The last day to sign up for 2014 coverage under the Affordable Care Act is Monday, March 31.
But a Mar. 24 study in PNAS found that many of the people who would benefit most from healthcare reform may not know enough to actually buy coverage.
In August and September 2013, researchers surveyed a nationally representative sample of 6,000 Americans, who answered questions about both the ACA and health insurance in general. Here’s what they found:
When the survey was conducted, half of Americans hadn’t even heard of the health exchanges, where people can sign up for coverage, or of the subsidies that help people pay for insurance — and those numbers are even worse for the uninsured.
Only a quarter of survey respondents said they knew “a fair amount” about the Affordable Care Act, suggesting that educated decision-making about coverage will be difficult for the majority of Americans.
Why this is a big problem
According to the authors, one of the most important ways to evaluate the success of the exchanges will be to see if they promote competition that results in cheaper, better coverage for individuals. But it will be hard for that to happen if uninsured people don’t use the exchanges, or if they can’t figure out how to buy the right coverage for themselves in the first place.
Part of the problem is the complexity of the insurance system itself. The relationships between deductibles and premiums can difficult for buyers to understand, and different plans cover different things. The authors say that this complexity may deter people from making a choice at all.
Overall, 42% of respondents and 58% of uninsured respondents did not know that a deductible was what they would have to pay before their insurance started paying for coverage.
Even worse, more than half of people eligible for subsidies had not heard of the insurance exchanges or the subsidies designed to make their options more affordable.
While it’s likely that more Americans have learned about their coverage options since the time of the survey — people without insurance are signing up now at higher rates than they were when exchanges first opened — the results show that just one month before the exchanges opened for business, many of the most important beneficiaries were still in the dark.
For anyone without insurance, there’s one week left to buy it.
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