Uninsured People Don't Like or Understand Obamacare

The people the law was designed to help are far more confused about it than those who are already insured, a new study finds.

Most people (53 percent) now disapprove of Obamacare, compared with 41 percent who approve. Indeed, just a week before the deadline to buy health insurance on the Obamacare exchanges, opposition to the law is as high as the annual cap on out-of-pocket expenses for a family plan at the Bronze level.

The bigger problem? Many uninsured people have no idea what that last sentence means.

For a new study released today in the Proceedings of the National Academy of Sciences, researchers asked 3,414 Americans a battery of questions about Obamacare. Since most people get health insurance through work, they also targeted a sub-set that could stand to benefit from the law: people who are eligible for Medicaid, the uninsured, or those who make between 100 and 400 percent of the poverty level and thus qualify for the subsidies to buy health insurance.

The results were bleak—just two-thirds of the overall respondents knew that they had to get health insurance this month or face a penalty. Just over half knew about the exchanges to buy health insurance through Healthcare.gov, and less than half knew there might be subsidies available to help them afford coverage.


And less than a third knew about the finer points of the law, like the fact that plans must now offer certain required benefits or that people cannot be denied coverage because of pre-existing conditions.

Perversely, insured people and richer people had more knowledge about the ACA, and about how health insurance works in general, than did the uninsured. Knowledge about both the law and concepts such as premiums and deductibles increased with income. People who would qualify for the Obamacare subsidies were only able to answer an average of four of 11 questions about the law. Women were more ignorant than men were about healthcare reform, even though they arguably stand to benefit more.

Here's a summary of the findings in one sad chart:

(Silvia Helena Barcellos/PNAS)

"Clearly some of those most likely to be affected by the ACA were ill-prepared to navigate the new health insurance environment," the researchers wrote.

The results mesh with earlier research showing that a third of Americans have only basic or below-basic health literacy.

The PNAS study was conducted over the summer, before the Obama administration's healthcare advertising blitz, but a more recent survey performed by the Kaiser Family Foundation wasn't very encouraging, either. Among uninsured people polled in February, half said they didn't have enough information to understand the law's impacts, two-thirds said they only knew a little about the law, and only a quarter knew that the deadline to sign up for coverage is March 31.

However, not knowing what the law is or does did not stop the uninsured from disliking it: 56 percent told Kaiser that they had an unfavorable view.

The PNAS researchers recommend taking a "nudgy" approach; for example, having Healthcare.gov automatically present the least-costly Bronze, Silver, and Gold plan to minimize the decision-making required.

Most of the buzz around the latest Obamacare ad push has centered on viral videos like the president's "Between Two Ferns" appearance. It could be that a more effective way to reach the uninsured is to knock on doors and make phone calls. However, just 15 percent of the uninsured told Kaiser that they had received a phone call, email, text message, or door-to-door visit about the law. 

Mollyann Brodie, a pollster for the Kaiser Family Foundation, told me that it's partly the media's fault. Reporters, in her view, have been covering the controversy and political fallout of the law far more closely than its benefits and requirements.

"The contentious debate has seeped into the public's mind more than the details," Brodie said. "There's a massive public education challenge to help them understand what the law means and doesn't mean."


She points out that uninsured people are more likely to be poor, so they might be "working one or two jobs, trying to get their kids to school. They have complicated and stressful lives." That, combined with negative news coverage, might explain the don't-know-but-don't-like phenomenon.

Maybe we need more explainers about Obamacare? Unfortunately, Pew also reports that interest in healthcare news has plummeted since late last year. Just 23 percent of people now say they are following news about the rollout very closely. 

With that in mind, I guess I can only thank you all for sticking with me this far.