Insights into Low-Income Americans’ Experience with Coverage and Care

The Kaiser Family Foundation recently released an in-depth report that offers insight into the attitudes and health care experiences of adults at the start of Affordable Care Act (ACA) implementation and points us in the right directions for outreach and enrollment going forward. The Uninsured at the Starting Line: Findings from the 2013 Kaiser Survey of Low-Income Americans and the ACA took information from comprehensive surveys of people with low and moderate incomes, asking questions about health coverage, current patterns of care, and family situations. What people shared about their experiences with health insurance, how they access health care, and the obstacles they face is informative as we understand the challenges of open enrollment and adapt to meet people’s needs.

Access to Coverage
In addition to painting a picture of the lack of access to affordable health care coverage, the report reveals that most uninsured adults have been without coverage for 5 years or more. Adults with health insurance tend to have continuous coverage over time, but many have disruptions or changes to their plans, mostly due to changes in employment status employment. The numbers are sizable: 18 million adults lose or gain coverage during the year, and 17 million have changes in their insurance plan.

There has been a monumental effort during open enrollment to educate consumers about their new coverage options under the ACA and assist them in enrolling in plans. These report findings demonstrate that there will be a need for outreach and enrollment assistance that goes beyond helping consumers access care for the first time and provides continuous support to enroll and keep people in coverage, as well.

Choosing a Health Plan
The surveys found that people did not always prioritize the lowest cost when picking a health insurance plan. Thirty-two percent of people surveyed reported choosing a plan because of the benefits that were offered, 29% because the cost would be low, and 22% because of provider networks.

Internet access is an important tool for enrolling in a plan and maintaining coverage under the ACA. While most uninsured adults have access to the Internet, 19% of those qualifying for Medicaid (<138% FPL) and 14% of those eligible for the premium tax credit (139-400% FPL) reported that they did not have Internet access readily available. In addition, a regular monthly premium must be paid to maintain coverage, and 23% of uninsured adults (100-400% FPL) indicated that they did not have checking or savings accounts.

Certified Application Counselors and Navigators play a central role in helping consumers choose a health insurance plan. The task of filtering and explaining options in Healthcare.gov must consider the various priorities that people balance in plan selection and point consumers to resources that provide additional plan information. Consumers also rely on assisters to help them overcome logistical obstacles to access and payment.

Getting Care
Most people without insurance have little connection to the health care system. More than 41% of uninsured adults reported no health care visits in the last year, as compared to 10% of Medicaid beneficiaries and 13% of adults with employer coverage. A substantial number has health needs, many of which are unmet or met with difficulty due to cost.

Outreach may be needed to help those enrolling in plans for the first time to find a regular provider and establish a pattern of regular preventive care. Those who rely on care at an emergency room or urgent care center may need guidance in navigating the primary care system. Health Centers will play a critical role in ensuring access to primary and preventive care for those newly enrolled in coverage through the Marketplace, or the Healthy Michigan plan when it is available beginning in spring 2014. You can read more about the role of Health Centers here.

Data Tables
For a better understanding of uninsured adults and their patterns of coverage, you can link to data tables in the report:

Table A1: Demographics of Adults, by Insurance Coverage

Table A2: History of Uninsurance and Attempts to Gain Coverage Among Currently Uninsured Adults, by Income

Table A4: Reasons for and Problems with Choosing Health Plan, Among Adults who Had and Made a Choice, by Income

Table A6: Knowledge of Coverage Pathways available under the ACA, by Income and Coverage

If you have any questions about this article, please contact Julie Tatko, MPCA Program Coordinator, Outreach, Education & Enrollment.

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