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.

PASADENA, CA - NOVEMBER 19: People arrive to the free Affordable Care Act (ACA) Enrollment Fair at Pasadena City College on November 19, 2013 in Pasadena, California. The event, sponsored by the Chamber of Commerce and the Los Angeles Association of Health Underwriters, offers one-on-one sessions with insurance experts certified by Covered California to help people enroll for healthcare coverage under the ACA. (Photo by David McNew/Getty Images)
National Journal
Clara Ritger
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Clara Ritger
Jan. 23, 2014, 1:29 p.m.

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 Health­Care.gov 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 Health­Care.gov‘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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