"What's a subsidy?" -- It's hard to reach the uninsured

Back in May, I noted a remarkable finding in a McKinsey survey of those who bought or sought health insurance in the individual market during the ACA's first open season:  Most of those who failed to obtain coverage were eligible for subsidies but did not know they were eligible. Two thirds of subsidy-eligible respondents who visited healthcare.gov but did not enroll were not aware of their eligibility -- and so had no idea how much health insurance would actually cost them.

Those findings are corroborated in a survey conducted at about the same time (April 10-28), commissioned by EnrollAmerica and conducted by PerryUndem Research/Communication. I just happened on this because HuffPost's Jeffrey Young cited the results in a story about the challenges of meeting signup targets in ACA year 2. Ignorance among the uninsured remains perhaps the greatest barrier (excepting the refusal of about half the states to accept the law's Medicaid expansion).

The EnrollAmerica survey drew responses from 671 new enrollees and 853 people who remained uninsured. 60% of those who remained uninsured said they wanted insurance. Only 21% of those who did not try to enroll knew that financial help was available to low-to-moderate income buyers -- and only 38% of those tried but failed to enroll were aware of this basic fact.

Perhaps even more remarkably, only 56% of those who did enroll in coverage knew that the law gives financial help to low- and moderate-income buyers. At the same time, 75% of enrollees, including 69% of those who enrolled online, said that the signup process was easy. Perhaps in this one regard it was a bit too easy, i.e., it was not hammered home that your friendly federal government was subsidizing your purchase.

Whaddaya mean, you didn't know about the subsidy? --Improving healthcare.gov

Once healthcare.gov stopped crashing, how successful was it in transmitting the most basic information to most users -- how much they'd be likely to pay in monthly premiums, and how much in out-of-pocket costs they'd be on the hook for?

My sense from late December on was that the website's shop-around feature, enabling a user to get that basic information without registering or applying, worked reasonably well. I used it all the time to check premiums, deductibles and maximum out-of-pocket (OOP) costs for different ages, income levels and locations. You need to enter about eight pieces of information, including state and county, household size, household members' ages, and household income, to get a listing of available plans, ranked lowest premium to highest, and sortable by metal tier. Each plan summary clearly lists what you'll pay in premium, deductible and OOP max (if your income estimate is accurate). Cost Sharing Reduction (CSR) subsidies lowering deductibles and OOP, available to those earning under 250% of the Federal Poverty Level, are figured in.

And yet, many people who tried to use the site came away with no idea how much they would need to pay -- that is, how big a premium subsidy they eligible for, let alone CSR, or even that they were eligible for subsidies at all. A McKinsey study found that 72% of the respondents who reported that they shopped but did not buy were subsidy-eligible, and that 66% of subsidy-eligible respondents who cited perceived affordability as the reason they stopped shopping were aware of neither their eligibility nor the amount for which they were eligible. Their plight is illustrated by the tale of a newly retired Philadelphia cop who went online and concluded that insurance would cost her $800 per month, -- missing the subsidy that reduced the premium to $135.

On rate shock in Georgia

I have questioned (here and here and, to a lesser extent, here) whether Wall Street Journal coverage of the Affordable Care Act has a negative bias.  I don't want to overstate the case, as the Journal's health care reporters are well informed and thorough.  Perhaps the bias is mine. But today, in an article about how the experiences of potential beneficiaries of the ACA are likely to vary state by state, reporter Louise Radnofsky, sharing a byline with Amy Schatz, again made me bristle a bit, here: