As the U.S. enters the second year of enrollment for health coverage under the Affordable Care Act, a new poll of 1,900 consumers sheds light on what they value in health insurance, what they worry about and what they want to know when choosing their health coverage. About 20 million Americans have gained health insurance coverage under the law, and the percentage of uninsured dropped from 18 percent in 2013 to 13.4 percent as of May 2014. Many are getting coverage for the first time in their adult lives, and the Department of Health and Human Services now estimates that up to 9.9 million people will purchase insurance through the Affordable Care Act marketplaces in 2015.
While many are gaining health coverage, having insurance does not necessarily guarantee patients will have access to care. High deductibles, copays and coinsurance may result in out of pocket costs for patients, which would prevent them from accessing the care and treatments they need.
At a Washington briefing last week, Morning Consult released the results of a post-Election Day survey of more than 1,900 male and female voters regarding their present health care.
Money for nothing?
Marc Boutin, the Executive Vice President and Chief Operating Officer of the National Health Council and a panelist at the briefing, agreed that the law has done a good job in providing insurance for millions of Americans, but it needs to do a better job of explaining up front what a plan does and does not cover.
“Everything is focused on premium and people are choosing their health care plan based on that indicator alone,” he said. “That alone does not account for the true cost. In fact, costs can vary up to 600 percent.”
When it came to health insurance, the two top concerns cited by poll respondents were out-of-pocket costs for health care and premiums. Specifically, 31 percent of those surveyed cited out-of-pocket costs, like copays and coinsurance, as their top concern and 30 percent cited premiums.
Worries can be particularly acute among the nearly one in two American adults who live with at least one chronic illness. Among households with the same total health care spending, those with a chronically ill family member spend 76 percent more on prescription medicines than other households.
The survey also revealed that three out of four patients don’t want insurers to have a say in which medications their doctors can prescribe or suggest a patient take a different medicine than the one the doctor prescribed.
Transparency: Which drugs are really covered?
Knowing that needed health care providers and medications are covered is an important aspect of choosing a health plan. Americans want to make sure their doctors and medicines remain consistent during the course of the year on their plan.
The panelists agreed it can be disruptive to both patients and providers when a plan unexpectedly cuts off affordable access to a certain medicine. The survey respondents strongly agreed that health insurance plans should not stop covering a medicine in the middle of a plan year, as is currently allowed in plans sold through the marketplaces.
“We want consumers to be able to make informed decisions about the plans they choose. Unfortunately for many patients, that level of transparency isn’t there yet,” said panelist Lori Reilly, Executive Vice President for Policy and Research for PhRMA. With this in mind, PhRMA recently launched a new campaign that includes white board videos designed to help clear up some of the more confusing parts of health coverage.
“With regards to prescription medicines, information about the formularies was not readily available,” Reilly added. “Patients need to have a clear idea of which medicines are covered and which are not.”
Respondents also had concerns with how the average private health insurance plan covers medicines. Three quarters of Americans believe health insurance should cover the same proportion or a larger proportion of prescription drug costs as the cost of hospital and physician services. Government studies have shown that those with private insurance typically pay for a larger share of their total prescription drug costs compared to other costs.
The survey showed a need for more clarity and ease of understanding on what medicines the plans actually cover. An overwhelming majority of Americans believe consumers should have access to the list of medicines and out-of-pocket costs when selecting a health plan.
“Consumers deserve an out-of-pocket cost calculator, like exists for Medicare Part D, for easy comparison of expected costs,” said Reilly. “Clear links to formularies in 2015 would be an excellent start, especially for patients with chronic illnesses, the most frequent users of the health care system.”