Young Adults Unaware of ACA Exchanges

Published: Aug 21, 2013 By David Pittman, Washington Correspondent, MedPage Today Only 27% of young adults said they were aware of the Affordable Care Act's health insurance exchanges that are launching Oct. 1, a survey released Wednesday showed. Furthermore, those most likely to benefit from the ACA's exchanges and expanded coverage are the least likely to be aware of the exchanges, the liberal Commonwealth Fund said in the survey "Covering Young Adults Under the Affordable Care Act." Just 19% of young adults who were uninsured in the last year and 18% of low-income adults were aware of the exchanges -- or marketplaces, as they are sometimes called -- according to the survey. "These facts are concerning because young adults as a group have some of the highest uninsured rates and therefore stand to gain a lot from knowing about their options for affordable health coverage," Commonwealth Fund President David Blumenthal, MD, told reporters on a conference call. The low awareness could also be damaging for the ACA as a whole, health experts said, since insurers need the young, healthy premium payers to offset the costs of the older, sicker, and more expensive new enrollees. "If young, healthy people do not enroll, premiums will be much higher for those that do," David Howard, PhD, associate professor of health policy and management at Emory University in Atlanta, told MedPage Today. "Efforts to publicize the exchanges are just getting off the ground, but clearly the federal government and participating states have their work cut out for them between now and January 1, when coverage becomes effective." The exchanges will serve as a forum for the uninsured and small business employees to comparison-shop for plans. While the exchanges are open to all without employer-sponsored coverage, those making between 100% and 400% of the federal poverty line will be eligible for federal tax credits to help defray to cost of insurance. To conduct the survey, the Commonwealth Fund asked 3,530 adults ages 19 to 29 via email to complete an online questionnaire from February 11 to March 14. The survey had a 53.4% response rate. While the numbers for young adult awareness must improve, officials at the Commonwealth Fund said they are confident that young people will eventually come to shop for coverage in the ACA's marketplaces, based on experiences with the universal coverage program in Massachusetts. For example, Wednesday's survey found awareness in the ability to stay on parents' health plans through age 26 increased from an estimated 13.7 million in November 2011 to 15 million in March 2013, when this survey was conducted. "It's possible that young adults' awareness is significantly higher than it was in March," said Sara Collins, PhD, Commonwealth Fund vice president of affordable health insurance. "Over the next 6 months, awareness is likely to increase as more outreach is conducted." The survey identified education level as a factor for the marketplace's awareness. One-third of college graduates were aware of the exchanges, compared with 20% of those with a high school degree or less. The Commonwealth Fund said the results help dispel the notion that young adults don't think they need health insurance. They found 5% turned down coverage because they felt it was unnecessary when offered by an employer. Two-thirds took the coverage and 22% said premiums were unaffordable. Howard said the term "unaffordable" is subjective. "The survey shows that young adults will accept coverage if it is free or heavily subsidized," he said. "However, it does not address the question of how much they are willing to pay for coverage." A total of 82% of young adults who were uninsured at some point in 2013 would be eligible for subsidized insurance through the ACA's exchanges or expanded Medicaid, the Commonwealth Fund found. That's why Collins and Blumenthal were concerned that nearly half of states weren't going to expand their Medicaid programs, leaving potentially millions of young adults without coverage, they said. While the think tank didn't say how many young adults would be shut out of coverage in states where Medicaid isn't being expanded, 28% of those who were uninsured at some point in 2013 made less than the federal poverty level and wouldn't be eligible for the exchange subsidies offered to those making between 100% and 400% of the poverty line. http://www.medpagetoday.com/Washington-Watch/Reform/41103?xid=nl_mpt_DHE_2013-08-22&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g350341d0r&userid=350341&email=john@thebrokerageinc.com&mu_id=5344066