© transamerica center for health studies, 2013 transamerica center for health studies sm survey:...

© Transamerica Center for Health Studies, 2013© Transamerica Center for Health Studies, 2013

Transamerica Center for Health Studies SM Survey:

Pulse Check on Health Care Coverage Perceptions and Readiness – 5 Weeks

into Open EnrollmentNovember 2013

TCRS 9999-9999

www.transamericacenterforhealthstudies.org/

About the Transamerica Center for Health StudiesSM Page 3

About the Survey Page 4

Method Page 5

Executive Summary Page 6

Detailed Findings Page 8

Awareness of the ACA, Health Insurance Options and Preparedness Page 8

Preparations for Individual Mandate Page 19

Pre-Existing Medical Condition and the ACA’s Impact on Health Insurance 4

Demographics Page 27

Table of Contents

2

http://www.transamericacenterforhealthstudies.org/


The Transamerica Center for Health StudiesSM (TCHS) informs the national health care conversation, bringing clarity to the complex decision-making regarding health coverage and personal health and wellness. Through its broad-based analysis and research findings, TCHS offers consumers and employers a guide to navigate the financial implications of the health care decisions they are facing.

TCHS engages with the American public through national surveys, its website, research findings and consumer guidance. TCHS also collaborates with health care experts and organizations that are equally focused on health coverage and personal health and wellness.

A division of the Transamerica Institute, a nonprofit, private foundation, TCHS is dedicated to identifying, researching and analyzing the most relevant health care issues facing consumers and employers nationwide.

The Transamerica Institute is funded by contributions from Transamerica Life Insurance Company and its affiliates (not a major medical insurer) and may receive funds from unaffiliated third parties.

About the Transamerica Center for Health StudiesSM

3



In September 2013, TCHS released findings of its inaugural national survey of the U.S. General Adult Population and business Employers regarding their attitudes toward health care. The overall goals for the study were to illuminate emerging trends, promote awareness, and help educate the public.

TCHS then conducted a brief follow-up survey among the General Adult Population regarding their attitudes towards health care in November 2013 – then five weeks into the ACA open enrollment period.

Harris Interactive was commissioned to conduct the survey for TCHS. TCHS is not affiliated with Harris Interactive.

About the Survey

4



• A 7-minute online survey was conducted November 5-11, 2013 among a nationally representative sample of 1,005 members of the U.S. General Adult Population using the Harris online panel. Among the respondents:

• All were U.S. residents aged 18–64.• Data were weighted (statistically adjusted) on income, education, gender,

race/ethnicity, region, employment status, number of employees in company, and health insurance status to:

• Account for differences between the population available via the Internet versus by telephone.

• Be a representative sample of the U.S. General Adult Population age 18-64.• The following sub-samples were achieved:

– Black/African American: 121– Hispanic: 161– Uninsured: 221

• Percentages were rounded to the nearest whole percent. Differences in the sums of combined categories/answers are due to rounding.

• Terminology:– ACA: Affordable Care Act– Gen Pop: General adult population age 18-64– *Denotes proportion between 0 and 0.5% (unless otherwise noted)

Method

5



Executive Summary

The General Population is now more informed about the ACA and feels more prepared for the ACA now than they did in July. However, a majority has still not taken any action to prepare for the ACA in the last 12 months.• Majorities of the General Population are informed about the ACA (60 percent) and feel

prepared in the face of the ACA mandate (72 percent). Both of these measures are up from levels seen in July (48 percent and 63 percent, respectively).

• Though the level of preparedness has increased, this does not necessarily mean an increased level of activity among the General Population. Fifty-nine percent have done “nothing” in the past 12 months to prepare for the ACA.

Six percent of the General Population responded that they plan to purchase health insurance through the new Exchange. However, to-date, 2 percent indicate having done so.• A majority (57 percent) plan to keep their current insurance.

• Only 5 percent said they plan to not purchase health insurance and pay the tax penalty

• Many (21 percent) are still not sure what they will do when the insurance mandate takes effect.

Over half (51 percent) of those employed say either their employer has not provided information to them about the ACA (34 percent) or that they do not know if their employer has done so (17 percent).• A few of those employed say their employer has provided a summary or detailed

description of the law and its impacts (15 percent) or even a comparison of how health insurance costs may change (11 percent).

6



Executive Summary

A notable portion of those with a pre-existing medical condition believe they stand to benefit from the implementation of the ACA.• While nearly three in ten (29 percent) have a pre-existing condition, almost 10 percent of

the General Population have had a pre-existing condition and were unable to find a provider that would provide them coverage (3 percent) or were unable to afford health insurance with the condition (6 percent).

• Among those unable to access or afford health insurance due to a pre-existing medical condition, 35% say they can now get health coverage as a result of the ACA.

Although directly affected by the ACA, the uninsured now have more questions than answers as the deadline for the individual mandate approaches.• Despite their low level of satisfaction with the quality of the health care system they have

access to (34 percent versus 84 percent among both privately and publicly insured individuals), those uninsured are less informed about the ACA (42 percent being “very” or “somewhat” informed) as compared to those who are privately (64 percent) or publicly (65 percent) insured. In fact, 31 percent of those uninsured haven’t even heard of the new health insurance Exchanges.

• Further, a majority (55 percent) of those uninsured say they are “not sure” what they plan to do in response to the individual mandate.

• As the mandate approaches, the percentage of uninsured who feel informed about their healthcare options actually dropped, with those saying they are “very” or “somewhat” informed declining from 56 percent in July to 42 percent in November.

A strong majority (71 percent) of the General Population have not noticed a change in their health care choices as a result of the ACA.• A small portion of people (8 percent) reported their employers now offer health insurance

due to the ACA, and even fewer (5 percent) reported their employers no longer offer health insurance.

7



Detailed Findings: Awareness of the ACA, Health Insurance Options and Preparedness


© Transamerica Center for Health Studies, 2013

July (A) November (B)0%

20%

40%

60%

80%

100%

6 10

1920

53 46

22 24

Very informed

Somewhat informed

Not very informed

Not at all informed

BASE: All Qualified Respondents (July n=2505; November n= 1005)Q1005. How informed do you feel about your current options for health insurance (i.e., major medical insurance)?

B

A

75 70

Informed of Health Insurance Options

However, the portion of the General Population who feel informed in November (70 percent) is smaller than the portion in July (75 percent).

Most of the General Population are at least somewhat informed of their health insurance options.

Letters denote significantly greater proportion than the proportion of the indicated group

9


BASE: All Qualified Respondents (Privately insured: n=617; Public insured: n=177; Uninsured: n=211)Q1005. How informed do you feel about your current options for health insurance (i.e., major medical insurance)?

Informed of Health Insurance Options by Insured Status

However, fewer than half of the uninsured population feels informed about their current health insurance options.

Privately Insured Public Insured Uninsured0%

20%

40%

60%

80%

100%

413

2615

16

3255

47

32

27 2410

Very informed

Somewhat informed

Not very informed

Not at all informed

81

71

42

Among uninsured, 56 percent felt

“very” or “somewhat”

informed in July

In fact, the uninsured population is less informed now (42 percent) than they were in July (56 percent).

10


BASE: All Qualified Respondents (July n=2505; November n= 1005)Q1915. How informed are you about the Affordable Care Act, also known as healthcare reform, the ACA or sometimes called Obamacare?


20%

40%

60%

80%

100%

2112

31

28

37

43

11 17

Very informed

Somewhat informed

Not very informed

Not at all informed

A

A

B

48 60A

Informed about the ACA

The General Population are more likely to say they are “very” or “somewhat” informed now (60 percent) than they were in July (48 percent).

A majority of the General Population is at least somewhat informed about the ACA.


11


BASE: All Qualified Respondents (Privately insured: n=617; Public insured: n=177; Uninsured: n=211)Q1915. How informed are you about the Affordable Care Act, also known as healthcare reform, the ACA or sometimes called Obamacare?

Informed about the ACA by Insured Status


20%

40%

60%

80%

100%

1018 21

2616

37

46 47

30

18 18 12

Very informed

Somewhat informed

Not very informed

Not at all informed

64

65

42

12

Those uninsured (42 percent) are less likely than those privately (64 percent) and publicly (65 percent) insured to say they are “very” or “somewhat” informed about the ACA.

Less than half of the uninsured population feel at least somewhat informed about the ACA.


BASE: All Qualified Respondents (n=1005)Q1950. How are you familiar with the new Exchanges such as healthcare.gov through which you can buy health insurance for 2014, if at all?

Familiarity with New Health Insurance Exchanges

While 85 percent of all the General Population are familiar with the new Exchanges, the uninsured population is less likely than those privately insured to be familiar with the new Exchanges (69 percent versus 90 percent).

A vast majority of the General Population are familiar with the new health insurance Exchanges.

Gen Pop Privately Insured

Public Insured

Uninsured

Heard of Exchanges (NET) 85 90 82 69

I have visited one of the Exchange websites. 19 18 10 16

I have heard of the Exchanges and may go to one of the websites or call in the future. 15 14 8 27

I have called one of the Exchanges. 4 5 * *

I have spoken to a navigator or guide for an Exchange. 4 4 1 1

I have heard of them but have no need to visit the websites or call. 49 57 62 28

I haven’t heard of them. 15 10 18 31

13


BASE: If Heard Of Exchanges (n=830)Q1955. From what source(s) did you hear about the new Exchanges such as healthcare.gov? Please select all that apply.

News programs on television or radio

Advertising on television, magazines, newspapers, or radio

Friends or family

Articles in magazines or newspapers

Social media (Facebook, Twitter, etc.)

A government website such as www.healthcare.gov

Coworkers

My employer or my spouse/partner's employer

Communication from elected officials (local, state, and federal)

Health insurance companies

A search engine like Google, Yahoo or Bing

58

34

29

24

18

15

11

11

10

10

10

Online discussion boards

Online blogs

My health insurance agent

A medical website like WebMD, Medscape

A foundation/non-profit

Physicians, nurses and other healthcare professionals

A financial or benefits advisor

Hospital website (e.g., local hospital)

A navigator or guide for an Exchange

Pharmacist

Other

8

7

6

4

4

4

3

3

3

1

5

Source of ACA Information

A third (34 percent) have heard about them through advertising; and about three in ten heard about them from friends and family.

Over half (58 percent) of those familiar with the new Exchanges heard about them through news programs on television or radio.

14


BASE: All Qualified Respondents (July n=2505; November n= 1005)Q1940. As you may know, the ACA insurance mandate will go into effect in January 2014 and January 2015. In January 2014, individuals will need to

have health insurance or pay a fine for opting out of health insurance. In January 2015, employers with 50 or more employees will be required to provide health insurance for all full-time employees. Knowing this, how prepared are you to make decisions regarding your health insurance choices by then?


20%

40%

60%

80%

100%

15 11

2318

38

38

2533

Very prepared

Somewhat prepared

Not very prepared

Not at all prepared

A

B

63 72A

Preparedness to Make Health Insurance Choices after the ACA Mandate

The General Population’s level of preparedness has increased since July (63 percent) with now 72 percent feeling at least somewhat prepared.

Over seven in ten feel prepared to make decisions once faced with the ACA mandate on January 1*.

*Survey was administered before open enrollment was extended to March 31.Letters denote significantly greater proportion than the proportion of the indicated group

15


BASE: All Qualified Respondents (Privately insured: n=617; Public insured: n=177; Uninsured: n=211)Q1940. Knowing this, how prepared are you to make decisions regarding your health insurance choices by then?


20%

40%

60%

80%

100%

618 2312

10

4344 27

273845

7

Very prepared

Somewhat prepared

Not very prepared

Not at all prepared

82

72

Preparedness to Make Health Insurance Choices after the ACA Mandate by Insured Status

While a majority of the General Population feels prepared, only slightly over a third of those uninsured say they are prepared.

35

There is a sizeable gap between those uninsured (35 percent) and those privately (82 percent) and publicly (72 percent) insured in feeling at least somewhat prepared to make health insurances choices by the ACA mandate deadline.

16



20%

40%

60%

80%

100%

8 10

1317

5047

29 26

Very satisfied

Somewhat satisfied

Not very satisfied

Not at all satisfied

BASE: All Qualified Respondents (July n=2505; November n= 1005)Q730. Overall, how satisfied are you with the quality of the healthcare system you have access to today?

79B 73

Satisfaction of Quality of Health Care System

Though the portion of the General Population saying they are “very” or “somewhat” satisfied is lower now (73 percent) than it was in July (79 percent).

A majority are still satisfied with the Quality of the Health Care System.


17


BASE: All Qualified Respondents (Privately insured: n=617; Public insured: n=177; Uninsured: n=211)Q730. Overall, how satisfied are you with the quality of the healthcare system you have access to today?

Satisfaction of Quality of Health Care System by Insured Status

Satisfaction with the Health Care system largely depends on an individual’s access to health insurance.


20%

40%

60%

80%

100%

4 7

3112 9

3552

43

323241

3

Very satisfied

Somewhat satisfied

Not very satisfied

Not at all satisfied

84 84

34

Only a third of those uninsured (34 percent) are satisfied with the quality of the health care system they have access to.

18


Detailed Findings: Preparations for Individual Mandate



BASE: All Qualified Respondents (July n=2505; November n= 1005)Q1945. What actions, if any, have you taken in the past 12 months to prepare for the ACA? Please select all that apply.

July (A)

November (B)

Discussed it with my friends/family 23 B 17Researched possible new health insurance options 15 13Calculated healthcare expenses for me and/or my family 8 9Spoken to my healthcare providers about possible changes in access to their services 8 B 5

Spoken to my employer or HR about possible changes in healthcare benefits 8 B 5

Spoken to my current health insurance company about possible changes in service 6 5

Started saving more money to cover future healthcare expenses 9 B 4Applied for health insurance through a government-sponsored program such as Medicare, Medicaid, veteran’s benefits, etc. n/a 4

Purchased insurance through the traditional insurance market n/a 3Switched to my spouse’s health coverage n/a 2Purchased health insurance for 2014 through the new Exchanges such as healthcare.gov n/a 2

Obtained coverage through my college/university n/a 1Was added to my parent(s)’s health coverage n/a 1Other 3 3Nothing 57 59

Actions Taken to Prepare for the ACA

Most commonly, the General Population say they have discussed the ACA with friends/family (17 percent).

Nearly six in ten (59 percent) have not taken any action to prepare for the ACA.


20


BASE: All Qualified Respondents (Currently insured through employer: n=504; currently insured; not through employer: n=290; uninsured: n=211)Q1942. With the ACA's insurance mandate for individuals beginning in January 2014, which of the following do you plan to do?

Intentions in Response to ACA MandateAmong those uninsured, however, 55 percent are “not sure” what they will do when faced with the ACA mandate.

Majorities of those insured intend to either continue to receive coverage through their employer or keep the same insurance they have.

Currently Insured through

Employer

Currently Insured, not

through employer Uninsured

Continue to receive coverage through an employer 81 n/a n/aKeep the same insurance I currently have n/a 53 n/aPurchase health insurance through the new Exchanges such as healthcare.gov by the deadline 3 5 10

Not purchase health insurance and pay the tax penalty 1 5 12

Apply for new health coverage through a government sponsored program such as Medicare, Medicaid, veteran's benefits, etc.

3 7 12

Purchase new coverage through the traditional insurance market 2 6 2

Other * 6 9Not sure 10 18 55

Of those planning on paying the penalty, 68% are currently uninsured

21


BASE: If Planning to Pay Penalty (n=39) *Caution: Small base sizeQ1965. For what reason will you choose not to purchase health insurance? Please select the answer that best represents your reason.

Paying my health expenses and the tax penalty is less expensive than the options available to me.

I don't support the ACA on principle.

The process of signing up through the exchanges seems too difficult.

I'm healthy enough to not need insurance.

I'm not well informed enough about the ACA or my options so I will pay the penalty.

Other

48

38

6

3

1

3

Reasons for Not Purchasing Health Insurance*

Of those who intend to pay the penalty in lieu of purchasing insurance, nearly half (48 percent) say their health expenses plus the penalty would be less expensive than the options available to them.

22

A sizeable portion (38 percent) will not purchase health insurance on principle.


BASE: Employed and Qualified (n=608)Q1960. What has your employer done for you regarding the ACA, its requirement that individuals have health insurance by January 2014, or the new

Exchanges such as healthcare.gov through which you can buy health insurance?

Provided a summary or detailed description of the law and its impacts

Provided information via email

Provided information on or direction to the new Exchanges such as healthcare.gov

Provided a comparison of how health insurance costs may change

Provided a list/comparison of my options for obtaining health insurance

Held a webinar or meeting to provide information

Had one-on-one conversations with me

Other

My employer has not provided any information about the ACA

I do not know if my employer has provided any information

15

13

12

11

11

8

6

9

34

17

Employer’s Action Regarding ACA

Only 15 percent of those who are employed say their employer provided a detailed description of the ACA and its impacts.

Of those employed, fewer than half recall receiving any information from their employer about the ACA.

Over half (51 percent) of those employed say

their employer has not provided information or is unaware of employer-

provided information

23


Detailed Findings: Pre-Existing Medical Condition and the ACA’s Impact on Health Insurance



BASE: All Qualified Respondents (n=1005)Q735. Do you currently have or have you ever had a pre-existing medical condition that has made it difficult to get or afford health insurance?

Yes, I have had a pre-existing condition, but I have not had difficulty getting health insurance.

Yes, I have had a pre-existing condition, but it has not made health insurance more expensive.

Yes, the cost of insurance with the pre-existing condition was too expensive so I was unable to afford health insurance.

Yes, the cost of insurance with the pre-existing condition was more expensive but I was able to afford health insurance coverage.

Yes, I was unable to find a health insurance provider that would provide me health insurance.

No, I have not had a pre-existing medical condition.

8

7

6

5

3

71

9 percent of Americans are either priced out of or do not have access to health insurance due to a pre-

existing condition

Impact of Pre-Existing Medical Condition

Almost 10 percent of the General Population claim that they have a pre-existing condition and are unable to find (3 percent) or afford (6 percent) health insurance.

About three in ten (29 percent) of the General Population have a pre-existing medical condition.

25


BASE: All Qualified Respondents (n=1005)Q1966. How have your health insurance choices for 2014 been directly impacted by the ACA? Please select all that apply.

My employer or my spouse's employer now offers health insurance coverage

My employer or my spouse's employer no longer offers health insurance coverage

I am able to get coverage through my parent(s)'s insurance

I have a pre-existing condition and can now get health insurance coverage

I now have insurance through Medicaid

I can purchase a catastrophic care plan

Other

I haven't noticed a difference in my choices

8

5

5

4

3

3

7

71

ACA’s Impact on Health Insurance Options

A majority (71 percent) of the General Population is unaware of any impact the ACA has had on their health insurance options.

“Costs have gone up”“Fewer coverage options”“My employer has raised

the employee contribution”

“More difficult for me to obtain health care”

Among those unable to access or afford health insurance due to a pre-

existing medical condition, 35% say they

can now get health coverage*

26

Among those who have suffered insurance limitations due to a pre-existing condition, over a third (35 percent), say they can now get health coverage thanks to the ACA.

*Base among those unable to access or afford health insurance due to a pre-existing medical condition: n=79


Demographics

GenderJuly

(n=2505)

November(n=10

05)

Male 47% 47%

Female 53% 53%

Age

18-34 33% 35%

35-49 34% 34%

50-59 23% 19%

60+ 11% 12%

Ethnicity

White 71% 67%Hispanic 14% 16%Black 10% 12%Asian or Pacific Islander 2% 2%Native American or Alaskan Native

* *

Mixed Race - *Some other race 1% 1%

Employment Status July November

Employed full time 53% 50%Employed part time 10% 12%Self-employed 5% 7%Not employed, but looking for work 8% 7%Not employed and not looking for work 1% 1%

Not employed, unable to work due to a disability or illness 4% 4%

Retired 5% 6%Student 5% 7%Stay-at-home spouse or partner 8% 7%Employer Size (n=1704) (n=608)

1 – 9 16% 20%

10 – 24 8% 8%

25 – 49 8% 7%

50 – 99 10% 7%

100 – 499 14% 13%

500 – 999 9% 7%

1000 or more 34% 38%

27


Demographics

Primarily Receive Health InsuranceJuly

(n=2505)

November(n=10

05)

PRIVATELY INSURED 67% 65%

I receive benefits through an employer 57% 52%I buy my own health insurance, not through any organization

8% 10%

I receive benefits through a union 2% 3%I receive benefits through a trade association * 1%

PUBLIC INSURED 13% 13%

I receive benefits through Medicare 5% 5%I receive benefits through Medicaid or another state funded program 5% 4%

I receive VA benefits from my own service or through my spouse 2% 2%

I receive benefits through military service 1% 2%UNINSURED (I do not have health insurance at this time) 21% 22%

Insured (n=2150) (n=794)

The primary insured 74% 73%

A dependent or spouse 26% 27%

28

© transamerica center for health studies, 2013 transamerica center for health studies sm survey:...

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