Transamerica Institute

Highlights: Consumers 2014

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 coverage with possible subsidies.

  • Since November 2013, the percentage of uninsured Americans has fallen from 22 percent to 15 percent.
  • Among the remaining uninsured, 44 percent are between ages 18 and 34, and 33 percent are Latino.
  • 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.
  • 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.

More than three-quarters (78 percent) of the newly insured population (ages 18-64) are at least somewhat satisfied with the quality of the health care that they can access now.

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.
  • An increase in cost of premiums, deductibles or out-of-pocket expenses was the most cited (48 percent) impact felt by the continuously insured.
  • Overall, the group remains satisfied (84 percent at least somewhat satisfied – no change since November 2013) with the quality of health care system that they can access now.

In 2014, 33 percent of employers said they expect their companies to increase headcount in the next two years while accounting for the ACA, compared to 20 percent in 2013.  

  • Only 11 percent said they expect the number of employees at their company to decrease as a result of ACA.
  • The increases are anticipated primarily among businesses with over 50 employees that are impacted by the employer mandate, with 44 percent indicating a likely increase in headcount while accounting for the ACA.

With the individual mandate taking effect in 2014 and the employer mandate (for companies with over 100 employees) in 2015, employers are placing more priority on offering health insurance to all employees and less priority on minimizing health care costs.

  • In 2014, 12 percent of employers indicated that offering health insurance to all employees was the top benefits-related priority compared to 6 percent in 2013.
  • In 2014, only 6 percent of employers said minimizing health care costs was their top benefits-related priority compared to 18 percent in 2013.

Only half of small businesses with less than 50 employees are aware of the Small Business Health Options Program Marketplace (SHOP) which gives these businesses an opportunity to provide coverage for their employees (with potential tax credits).

  • 50 percent of small businesses are aware of SHOP, compared with 82 percent of businesses with 50-499 employees and 84 percent of businesses with 500 or more employees.
  • 12 percent of small businesses expect to offer coverage to employees through the Small Business Health Options Program (SHOP) marketplace within the next 1-2 years.

Highlights: Businesses 2014

Nine in ten (91 percent) employers believe that their employees are satisfied with the health insurance options offered to them.

  • This is not far off from what employees actually reported this year – three-quarters (76 percent) are satisfied with the health insurance plan available through work.

In 2014, 33 percent of employers said they expect their companies to increase headcount in the next two years as a result of the ACA, compared to 20 percent in 2013.  

  • Only 11 percent said they expect the number of employees at their company to decrease as a result of ACA.
  • The increases are anticipated primarily among businesses with over 50 employees that are impacted by the employer mandate, with 44 percent indicating a likely increase in headcount due to the ACA.

With the individual mandate taking effect in 2014 employers are placing more priority on offering health insurance to all employees and less priority on minimizing health care costs.\

  • In 2014, 12 percent of employers indicated that offering health insurance to all employees was the top benefits-related priority compared to 6 percent in 2013.
  • In 2014, only 6 percent of employers said minimizing healthcare costs was their top benefits-related priority compared to 18 percent in 2013.

Little consensus exists among businesses on the impact the ACA will have on the quality of health care offered.

  • Although a majority do not anticipate the ACA will impact the quality of the health insurance employers are able to offer their employees, the rest are split on whether the ACA will result in an improvement (28 percent) or a decline (21 percent) in quality.
  • On the whole, businesses appear to be somewhat more optimistic about the impacts of the ACA. In July 2013, 36 percent of businesses said the ACA will provide no improvements the company is interested in, but just 28 percent say the same in 2014.

Highlights: Pulse Check Survey 2014

Employers are significantly more informed about their companies’ options for offering health insurance than they were in 2013. Thirty-two percent more employers reported being very informed in 2014.

  • In the 2013 benchmark study, only 37 percent of employers reported being very informed about their options. In 2014, 69 percent are very informed.

More employers think their number of employees will increase due to the ACA.

  • Twenty-eight percent of businesses expect the number of their employees to increase as opposed to decrease (15 percent) as a result of the ACA.

Over a quarter (29 percent) of employers are researching actions that may avoid the need to fully comply with ACA mandates.

  • Almost a quarter (23 percent) of U.S. businesses are researching reductions in employees or full-time employees in preparation for the ACA implementation.
  • A third of businesses with 100+ employees are researching reductions.
  • Fifteen percent are calculating the cost of the tax penalty vs. the cost of complying with the ACA.

A significant number of small businesses are not well informed about the Small Business Health Options Program (“SHOP”).

  • Although eight in ten companies are aware of the SHOP, only six in 10 businesses with fewer than 50 employees are aware.
  • Just seven percent of small businesses intend to offer employees coverage through SHOP.

Most employers expect changes resulting from the ACA, but details remain unclear.

  • Most (64 percent) employers plan to take action as a result of the ACA.
  • But no particular change is cited by more than 20 percent of businesses.
  • Nineteen percent plan to change plan options
  • Seventeen percent plan to tighten requirements for employees to be eligible for health care benefits
  • Seventeen percent plan to change insurers

Medium size (50-99 employees) employers are aware of ACA mandate deadline extension.

  • Ninety-one percent of employers with 50-99 employees are aware that the deadline of January 2015 for companies of their size to offer employees health care insurance was extended to January 2016.
  • Virtually all (98 percent) employers of this size were aware of the mandate in the first place.

Despite concerns that the ACA would cause companies to eliminate dependent coverage, it appears there may be very little net effect on dependent coverage.

  • Ten percent of companies reported that they plan to eliminate coverage of dependents from their health plans, but nine percent said they plan to add dependent coverage as a result of ACA.