Consumers report mixed feelings towards healthcare exchanges

Consumers who bought healthcare insurance through the online exchanges during the first open enrollment period were dissatisfied with the overall experience, but increasingly pleased with many specific aspects of the exchanges, and with the quality of the coverage itself.

Those somewhat contradictory findings emerge from The Commonwealth Fund’s most recent tracking survey regarding the implementation and effects of the Affordable Care Act, conducted from early April to early June. Sixty-five percent of respondents who purchased coverage on the federal exchange, and 55% who did so on a state exchange, described their experience as either “fair” or “poor.”

At the same time, however, 57% said it was “very easy” or “somewhat easy” to compare the premium costs of different plans, compared with 37% in October 2013, when the exchanges started up. Similarly, 48% said it was “very” or “somewhat” easy to

Sara Collins, Ph.Dcompare potential out-of-pocket costs, (up from 34% the previous October) and 47% found it “easy” or “somewhat easy” to compare benefits coverage (up from 30% the previous October.)

Asked to rate their healthcare insurance overall, 68% of those who purchased coverage on the exchanges said it was good, very good, or excellent. By contrast, 86% of respondents with employer-provided coverage gave it a positive evaluation.

“These findings suggest that the process of enrolling was challenging for many people who went to the marketplaces, but the significant need for insurance coverage among uninsured Americans who could not afford it prior to the law, meant that people were largely willing to put up with the complexities of selecting health insurance so that they could finally have health insurance, Sara Collins, Ph.D., vice president for healthcare coverage and access for The Commonwealth Fund told Medical Economics.

Next: Responses vary by age, income and political affiliation

Opinions regarding some aspects of the exchanges varied by income, age and political affiliation. For example, 49% of those with incomes less than 138% of the poverty level said it was somewhat or very easy to find an affordable plan, compared with 36% of those with incomes 400% of the poverty level or higher.

The authors say the difference is probably due to the “cost protections and improved affordability for adults with lower incomes, who may be eligible for Medicaid or receive premium and cost-sharing subsidies for health plans sold through the marketplace.”

Similarly, 47% of self-identified Democrats said their experience with the exchanges were good or excellent, compared with just 24% of Republicans. And 46% of adults age 19 to 34 had positive experiences, versus 33% of those age 50 to 64.

When it came to plan selection criteria, 38% of respondents named the premium amount as most important, followed by the deductible and other copayment amounts (34%) and whether their doctor was included in the network (20%.)

The survey found that the ACA appears to be succeeding thus far in making healthcare insurance more affordable and available to Americans with low and moderate incomes. Nearly two-thirds (65%) of low- or moderate-income adults said it was very or somewhat easy to afford their premiums, while 54% of adults with incomes of 250% or more of the poverty level said it was very or somewhat easy.

On the other hand, 79% of those with incomes above 250% of the poverty level and employer coverage said it was easy or somewhat easy to pay their premiums, compared with 54% of those with incomes below that level. Consequently, say the authors, “while the insurance market reforms have made it far easier for people without employer coverage to gain access to comprehensive benefits without being charged more based on their health status, employer-based insurance continues to be a better deal for people with higher incomes.”