People buying health insurance through the Affordable Care Act are getting frustrated with their premiums and deductibles, according to a poll out Friday, although a substantial majority still think highly of the coverage they get.
The poll, from the Henry J. Kaiser Family Foundation, provides a snapshot of how the people most affected by Obamacare feel the law is working out for them. The survey focuses on what experts call the “non-group” market for insurance -- that is, Americans buying private coverage directly for themselves and their families, rather than those who get coverage through employers or from government programs like Medicare and Medicaid.
Until 2014, when the bulk of the Affordable Care Act’s coverage expansion took effect, people in this situation were at the mercy of what was widely considered to be a dysfunctional insurance market. Carriers in most states could deny coverage or charge higher premiums to people with pre-existing health conditions. They could also sell policies with huge gaps in coverage. Meanwhile, even people with access to coverage frequently couldn’t afford it.
The Affordable Care Act has imposed new rules in an effort to fix these problems. Now, insurers must cover anybody willing to pay the premiums, with no markups for pre-existing conditions, and the plans must pay for maternity care, prescriptions, and other services that the government deems essential. The law also created exchanges -- special electronic marketplaces through which consumers can comparison shop for policies and, depending on their incomes, receive tax credits that can reduce premiums and sometimes out-of-pocket costs significantly.
As of early this year, nearly 13 million people had signed up for coverage on the exchanges, which consumers know as healthcare.gov or state-specific marketplaces like Covered California. It’s a major reason the number of uninsured Americans has fallen to historic lows. And, according to Kaiser’s poll, the majority of consumers getting private coverage through one of the exchanges have positive feelings about it -- with 54 percent saying their insurance is “good,” according to the poll, and another 14 percent rating it “excellent.” Just 16 percent said it was “not so good,” while 13 percent called their insurance “poor.”
Those figures represent a slightly more negative take on coverage, compared with what the Kaiser Foundation found in 2014 and 2015, when it asked the same questions. Even so, more than two-thirds are giving their new insurance high marks. These numbers are more or less the same for people who buy the newly regulated plans directly from insurers, outside of the exchanges.
But deeper in the poll are signs that, even with government assistance, consumers are growing weary of what they are paying for their insurance and their health care. A slim majority of exchange consumers (51 percent) say the value of their plans is “only fair” or “poor.” This is a reversal from the previous two years, when majorities said the value of their plans was “good” or “excellent.”
The big problem doesn’t seem to be choice of doctor and hospital, despite all the media attention to “narrow networks” in the new plans. Large majorities of customers said they were satisfied with those choices. Rather, the two largest sources of dissatisfaction, according to the survey, were premiums and deductibles.
The health care law actually limits out-of-pocket spending for non-group plans. Before the Affordable Care Act, no such limits existed. But some consumers can still end up owing thousands of dollars in medical bills before hitting those limits. Among survey participants reporting problems with their current insurance policies, the most common complaint was discovering that an insurer paid less for a service than the consumer expected.
The survey compared responses with those from people who get employer-sponsored insurance. Overall, people buying coverage on their own were generally less happy with their insurance. But that’s always been the case, and satisfaction with employer plans also seems to be declining -- which probably has something to do with the fact that deductibles in employer plans have also been rising, and had been even before the Affordable Care Act took effect.
How attitudes change in the future is obviously impossible to predict. Many insurers have indicated they will be seeking substantial premium increases next year, because the current levels aren’t adequate to cover the medical bills of the newly insured. That's bound to cause more dissatisfaction. But the tax credits provide insulation against large hikes, at least for most of those buying on the exchanges, although sometimes consumers must switch plans in order to keep costs low.
Helping people deal with medical expenses has already been a topic of much discussion in the presidential campaign. Hillary Clinton, front-runner for the Democratic presidential nomination, has proposed making additional financial assistance available to people with high medical costs. Her rival, Sen. Bernie Sanders (I-Vt.), has proposed scrapping the existing insurance system altogether and replacing it with a single, government-run plan, financed by taxes rather than premiums, that would have no cost-sharing for covered services.
Presumptive GOP nominee Donald Trump has been less specific about his ideas on health care. He has committed himself to repealing Obamacare, which he calls a “disaster,” and has indicated his support for some traditional conservative ideas, like allowing purchase of insurance across state lines. The end result of his agenda would likely be many more people struggling with health care bills, although Trump has promised that what he creates in place of the existing system will be “something terrific.”