Transamerica Institute

One Year In: Americans Respond to the Affordable Care Act (ACA)

As a follow up to a survey conducted in September of  2013 that measured individuals' and businesses' knowledge of and preparedness for the Affordable Care Act, Harris poll conducted two surveys, One Year In: Americans Respond to the Affordable Care Act and One Year In: Businesses Respond to the Affordable Care Act on behalf of the Transamerica Center for Health Studies.

The general population survey was fielded between July 14 and July 25, 2014 among a nationally representative sample of 2,624 of the U.S. general population age 18 – 64. Results were weighted (statistically adjusted) as needed on income, education, gender, race/ethnicity, region, employment status, number of employees in company, and health insurance status.

Highlights from the Survey:

In general, continuously insured (insured pre-mandate and currently insured) Americans (ages 18-64) noticed few changes in their health care options.

  • The group of continuously insured Americans makes up the largest portion of the population at 78 percent.
  • 96 percent of this group obtained coverage from the same source in 2013 and 2014.
  • 77 percent of this group did not notice a change in health insurance choices as a result of the ACA.

Nearly half (46 percent) of uninsured Americans (ages 18-64) are uninformed about the individual mandate provision of the ACA and 43 percent have not heard of the state exchanges where they can apply for assistance.

  • Since November 2013, the percentage of uninsured Americans has fallen from 22 percent to 15 percent.
    • 44 percent are between age 18 and 34, compared to 33 percent of the general population.
    • 31 percent are Latino, compared to 17 percent of the general population.
    • 23 percent are unemployed, but looking for work, compared to 7 percent of the general population.
    • 41 percent have a HS or less level of education, compared to 27 percent of the general population.
  • 22 percent said they did not obtain health insurance prior to the ACA deadline because they were not aware of the individual mandate to obtain coverage.
  • Over half (52 percent) of uninsured Americans feel uninformed (not very/ not at all informed) about their current options for health insurance and 47 percent feel uninformed (not very/ not at all informed) about the ACA.
  • 40 percent of uninsured Americans have not gathered information about their health, health insurance, and the health care system in the past 12 months.

Less than half (42 percent) of the uninsured could afford health insurance premiums of just $100 per month.

  • Of those who remain uninsured, 11 percent stated they did not obtain insurance because it is too expensive and 27 percent said paying the tax penalty and health expenses costs less than paying for health insurance.
  • The median household income of uninsured Americans ($37,300) was more than that of newly insured Americans ($33,200), and less than that of continuously insured (insured pre-mandate and currently insured) Americans ($75,200), suggesting a potential affordability gap for middle income Americans.
  • Only about one-fifth (22 percent) of uninsured Americans are currently able to afford routine health expenses, and only five percent are currently saving for health care expenses.

For those continuously insured, an increase in cost was the most commonly experienced change as a result of the ACA. 

  • An increase in cost of premiums, deductibles or out-of-pocket expenses was the most cited (48 percent) impact felt by the continuously insured.
  • 57 percent stated that health insurance premiums of $200 would be affordable.
  • Overall, the group remains satisfied (84 percent at least somewhat satisfied – no change since November 2013) with the quality of health care system they have access to.
  • 83 percent of the continuously insured are currently able to afford routine health expenses, and 26 percent are currently saving for health care expenses.

More than three-quarters (78 percent) of the newly insured population (ages 18-64) are at least somewhat satisfied with the quality of the healthcare system to which they now have access.

  • The newly insured are more satisfied with the quality of the health care system than uninsured Americans (of whom only 47 percent are satisfied with the health care system).

Of newly insured Americans (those who obtained health insurance in the past 12 months and were previously uninsured):

  • 30 percent purchased health insurance through the new Exchanges.
  • 28 percent applied for new health coverage through a government-sponsored program.
  • 33 percent obtained health insurance through an employer or family member’s plan

Newly insured Americans face a more difficult financial burden than continuously insured Americans.

  • Just 10 percent of newly insured Americans are saving for health care expenses (compared to 26 percent among continuously insured).
  • 39 percent say they cannot afford routine health expenses (compared to 17 percent among continuously insured).
  • Just over half of newly insured Americans are able to afford health insurance at a $100/month premium.

Newly insured Americans have the following characteristics:

  • 36 percent are between age 18 and 34, compared to 33 percent of the general population.
  • 11 percent are unemployed, but looking for work, compared to 7% of the general population.
  • 27 percent have a HS or less level of education, compared to 27 percent of the general population.
  • $33,200 is the median HH income, compared to $67,000 of the general population.

Fact Sheets:

 

The Uninsured


The Newly Insured 


The Continuously Insured


Wellness