ACA & The New Normal

Has Affordable Care Finally Gained Traction?

Americans Settle in During Healthcare Uncertainty

A new study from Transamerica Center for Health Studies suggests consumers varying degrees of awareness that possible health policy changes may impact their health coverage and healthcare in general. Read the full report here.

Six years after Health Insurance Exchanges were first launched as a result of the Affordable Care Act (ACA), Americans report they are largely satisfied with their healthcare options, according to a survey of 3,760 adults ages 18-64 in August 2019 by national nonprofit Transamerica Center for Health Studies® (TCHS). This seventh annual survey, Americans Settle in During Healthcare Uncertainty, comes as efforts to repeal and replace the ACA were made (largely unsuccessful) and regulatory changes to the ACA have occurred over recent years. As a result of these changes, consumers have varying degrees of awareness that possible health policy changes may impact their health coverage and healthcare in general.

The following are some key findings from the survey, with a focus on: health coverage, policy, healthcare, affordability, health technology, and prescription drugs.

Health Coverage

The percentage of adults reporting they are uninsured remains consistent with last year, holding at 13%. (Q602) As seen in previous waves of the survey, adults who say they are uninsured tend to be younger, people of color, have lower household incomes, and report being in poorer health. When asked why they have not obtained coverage, the most common response by far is cost (48%). (Q1942) Newly insured adults are increasingly covered by state-funded programs.

Of those who did not previously have health insurance, the most common sources of coverage are employers (41%) and state programs (28% up from 18% in 2018). (Q1941a)

Healthcare Policy

Over two in five Americans have a positive impression of the ACA (42%), furthering the trend since 2017. (Q1916)
Black/African American adults are more likely to have a very positive impression of the ACA (35% vs. 17% White, 25% Latino, 19% Asian/Pacific Islander and 18% Other). (Q1916)

The majority (67%) are at least somewhat aware of potential healthcare policy changes from Washington. Among those who are aware of potential changes, more than half (53%) are concerned about these potential changes. (Q1370, Q1373)
Younger adults are more likely to say they are aware of potential policy changes and are most likely to believe the government should have an individual mandate for insurance coverage.

Gen X and Baby Boomers are more likely to be not at all/somewhat aware (80% Gen X and 82% Baby Boomers vs. 66% Gen Z and 70% Millennials). (Q1370) If the employer mandate is removed, the most desired reaction among employed adults (30%) is for companies to not make any changes in coverage. (Q1375)

When asked about fears associated with health policy changes, around a quarter or more say losing healthcare due to a preexisting condition (31%), a reduction in Medicare (29%) and Medicaid (26%), no annual out-of-pocket limits (24%), and no lifetime limits (23%) are their biggest fears. (Q1930)

Healthcare

Satisfaction with healthcare is at its highest level since the survey was first conducted in 2013 and the same can be said for the percentage of adults who feel the quality of their insurance has increased.

Despite the majority of Americans saying they can afford routine healthcare expenses, more than one in four have canceled an appointment due to the expected costs, most commonly Latinos Generation Z and Millennials...

  • 84% of adults say they are satisfied with the quality of the healthcare system they have access to today. (Q730)
  • 13% say the quality of the health insurance plans they have access to has increased. (Q1927)

There was an increase in the number of people visiting urgent care in 2019 (25% vs. 21% in 2018) and walk-in clinics (19% vs. 15% in 2018). (Q719) Around one in four adults insured via an Exchange (26%) say there has been a decrease in the quality of health insurance plans they have access to. (Q1927)

And, similar proportions of those on Exchanges (23%) say the number/variety of health insurance options they have access to has decreased – consistent with 2018 findings. (Q1927)

  • Insurance is on the rise as an important factor in staying at a job with around half of employed adults saying they can not switch jobs because they need the health insurance.

 

  • Half of employed adults (51%) agree they have to stay at their current job for the health insurance. More than one in five (22%) strongly agree with this, which increased significantly from 18% in 2018. (Q1935)
  • Three in five (61%) say healthcare benefits are very important to their overall job satisfaction, second only to salary/pay (72%). (Q1105)
  • On the other hand, lack of health insurance can also be a driver to switch jobs as three in 10 adults (30%) had to leave a previous job because the company did not offer health insurance. (Q1935)
  • One in ten (10%) of Americans had a telemedicine visit in 2019. (Q719)
  • More than a quarter used mobile health technology to help monitor or diagnose a health condition in the past 12 months. (Q9)
  • One in three adults have asked their doctor about a diagnosis or treatment they found online. (Q5)
  • Almost one in five adults (17%) say they have insisted on receiving a treatment, medication or test against their doctor’s recommendation. (Q6)

Affordability

Being able to pay for necessary care (32%) and being seen in a timely manner (28%) are by far the most important to Americans. (Q735) When asked why they did not enroll in health insurance, nearly one-quarter report they did not obtain health coverage due to cost (24%). (Q1112) Slightly fewer report premium costs increased in 2019 (30% compared to 35% in 2018). (Q1927) The same is true for deductibles (26% compared to 29% in 2018). (Q1927)

Despite the majority of Americans saying they can afford routine healthcare expenses (82%), more than one in four (27%) have canceled an appointment due to the expected costs, most commonly Latinos (37%), Generation Z (33%) and Millennials (31%). (Q760, Q11)

Almost one in four (22%) say they have not taken prescribed medications in the past 12 months due to the expense. ( Q7) However, this aligns with the proportion of adults reporting they have been hit by an unexpected bill they thought was covered by insurance (37%). (Q2220)

Privately insured adults are more likely to pay out-of-pocket expenses with savings (37% vs. 18%), credit cards (36% vs. 19%), disposable income (28% vs. 16%), or 401(k) withdrawals (10% vs. 4%) compared to those covered by public plans. (Q763)

Health Technology

  • One in ten (10%) of Americans had a telemedicine visit in 2019. (Q719)
  • One in three adults have asked their doctor about a diagnosis or treatment they found online. (Q5)
  • More than a quarter used mobile health technology to help monitor or diagnose a health condition in the past 12 months. (Q9)

Prescription Drugs

More than seven in 10 adults (71%) say prescription drug prices are too high. (Q2)

One in five adults (21%) have had trouble affording prescription drugs in the past six months, a sentiment that has increased slightly from 17% in 2018. (Q2200)

A majority also feel the federal government should be allowed to negotiate these prices (78%). (Q4)

When asked who is responsible for high prescription drug prices, the vast majority of Americans say pharmaceutical companies (78%) and insurance companies (59%), but when asked who is the most responsible, adults overwhelmingly point to pharmaceutical companies (53%). (Q2205)

Read the full report here