Those who experienced the rocky rollout of the Obamacare health exchanges firsthand are feeling nervous about prices and wary of technical glitches on the eve of the second open enrollment period, according to the latest Bankrate Health Insurance Pulse survey. All of the survey respondents were from households that used the exchanges during the initial open enrollment last fall and winter.
Within that group of respondents, a slight majority — 52 percent — report they had a positive experience, and 53 percent feel confident that the online health insurance marketplace will operate smoothly this time around. In an earlier Bankrate survey, only 39 percent of the general population expressed confidence that the exchanges will work well during the new signup season.
On the other hand, a slight majority of the exchange veterans (51 percent) say they don’t plan to return for round two, which begins Nov. 15.
Results don’t surprise experts
Such mixed feelings toward a possible repeat of last fall’s disastrous debut are understandable, according to Gerald Kominski, director of the UCLA Center for Health Policy Research.
“It’s left almost half of the people surveyed feeling a lack of confidence,” he says. “In the end, the exchanges rallied like a football team that goes down three touchdowns in the first half and has a great second half and pulls it together. But they can’t afford to do that again.”
Mark Schlesinger, a professor at the Yale School of Public Health, says consumer discontent likely varies widely by location.
“State-implemented exchanges have a lot more resources than does the federal HealthCare.gov exchange, a lot more consumer assistance and navigators to help people make choices,” he says. While most states are relying on the federal website, more than a dozen — including California, Kentucky and New York — have built their own exchanges.
“There really is kind of a divide in how well the program is working,” Schlesinger says.
Do you think you or someone in your household will again shop in a health insurance exchange website this fall?
- 53% of those earning less than $30,000 say they plan to give the exchanges another try, compared with just 35% of respondents making $75,000 a year or more.
- 66% of previous exchange users who identify as Republican say they won’t return to the Obamacare marketplace, versus 41% of Democrats and 55% of independents.
- 52% of respondents who work part time say they plan to shop in the exchanges again, compared with 39% of full-timers.
How confident are you that the health exchanges will operate smoothly this fall?
- 55% of women who used the exchanges during the last open enrollment say they’re either very confident or somewhat confident that the websites will work well this time, compared with 50% of men.
- 72% of Republican veterans of the exchanges are either not too confident or not at all confident that the Obamacare marketplace will operate smoothly in the new enrollment season, versus 30% of Democratic respondents and 50% of independents.
- 62% of respondents who work part time are feeling very or somewhat confident about how the exchanges will perform, compared with 47% of full-time workers who used the websites previously.
Editor’s note: Percentages may not equal 100, due to rounding.
Overcoming a bad experience ‘on steroids’
Doug Hough, associate director of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, cites another factor for the public reluctance to embrace the exchanges.
“We’re now so used to the ease of shopping online that when it doesn’t work, we get really annoyed. And not only did the exchanges not work, they didn’t work on steroids,” he says. “Which wasn’t really surprising. Ask (Amazon.com founder) Jeff Bezos what it would have been like if Amazon had gone from zero to millions of customers in one day.”
While 1 in 5 previous exchange users (21 percent) most dread a repeat of the endlessly spinning clock displays and frustrating error messages that came to symbolize the first open enrollment, fear of “much higher” health insurance rates is the biggest concern (43 percent) on the worry meter.
The fear levels mirror those of the general public in Bankrate’s earlier survey.
Consumers may be ‘surprised and happy’
All three experts say those fears, while logical, are largely unfounded.
“That is just absolutely, certainly not going to be true,” says Schlesinger. “A lot of people who may be worried about … the exchanges will be surprised and happy because we know there’s not going to be much movement on price. In some places, it’s actually going down a little.”
What some consumers may perceive as a premium increase could actually be the result of a change in their federal tax subsidy.
“The one part that may affect them is, if their income has gone up, they’re not going to get as big a subsidy,” Schlesinger explains, “so effectively they could face a higher price — not because the insurance price has changed, but because the subsidy has gone down.”
He calls the subsidy lesson part of our national learning curve on how to shop on the exchanges. “People will have to build some skills before they become comfortable with the choices they make.”
Where will the exchange-phobes go?
What about the more than half of the respondents who say they won’t return to the exchange for the second open enrollment? What’s their plan B?
“That’s a good question,” says Kominski. “Going without insurance is far more risky than trying to make the exchange work. My guess is they don’t qualify for a subsidy and therefore are going to shop for coverage outside the exchange. That’s a reasonable alternative because the law regulates those so-called ‘mirror’ policies to where there aren’t significant differences. But I don’t think there are any huge bargains there.”
Schlesinger says changes in employment, income or family status also could pull some people away from the exchange and onto either employer plans, Medicare or Medicaid.
“Some of it may be that they’re just in different circumstances,” he says.
Auto-renew to avoid revisiting exchanges?
But Hough predicts that those who currently have exchange policies and simply don’t bother to log onto their state exchange may be surprised by the result.
“They’re going to be auto-renewed,” he says. “With 43 percent saying their experience last time was somewhat or very bad, they’re not looking forward to doing it again. That in itself will encourage people to just go with auto-renew. I predict we’ll see lots and lots and lots of auto-renewals.”
Methodology: Bankrate’s Health Insurance Pulse survey was conducted by phone between Sept. 25 and Oct. 19 by Princeton Survey Research Associates International with a nationally representative sample of 558 adults from households in the continental U.S. that visited the health exchanges during the previous enrollment season. The margin of sampling error is plus or minus 4.7 percentage points.
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