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Medicaid-Eligible Americans Don't Know the Affordable Care Act Is Affordable

The entitlement program has an influx of new participants, but for Obamacare to reach its goals, they’ll have to understand what they’re signing up for.


A new study finds that not many Americans eligible for subsidized coverage on the Obamacare exchanges or Medicaid are aware of navigators who have been tasked with educating them about obtaining health insurance.(David McNew/Getty Images)

Medicaid is expanding. Americans' understanding of it isn't—and that's a big problem if Obamacare is going to meet its mandate for improving the health care system.

Few of those who successfully enrolled in Medicaid coverage even knew the program had expanded, and most of them weren't aware of what their new coverage meant, according to data from Perry Undem, an independent research firm.


The firm is conducting ongoing focus-group studies about the expansion for the Medicaid and CHIP Payment and Access Commission, an independent congressional payment-advisory body.

Focus groups in Baltimore, Reno, Nev., and Los Angeles were asked about their awareness of the president's health law and the new coverage opportunities it would provide, details about the enrollment process and how to improve it, and how they plan to use their new Medicaid coverage in the future.

Although all three of those cities' states are operating their own exchanges, participants reported being aware of and the glitches Americans experienced in its first months. Some of them had troubles of their own, starting the enrollment process online, then calling for help, and eventually completing the application process in person, said Michael Perry, a partner at Perry Undem.


"Even though many had successfully come through the enrollment process, they didn't know what they have," Perry said. "They knew things like the woman's face on's home page had changed but they didn't know key things about the Affordable Care Act, such as that there was financial help available for coverage on the exchange, or that Medicaid had expanded."

The focus groups met in December, just before the deadline to sign up for coverage that started Jan. 1. The biggest problem, they explained, was not having anyone to follow up with to be sure their application had gone through.

"Many had gotten through the enrollment process successfully, had gotten a confirmation email, but then heard nothing else," Perry said. "They had been putting calls in and had long wait times and people wouldn't get back to them about their case. January 1 was approaching and they didn't know what was coming next."

Some even reported being excited about having dental care—a service that is not covered under the Affordable Care Act. In fact, less than half of states offer comprehensive dental coverage in their state Medicaid programs.


The problem that could have the most impact on enrollment, however, is a lack of knowledge among eligible but unenrolled Americans and lack of understanding among Latinos. The two groups were less educated about the Affordable Care Act, financial assistance, and Medicaid eligibility than the rest of the participants. For Latinos, a lack of Spanish resources was a major reason for the lack of awareness. But for the unenrolled, Perry said, health insurance had always been perceived as unaffordable, and they didn't know that would change.

"To this group, you don't shop for health insurance if you can't afford health insurance," he said. "It would make a difference if they knew they could get affordable coverage."

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