said the answers suggested that “people buying coverage under the new plans are somewhat sicker than those who were previously getting coverage in the individual market.”
However, Ms. Hamel said, it is not clear what this portends for premiums in 2015 because insurers generally expected customers to be “sicker than average” when they set rates for this year. Under the law, insurers generally cannot deny coverage to people with medical problems, and people excluded from the market in the past are now able to obtain coverage.
The cancellation of policies touched off a political furor last fall, with many people complaining that they faced higher premiums for new coverage. But the survey found that people switching plans were about as likely to pay more as to pay less, after taking account of their subsidies, or tax credits.
The Obama administration reported this week that most people buying insurance on the federal exchange were paying less than $100 a month in premiums.
For people who selected health plans with tax credits in the federal marketplace, the full premium averaged $346 a month, but federal subsidies reduced the consumer’s share to $82 a month.