Harris Poll: Large majorities of Americans know little about new health insurance exchanges

The main findings of this Harris Poll are:

• Only 9% of the public report that they are extremely or very familiar with the term health insurance exchange, while another 21% are somewhat familiar. Fully 70% are not at all or not very familiar with it. Those without health insurance are even less familiar (with 73% not at all or not very familiar).
• Those who have insurance today would be more likely to buy on the Exchange than those currently without coverage. 
  • When asked what they would do if their employer did not provide insurance, over half (59%) of those with employer-provided coverage say that they would purchase insurance through the exchanges (as opposed to paying a penalty).
  • The numbers are similar for those already buying insurance on the Individual market, with over half (52%) anticipating they will purchase health insurance through the exchange.
  • However, only one-third (33%) of those who are currently uninsured said they would do so, with over half (54%) not sure and more than one in ten (13%) who say they would just pay the penalty.
• Further evidence of how unprepared most people are to use the exchanges is provided by those who agree with the following statements:
  • 71% of all adults, and 70% of the uninsured, believe health insurance exchanges will be difficult to understand (and, in reply to another question, only 7% of the public think it will be very easy to understand).
  • 74% of adults, and 72% of the uninsured, believe that health insurance purchased through an exchange will be expensive (and, in reply to another question, 32% of all adults and 34% of the uninsured think that it will be very expensive).
• However, on a more positive note, about half of both Americans overall (49%) and the uninsured specifically (53%), believe that they will be able to find a health plan on an exchange that will meet their needs at a reasonable price.
• There is a perceived positive impact of the "navigators" who are intended to help people find health plans and sign up for them. Most people, when asked about them, think they would be very (27%) or somewhat (40%) helpful, as do similar proportions of the uninsured (29% and 41%, respectively).

"As health insurance exchanges go live, consumers will have the opportunity to evaluate and select the health insurance plan and benefits that best fit their medical needs and wallet," says Debra Richman, Senior Vice President, Healthcare Strategy, and Co-Chair of Strategic Health Perspectives. "These findings suggest that unless knowledge and understanding of the exchanges begin to grow, particularly among those who aren't covered today, some of consumers may be slow to utilize them. Health insurers must first understand these new individual customers and work to close the huge consumer education gap." 

"We see a fairly high percentage of Americans that actually believe the exchanges will enable them to find affordable health insurance that will meet their needs. This offers health plans a strong opportunity to engage consumers," Richman adds. "The key to a plan's success will be the ability to address consumers' exchange familiarity and also understand the important differences in consumer preferences and purchasing behaviors."

Important Differences Among States with Different Types of Exchanges:

States fall into three categories, with different types of public exchanges.  In some, mostly blue, states (controlled by Democrats), there are state run exchanges. In other, mostly red, states (controlled by Republicans who have not opted to start state exchanges), there are Federal exchanges. And in a third group of states, the Federal government is partnering with the states to run their exchanges. 

Surprisingly perhaps, the replies given by people in these three different categories of states are virtually identical.

• Only slightly more people in the states with their own exchanges agree that they will be able to find a health plan that will meet their needs at a reasonable price than in the states with hybrid (i.e. state and federal) exchanges or federal exchanges (52% compared to 48% and 47% respectively).
• A similar trend exists for perceptions that the process of enrolling in health insurance on an exchange is going to be easy to understand, with those in states with their own exchanges (37%) more likely to agree with this than those in hybrid (31%) or federal exchange (30%) states.

This new Harris Poll shows how difficult it may be, at least initially, to get many of the uninsured to buy insurance through the health insurance exchanges. Those with an interest in promoting the use of the new exchanges – including health insurance companies, as well as the exchanges themselves – have a lot of heavy lifting to do in order to get across the basic concept of what an exchange even is.

Consumer decisions are likely to be impacted by how information and choices are presented. "In the current environment of consumer unpreparedness, it will be vitally important for health plans to take a role in structuring plan options with the aim of helping consumers make better choices," states Richman.