Who Did and Did Not Enroll on the Exchanges

A survey supported by the Robert Wood Johnson Foundation was conducted in April 2014 among 671 people who were newly enrolled through the exchanges (69% in private plans and 31% in Medicaid) and 853 who stayed uninsured.  The survey sought to ascertain factors influencing decisions to enroll or not.   (Enrollment Report)   Those who enrolled had to be prepared to put a lot of time into the effort, 60% reported it taking more than a week to complete the entire enrollment process.  Of those who didn’t enroll, 43% said they wanted coverage but couldn’t find a plan to meet their needs, 18% “meant” to sign up but got distracted (valley girls), 15% didn’t know they could sign up (Homer Simpson, doh!!), 15% didn’t want health insurance and 9% didn’t give a reason.  In regard to their next opportunity to enroll, among those who didn’t this time and were told about the mandate and fine, 43% said they definitely or probably would enroll, 41% said they were unsure and 15% said they probably or definitely would not.  If the respondents weren’t told about the mandate and fine, 42% said they definitely or probably would enroll, 43% weren’t sure and 14% gave the finger to health reform (i.e., not going to do it).  That mandate and fine are really having an impact.  Among the unenrolled, African-Americans and Latinos, the colleges educated, employed people and 45-64 year-olds were most likely to say they would likely enroll next year.

Those who enrolled this year were generally more knowledgeable about the reform law and insurance in general.  News was the most cited resource for information, along with websites and family and friends.  Affordability was the biggest concern for those who did not enroll and many of these people were unaware of potential financial assistance.  But 20% of those who didn’t tried to enroll said they didn’t want “Obamacare” and 15% said it was too confusing.  For those who looked but didn’t enroll, 40% said the coverage wasn’t worth the cost, 27% said they had trouble with the website and 26% said it was too confusing.  And for those who did sign up, 36% said it was because it was the law and 34% because they did not want to get fined, not apparently because they felt like they needed it or would get any real benefit.  Forty percent said they would not have signed up in the absence of the mandate.  The health status of those who did enroll was similar to that of those people who did not, with both groups being roughly equally likely to self-report excellent, very good, or good health.  Only 40% of those newly enrolled in private plans are very confident they can afford the premiums, with 34% somewhat confident.  Thirty-one percent say the premium is more than they expected and 25% said it was less than they expected.  This survey was conducted by RWJ, a noted apologist for the flawed reform effort, and Enroll America, as its name suggests, is an advocacy group for enrollment.  Even so, the results of the survey indicate just how bad the response to the law has been.