Survey: Most Buying On Insurance Exchanges Weren’t Previously Covered

Reprinted with permission from Kaiser Health News

Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law.

That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured.

The survey also found that consumers who purchase their own coverage because they can’t get it at work are more likely to have a favorable view of the Affordable Care Act than the general public. Still, they are nearly evenly divided, with 47 percent holding a favorable view of the law and 43 percent an unfavorable one, according to the survey by the Henry J. Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

That compares with 46 percent of adults nationally who are sour on the law, and 38 percent who hold favorable views.

Consumers who received a government subsidy to help them purchase a plan were most likely to say they benefited from the law, according to the Kaiser survey. Those most likely to say they were negatively affected were those who had prior coverage but had to switch because their plans were discontinued for not meeting the law’s standards or for other reasons.

The report is likely to provide fodder for all sides in the debate about the law’s effect on health care costs and reducing the number of uninsured, which remains sharply partisan.

The findings suggest the new market for those who buy their own insurance “is working far better than critics say it is, but probably not as well as advocates hoped it would be,” said Drew Altman, president and CEO of the nonpartisan foundation.

Aside from data about premium costs, there has been little information so far about the experiences and perceptions of those who buy their own coverage. Are they healthier or sicker than those who get coverage through their jobs? Did people who lose their former coverage end up paying more or less for new plans? Do they like their coverage?

The Kaiser survey provides additional details based on a telephone survey of a nationally representative sample of 742 adults who purchased their own coverage. Many of the health law’s provisions were aimed at them, from the subsidies to help low- and middle-income residents buy coverage, to rules barring insurers from rejecting people with medical conditions, or charging women more than men.

The report shows sharp contrasts between those who say the law benefited them and their families and those who felt it hurt them:

— 34 percent of enrollees say they have benefited from the law, often citing lower costs or better access to care, while 29 percent said they were negatively affected, generally as a result of increased costs.

— 71 percent of those who enrolled in a plan that took effect after Jan. 1 rate their coverage as excellent or good, with 55 percent saying it is an excellent or good value for what they pay, but 39 percent rate it as an “only fair” or “poor” value.

— 43 percent say it is difficult to afford their monthly premiums and nearly half, 46 percent, are not confident they would be able to afford their share of the cost of a major illness or injury. About one third of those with new plans say they are dissatisfied with their deductibles.

Overall, about half of those who purchased a plan that met the health law’s rules said they got help in enrolling, from family members, assisters, brokers or others.

The survey was taken in April and early May, which means some respondents had held their policies since January, while others didn’t finish enrolling until mid-April, so had little or no experience using the new plans.

“It’s still fairly early so I’m not sure how much weight to give these responses,” said Sabrina Corlette, project director at the Health Policy Institute at Georgetown University. “How many are satisfied but haven’t used their plan yet?”

Altman acknowledged that it will be several years before the full picture is known, but said the survey offers insights into several important policy questions, from the percent of enrollees who were previously uninsured to their health status when they signed up.

The relative health of new enrollees is important because insurers base their premiums partly on estimates of how much they may have to pay out in claims. Under new rules, they can no longer bar the sick or charge them more.

The survey found that people enrolling in new coverage were more likely to report being in “fair” or “poor” health (17 percent) than those who hung onto older plans purchased before the law went into effect (6 percent), suggesting they may be sicker and costlier to cover. Insurers built such projections into their rates for this year and as people start to use their coverage, are only starting to find out if they projected correctly.

One section of the survey examines the experiences of those whose policies were canceled, or who switched from previous coverage to something new for other reasons.

While the law’s critics have argued those consumers ended up paying more and getting less, the report found that 46 percent of those who switched plans paid less for their coverage, often because of subsidies, while 39 percent paid more. Annual deductibles – the amount enrollees pay before insurance picks up most of the tab – are similar to what they paid before. More than half described their choice of medical providers as “about the same.”

Even so, the survey found that those who switched are less satisfied with the cost of their plans than those who were previously uninsured and less likely to believe their coverage is a good value.

Those reactions should not be seen as “a call to arms to beef up this coverage” since such efforts could boost premiums and government spending on subsidies, said Joe Antos of the American Enterprise Institute.

The federal government is expected to spend about $12 billion on insurance subsidies this fiscal year, which ends in September, according to the latest report from the Congressional Budget Office. People earning between 100 percent and 400 percent of the federal poverty level – about $11,500 to $46,000 a year — can qualify for subsidies on a sliding scale.

“There are resource limits,” Antos said. “Going back to taxpayers and saying we want you to cough up more money probably won’t be a big seller.”

The survey’s margin of error is plus or minus 4 percentage points for results based on the full sample, 5 percentage points for those who bought plans on or after Jan. 1 and 6 percentage points for those in plans purchased through the marketplace.

Norman Ornstein Writes Once Again That The Republicans Are The Problem

Norman Ornstein once again sets the record straight, resonding to those who say both parties are responsible for the degree of polarization and gridlock we are now experiencing:

Tom Mann and I, among others, have said that the polarization in the capital is asymmetric, much more on the conservative and Republican side than on the liberal and Democratic side. An army of journalists—including Ron Fournier, Paul Kane, and others—have said both sides are to blame. And journalists led by Jim Fallows have decried what he first called “false equivalence.” This malady itself has two components. The first, which in many ways is a larger ingrained journalistic habit that tries mightily to avoid any hint of reporting bias, is the reflexive “we report both sides of every story,” even to the point that one side is given equal weight not supported by reality. The second, often called the Green Lantern approach and typified by Bob Woodward, is that presidential leadership—demanding change, sweet-talking, and threatening lawmakers—could readily overcome any dysfunction caused by polarization, thus allocating responsibility in a different way that deflects any sign of asymmetry.

As the Pew study makes clear, in the mid- to late-1990s, we did not have anywhere near the level of public polarization or ideological or partisan animosity that we have now. In the public, this phenomenon has been much more recent (and is accelerating). But in the Gingrich era in Congress, starting in 1993, where Republicans united in both houses to oppose major Clinton initiatives and moved vigorously from the start of his presidency to delegitimize him, the era of tribalism started much earlier, while the ante was upped dramatically in the Obama years. The fact is that it was not public divisions on issues that drove elite polarization, but the opposite: Cynical politicians and political consultants in the age of the permanent campaign, bolstered by radio talk-show hosts and cable-news producers and amplified by blogs and social media, did a number on the public.

The elite tribalism was not all one-sided. To be sure, there was plenty of vitriol hurled by Democrats at George W. Bush. But Democrats worked hand-in-glove with Bush at the early, vulnerable stage of his controversial presidency to enact No Child Left Behind, which gave his presidency precious credibility and provided the votes and support needed for his tax cuts. Contrast that with the early stages of the Obama presidency.

Merry uses immigration to dispute our characterization of the contemporary Republican Party as an insurgent outlier, dismissive of science; no surprise that he does not mention climate change. As for Ron Fournier, I have one point of contention and one response to his question, “Who cares?” First is the characterization of those who believe that the polarization is asymmetric as partisans. There are partisans who have seized on the ideas, but it is very unfair to characterize the scholars and most journalists who have written about this as biased—just as it would be deeply unfair to characterize Fournier, a straight-up journalist of the old school, as an instrument of Republicans or the Right.

More important is the question he raised. Does it matter whether the polarization, and the deep dysfunction that follows from it, is equal or not, including to the average voter? The answer is a resounding yes. If bad behavior—using the nation’s full faith and credit as a hostage to political demands, shutting down the government, attempting to undermine policies that have been lawfully enacted, blocking nominees not on the basis of their qualifications but to nullify the policies they would pursue, using filibusters as weapons of mass obstruction—is to be discouraged or abandoned, those who engage in it have to be held accountable. Saying both sides are equally responsible, insisting on equivalence as the mantra of mainstream journalism, leaves the average voter at sea, unable to identify and vote against those perpetrating the problem. The public is left with a deeper disdain for all politics and all politicians, and voters become more receptive to demagogues and those whose main qualification for office is that they have never served, won’t compromise, and see everything in stark black-and-white terms.

Besides, this excerpt, read the full article, along with his writings with Thomas Mann, including this op-ed and their book, It’s Even Worse Than It Looks. For a look at the unprecedented obstructionism towards Obama practiced by the Republicans, see this Frontline documentary,The Republicans’ Plan For The New President:

On the night of Barack Obama’s inauguration, a group of top GOP luminaries quietly gathered in a Washington steakhouse to lick their wounds and ultimately create the outline of a plan for how to deal with the incoming administration.

“The room was filled. It was a who’s who of ranking members who had at one point been committee chairmen, or in the majority, who now wondered out loud whether they were in the permanent minority,” Frank Luntz, who organized the event, told FRONTLINE.

Among them were Senate power brokers Jim DeMint, Jon Kyl and Tom Coburn, and conservative congressmen Eric Cantor, Kevin McCarthy and Paul Ryan.

After three hours of strategizing, they decided they needed to fight Obama on everything. The new president had no idea what the Republicans were planning.