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Public Insurance Exchange Users

By August 6, 2015Commentary

Deloitte’s Center for Health Solutions surveyed consumers with different forms of coverage, including those who enrolled through a public health insurance exchange, to ascertain their perspectives on their health plan.  (Deloitte Report)   Given the lousy nature of the coverage that is generally available on the exchanges, it is not surprising that only 30% of these public exchange members are satisfied with their coverage, compared to 42% of people getting medical benefits through their employers.  And price is the primary reason reported for dissatisfaction.  These enrollees are also much more focused than other commercial members on the amount they have to pay in premium sharing, deductibles and copays.  This concern with price is reflected in the higher willingness of exchange insureds to accept smaller networks of hospitals or doctors in return for lower prices, even though the nature of the provider network ranks second to cost as a factor in selecting a plan.  Only 24% are confident they can get affordable care and 16% say they feel financially prepared to handle their future health care costs.  16% also say they still skip health care at times because of cost concerns.

These consumers have a slightly better understanding of their plan benefits and costs than do those enrolled in other forms of coverage.  In terms of trusted sources of data to help them make health plan selections, 38% trust family and friends, 36% their health care providers and 36% independent consumer organizations.  Of those who had coverage through an exchange in both 2014 and 2015, 82% said they stayed with the same carrier, but 29% of those switched plan type within the carrier, so overall, 45% changed plans, with price once again being the primary motivator, although provider choice and other factors play a role in these decisions.  And most people who used the exchanges reported some kind of technical or other issue which made the process difficult.

While over two-thirds report a strong interest in using digital technologies for health coverage purposes, a much smaller percentage actually do so.  On the plus side, 76% of exchange members say they have a health care professional they consider to be their primary care provider, while only 34% of those who are still uninsured (wait, what!! there are still uninsured people after all the turmoil we went through to get this wonderful reform law passed?).  And why don’t some people have insurance?  57% say it is due to cost, 24% say they weren’t eligible for Medicaid, 22% said the cost outweighs the benefits, 15% said they would rather pay for health care if and when they need it and 14% said they are healthy and don’t need insurance.  The survey is just another indicator that while an insurance exchange may be a good idea, they have hardly turned into a source of affordable, reliable health care coverage.

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