qotd: Lack of affordability is primary reason for not enrolling in exchange plans

The Commonwealth Fund
September 25, 2015
To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance
Under the Affordable Care Act While Others Have Not
By Sara R. Collins, Munira Gunja, Michelle M. Doty, Sophie Beutel


Exhibit 2. Just under half of the adults who have visited the
marketplace enrolled in a marketplace plan or Medicaid

52% - Did not select a private plan or enroll in Medicaid

30% - Selected a private health plan

15% - Enrolled in Medicaid

2% - Don't know/refused


Exhibit 6. Among market-place visitors who didn't enroll, more than
half said they couldn't find an affordable plan

Can you tell me why you did not obtain a private health insurance plan
or Medicaid coverage when you visited the marketplace? Was it because…?

Percent of adults ages 19-64 who visited the marketplace but did not
select coverage

57% - Could not find a plan you could afford

51% - Obtained health insurance through another source

43% - Not eligible to enroll in Medicaid or for financial assistance

38% - Found the process of enrolling in a plan difficult or confusing

32% - Could not find a plan with the type of coverage you need

15% - Decided you did not need health insurance

14% - Did not know where to get help to sign up

23% - Some other reason

Affordability was a key reason people did not enroll in plans. More than
half (57%) of adults who visited the marketplaces but did not enroll
said they could not find a plan they could afford. Excluding the adults
who also said they gained coverage elsewhere, the majority of those who
did not enroll because they couldn't find affordable plans had lower
incomes. More than half (54%) had incomes in the range that made them
eligible for subsidies (i.e., from 100 percent to 400 percent of the
federal poverty level, or $11,670 to $46,680 in annual income for an
individual). Thirty percent had incomes under 100 percent of poverty. An
estimated 26 percent (and thus nearly all of those with incomes under
100 percent of poverty) were likely in the so-called Medicaid coverage
gap. That is, they were living in states that had not expanded
eligibility for Medicaid at the time of the survey and had incomes under
100 percent of poverty and thereby not eligible for marketplace
subsidies. About 11 percent had incomes that exceeded the threshold that
made them eligible for subsidies (i.e., 400 percent of poverty).

Many adults (43%) said they did not enroll because they were not
eligible for subsidized coverage or Medicaid. Again, excluding those who
gained coverage elsewhere, most people who gave this reason had lower
incomes: 50 percent had incomes that made them eligible for subsidies,
and 33 percent had incomes under 100 percent of poverty. An estimated 27
percent — most of those with incomes under 100 percent of poverty — were
likely in the Medicaid coverage gap. About 14 percent had incomes above
the threshold that made them eligible for subsidies.

Other adults who did not enroll were overwhelmed by the process. About
four of 10 adults (38%) who did not sign up for coverage said they found
the process of enrolling difficult or confusing.

http://www.commonwealthfund.org/publications/issue-briefs/2015/sep/to-enroll-or-not-to-enroll

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Comment by Don McCanne

Is the Affordable Care Act a misnomer? Although half of the individuals
who visited the insurance exchanges and did not enroll obtained coverage
outside of the exchanges, the other half did not enroll because they
found the plans unaffordable.

Making health care affordable for everyone was the primary goal of
reform. It didn't happen. But it would if we were to enact a single
payer national health program.