Nearly half of Americans lacking health insurance during the first year of the health law’s marketplaces appeared to be eligible for government assistance, but two-thirds of them said they found the health plans too expensive or were told they didn’t qualify, according to a survey released Thursday.
Far fewer cited reasons often mentioned in political circles: a philosophical opposition to the 2010 health law or sign-up difficulties cause by the early technical problems experienced by the government’s healthcare.gov enrollment website, according to the Kaiser Family Foundation survey of 10,502 non-elderly adults. (KHN is an editorially independent program of the foundation.)
“Lack of awareness of new coverage options and financial assistance appear to be a major barrier,” the report said.
About 30 million Americans lack health insurance. Some of them are not eligible for financial assistance, either because they are not in the country legally or because their incomes are too high. Others live in a state that has not opted for a health law provision to expand Medicaid, the state-federal health program for the poor, to cover people earning up to 138 percent of the federal poverty level, which is $32,913 for a family of four.
Those people in the so-called “coverage gap” —about 4 million — don’t qualify for their states’ existing Medicaid program and don’t earn enough to qualify for the other financial assistance created in the 2010 health law. (As of this week, 22 states have not expanded their programs.)
The survey found that nearly six out of 10 uninsured people who appeared eligible for coverage through the health law did not attempt to get it last year. Cost was the main reason cited by more than half the people who seemed eligible for coverage but who remained uninsured.
When seemingly eligible people did try to obtain coverage, 37 percent said they were told they were ineligible and another 30 percent found the cost was too much, even with financial assistance. Under the health law, low-income people who earn too much to qualify for Medicaid have to pay between 2 percent and 9.6 percent of their incomes on premiums before the government subsidies start. Many of the plans also carry sizable deductibles and cost sharing.
“While premium subsidies are based on a sliding scale, it appears that many still find the coverage unaffordable,” wrote foundation researchers Rachel Garfield and Katherine Young.
While most people who were interviewed for the poll did not blame red tape in enrolling, six in 10 eligible people reported difficulty with at least one aspect of applying for insurance, including trouble collecting all the required paperwork or submitting an application.
The national survey was conducted between Sept. 2 and Dec. 15 and has an overall margin of error of +/- 2 percentage points At the time of the survey, few of the people questioned said they had plans to get coverage for this year.