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Despite flawed rollout, consumers haven't given up on insurance exchange, says study

This article originally appeared the St. Louis Beacon. - The rocky rollout of the Affordable Care Act's insurance marketplace apparently hasn’t changed the level of consumer support for the health-reform program. For weeks, administration officials and policy analysts have been concerned that many people were confused about the law and might be turned off because of difficulties buying insurance through the insurance exchange.

A new Commonwealth Fund survey paints a more nuanced picture. Conducted between Oct. 9-27, the survey shows generally encouraging consumer attitudes about their marketplace experiences even if they were unable to sign up on their first try.

A policy brief based on the survey has been issued by Dr. David Blumenthal, president of the Commonwealth Fund, and economist Sara R. Collins, vice president for the fund’s health care coverage and access program. The Commonwealth Fund is nearly 100 years old. It focuses on collecting and sharing information on "excellence in health care" in the U.S. and  across the world. The study provides some clear data in the midst of a flurry of anecdotal stories and political wrangling.

The two say their work is the first in a series of surveys that they say are needed because a lack of objective data about consumers’ overall experiences “feeds the volume and intensity of the controversy.”

The survey sought to determine who was shopping for coverage through marketplace websites, why they might have been unable to enroll, and whether the experience would discourage them from trying again before the enrollment period ends on March 31. The authors found that:

  • 60 percent of potential users are now aware of the ACA’s health insurance marketplaces.
  • 17 percent visited their state’s marketplace in October to shop for health care.
  • 21 percent of those who went to the marketplaces were between the ages of 19 and 29.
  • 21 percent of all who went to marketplaces said they had been able to enroll in a health plan.
  • 58 percent who either had yet to go to marketplaces or visited them without enrolling said they were likely to shop for marketplace coverage before the deadline.

“Our findings are both encouraging and concerning,” the authors said.
The survey found that awareness of marketplaces had risen from about 33 percent in early 2013 to 60 percent among potential users. The authors said this meant more than half of those eligible are now aware that financial assistance is available to help them buy insurance.

The demographics of the eligible marketplace population in the survey bode well for the program, the authors believe. One concern had been that the failed rollout would stop young and generally healthy consumers from enrolling. They are needed to help offset the health care costs of the elderly and poor who tend to need more medical services.

The survey found that the age and health status of marketplace visitors were consistent with general demographics of the eligible population. “Visitors were generally healthy, with nearly three-quarters describing their health as good to excellent,” the authors said in their brief, noting that 21 percent of marketplace visitors were young adults between the ages of 19 and 29, and that about half were between the ages of 30 and 49.

Critics have pointed to the relatively low number of marketplace applications as an indication that the program was likely to fail. Last week, data released by federal health officials confirmed the low sign-up rates. The information showed, for example, that only 14,131 consumers in Missouri completed applications, and only 751 had selected marketplace plans. In Illinois, about 30,000 completed applications, and just under 1,400 had selected plans.

Pointing to the experience in Massachusetts, when that state rolled out its marketplace in 2007, the Commonwealth authors said a vast majority of consumers in Massachusetts didn’t sign up until near the end of the state’s enrollment period. The authors say a similar deadline-driven surge in applications for ACA benefits might occur near March 31.

Still, the brief says the ACA program has some problems. It praises the law for simplifying consumer choices to three or four plans (bronze, silver, gold and platinum), requiring all plans to offer the same health package and making variations only by premium and out-of-pocket costs. 

But it says some consumers still have difficulty comparing benefits, premium costs and out-of-pocket expenses under various plan options. The brief says: ”Plan choices can remain difficult, especially in states that are consciously obstructing the work of navigators and others providing consumer assistance with sign-up.” It refers to a previous Conmonwealthreport, which identifies Missouri as being among four states, along with Georgia, Ohio and Tennessee, as barring navigators from providing “consumer friendly advice about the benefits, terms and features of a particular health plan.”

Missouri is still grappling with the question of expanding Medicaid to provide  health benefits to those earning less than 133 percent of the poverty level – roughly $11,500 a year for a single person. Gov. Jay Nixon is appealing to the Missouri Legislature to support expansion, but many lawmakers say the state needs to reform its Medicaid program before talking about expanding it.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.