One Year In: Americans Respond to the Affordable Care Act. With Focus on Women, Millennials, Latinos, and African Americans

Transcription

1 One Year In: Americans Respond to the Affordable Care Act With Focus on Women, Millennials, Latinos, and African Americans January 2015

2 2014 was a seminal year in the world of health care coverage. With the implementation of the Affordable Care Act (ACA), we have seen significant reductions in the number of uninsured, as newly eligible Americans take advantage of expanded private and public health coverage in order to comply with the health coverage mandate. As part of the Second Annual report by the Transamerica Center for Health Studies SM, we see how different racial, ethnic, gender, and generational groups are taking advantage of expanded coverage, how they are getting their information about the ACA, and examine some of the continued obstacles to expanding health care coverage. Expanding coverage: About one-third of America s uninsured have obtained coverage since November Overall, the uninsured population has fallen from 22% to 15%. Clearly, more Americans who were previously without health insurance coverage now have coverage. The newly insured are enrolling through expanded government programs, private insurance coverage offered through state or federal government Exchanges, or their employer or family plan. Likelihood of receiving health insurance benefits from an employer Remaining uninsured individuals are more likely to be women, Millennials, Latino, and African American. Latinos make up just 17% of the population in the United States, but comprise 31% of those who still do not have health coverage. African Americans are also disproportionately likely to not covered, making up 13% percent of the U.S. population, but 15% of the uninsured. Women are less likely than men to have health coverage. Of the 10 million Americans who signed up for new health care coverage last year, 54% were women. Despite signing up at a higher rate than the general population women continue to be more likely to be uninsured than men. The TCHS survey found that of the remaining uninsured, 59% are women. Women are also less likely than men to receive insurance through an employer. 2

3 Young adults are less likely than other age groups to have health insurance. The uninsured population is disproportionately comprised of young adults. Americans between the ages of account for 44% of those without coverage, even though they are just 33% of the overall U.S. population. Cost continues to be a major obstacle for the remaining uninsured. More than half of those who still lack coverage say they cannot afford even a $100 monthly insurance premium. The median household income of those without health insurance ($37,300) was higher than that of newly insured ($33,200), suggesting an affordability gap for middle-income Americans. These are people who may make too much money to qualify for subsidized coverage, but feel they cannot afford the expenses of health care coverage. Penalties are not always a deterrent. While many of those surveyed said they were unaware of the penalty for not having coverage that complies with the ACA (22% of the uninsured population), others said it was cheaper to pay the fine than to pay for coverage (27% of the uninsured population). Outreach continues to be an issue. Large numbers of the uninsured are unaware of the expanded eligibility for government and private insurance. Over half (54%) of the uninsured were uninformed of the government Exchanges that offer subsidized coverage for those with an income of up to 400% ($46,680 for an individual in 2015) of the federal poverty level. Among those who remain uninsured even after the individual mandate, more than one-fifth were not aware of the ACA mandate for individuals. Nearly two-thirds of the newly insured are covered by a government sponsored plan. Health Exchanges, employer and family plans, and government-sponsored plans are all playing significant roles in expanded coverage. Here s how the newly insured are obtaining coverage: 30% purchased private health insurance through state or federal Exchanges 28% applied for new health coverage through a government-sponsored program 33% obtained health insurance through an employer or family member s plan Technology and the ACA. Online research is a top source for education about the Affordable Care Act. However, different age and ethnic groups get their information in slightly different ways. African Americans, Latinos and Millennials are all more likely to use mobile devices for their 3

4 research than the general population. When researching health and health related information, 23% of adults use smartphones, and 15% use tablets. Among Latinos, 38% use smartphones for health related research compared to 23% of the general population. Millennials: 41% of young adults use smartphones to research health care information, while 22% use tablets. Millennials are more likely than the general population to obtain health and health care related information through a variety of Internet-based and social media sources. African Americans are also more likely to use smart phones or tablets than the general population: 29% use smartphones and 31% use tablets. Say they obtain health care related information from: Internet searches (28%), social media (11%), YouTube (8%), online discussion boards and blogs (14%) were all important sources for young people looking to obtain information about health coverage. Millennials are also receiving health care related information from friends and family (28%), co-workers (11%) and financial advisors (5%) at a higher rate than older generations. 4

5 More details on how various gender, ethnic, and generational groups are faring one year after implementation of the Affordable Care Act. Women Of the 10 million Americans who signed up for new health care coverage last year, 54% percent were women. According to the U.S. Census Bureau, women make up 51% of the population. Women are more likely than men to have used physicians, nurses or health care professionals to gather information on health, health insurance and the health care system in the past 12 months. One third of women surveyed visited a provider or sought out health information compared to just 26% of men. Despite using health care more frequently and enrolling at a higher rate, women still reported feeling uninformed about the ACA. Just 51% of women said they had sufficient information about the Affordable Care Act, compared to 64% of men surveyed. Women have signed up for health coverage through a government Exchange at a much higher rate than men. Of those who have selected a Marketplace plan, 54% are women. Women were more likely to report that making a positive personal health change this year is a top priority. 25% of females cite making personal health changes (e.g. losing weight, quitting smoking) as their most important health-related priority right now, compared to just 21% of men. Latinos The ACA has had perhaps its most dramatic impact on the Latino population. More than four out of every ten Latino respondents (41%) acquired new health insurance within the past 12 months compared to 31% of the general population. 5

6 Latinos were less likely than the general population to receive health insurance benefits from an employer. Just 48% of Latinos receive work-related coverage, compared to 56% of the general population. The TCHS survey found that many Latinos do not sign up for employer-based health coverage, even when it is offered. Those who are offered major medical benefits through work only enroll in it 39% of the time, which is far less than the general population (54%). Latinos are more likely than the general population to receive coverage from their trade union, Medicaid or Medicare, or as a dependent or spouse. African Americans Likelihood of being publicly insured African Americans are significantly more likely to be uninsured or publicly insured than the general population. Among African Americans, 20% have no health coverage, while 19% have some form of public insurance. This is compared to the general population where 15% have no health coverage, and14% obtain insurance through a government program. Despite these results, an overwhelming majority of African Americans say they are satisfied with the quality of the health care system they have access to today. Additionally 87% of those surveyed said they are satisfied with their options, compared to 78% of the general population. African Americans are significantly less likely to rate themselves in good or excellent health (69%) than the general population (78%). They also cite making personal health changes (e.g. losing weight, quitting smoking) as their most important health-related priority (31%) more often than the general population (23%). They also value follow-up care to keep people on the right track, with 25% associating follow-ups with quality of health care compared to 18% of the general population. 6

7 Cost remains a major obstacle to coverage and quality care in the African American community. African Americans are less likely to be saving for health expenses (18%) than the general population (22%) and are less likely to be able to afford routine health care expenses (63%) than other adults (72%). 44% of African Americans indicated they would not be able to afford premiums of $100 per month, while only 29% of all adults said the same. Millennials Among adults aged 18 to 34, health coverage is on the rise. Of the % of Millennials surveyed, 39% said they acquired new health insurance within the past 12 months compared to just 31% of the general population. However, many younger Americans are voluntarily choosing to go without health insurance. Among young adults, 21% say they don t need health coverage. Millennials are more likely to rate themselves in excellent health (30%) than the general population (21%). Millennials are also buying less comprehensive coverage than other age groups. Many (55%) say their top health-related priority is staying healthy and covering basic preventive healthcare expenses compared to 47% of the general population with these priorities. Even though Millennials report being healthier and insured at a lower rate than older generations, they are doing more research as they enter the workforce to try to navigate the complex health insurance market for the first time. Despite their research, Millennials feel less informed about their current health insurance options than the general population. Just 64% of young adults said they feel very or somewhat informed about their health care options, compared to 72% of all adults. 7

8 About the Author Hector De La Torre is the Executive Director of the Transamerica Center for Health Studies, a national nonprofit focused on helping consumers and businesses navigate the health care landscape. De La Torre was chosen to lead this new initiative because of his private and public sector experience, particularly his leadership role on health care and advocating for consumers and businesses. Among his accomplishments as an elected official were expanding access to doctors in underserved communities, consumer protections against retroactive cancellation of health insurance, and supporting improvements at Children s Hospitals. De La Torre is also a member of the Board of Trustees at Occidental College in Los Angeles, serves on the California Air Resources Board (CARB) as a gubernatorial appointee, and serves on the Board of L.A. Care. De La Torre served as a State Assemblymember for California s 50th District from Prior to that, he was Mayor and Councilmember in his hometown of South Gate. De La Torre was also a Manager at the County of Los Angeles Superior Court and served as Manager at Southern California Edison. Previous to those positions, he was Assistant/Chief of Staff to the Deputy Secretary at the U.S. Department of Labor. About Transamerica Center for Health Studies SM The Transamerica Center for Health Studies SM (TCHS) informs the national health care conversation by bringing clarity to the complex decision-making regarding health coverage and personal health and wellness. The Transamerica Center for Health Studies (TCHS) is focused on empowering consumers and employers so that they can achieve the best value and protection from their health coverage, as well as the best outcomes in their personal health and wellness. Through its broad-based analysis and research findings, the Transamerica Center for Health Studies offers consumers and employers a guide to navigate the financial implications of the health care decisions they are facing. The Transamerica Center for Health Studies (TCHS) is a division of the Transamerica Institute, a nonprofit, private foundation. The Transamerica Center for Health Studies (TCHS) is a division of the Transamerica Institute, a nonprofit, private foundation. The Transamerica Institute is funded by contributions from Transamerica Life Insurance Company (not a major medical insurer) and its affiliates and may receive funds from unaffiliated third parties. 8

9 About One Year In As a follow up to a survey conducted in September 2013 that measured individuals and businesses knowledge of and preparedness for the Affordable Care Act, the Transamerica Center for Health Studies commissioned Harris Poll to conduct two surveys. One Year In: Americans Respond to the Affordable Care Act and One Year In: Businesses Respond to the Affordable Care Act. The general population survey was fielded between July 14 and July 25, 2014 among a nationally representative sample of 2,624 of the U.S. general population age Results were weighted (statistically adjusted) as needed on income, education, gender, race/ethnicity, region, employment status, number of employees in a company and health insurance status. Contact Info: Follow us on Follow us on Twitter in 9