By Hanna Horvath & Myles Ma
Former President Barack Obama's health care law — formally known as the Affordable Care Act and commonly known as Obamacare — is the most prominent and, perhaps, notorious piece of legislation signed in a decade.
It may also be the most misunderstood.
Millions of people have purchased health insurance since the federal and state marketplaces opened in 2013, but a majority of Americans remain clueless about basic Obamacare facts, according to a new Policygenius survey.
Nearly 79% of people do not know federal open enrollment for 2019 is set to begin in just a few short weeks. (Healthcare.gov is open from Nov. 1 to Dec. 15 this year.) And only 20% of Americans can name the 10 essential benefits Healthcare.gov plans are required to cover, including ambulance services, substance abuse rehabilitation and maternity care. People without insurance were even less knowledgeable: Out of the 331 people who said they had no insurance, only 25 (7.6%), knew all the essential health benefits. Nearly half of people believe these plans don't have to cover hospitalization. (They do.)
Policygenius surveyed 1,501 people on their awareness of the health law through Google Consumer Surveys from Oct. 1 to Oct. 4, 2018. The survey’s margin of error is between 4% and 5%.
People weren’t any more knowledgeable about Obamacare last year. Policygenius conducted a similar survey in 2017 that found only 76% of people could name the correct open enrollment dates, while just 22% of people could name all the "essential health benefits" plans must cover.
But other stats point to growing confusion. More than a quarter of Americans believe Obamacare was repealed in 2018, up from 13% who thought the law was overturned in 2017.
Bonnie Braun, a professor at the University of Maryland School of Public Health, said she wasn’t surprised so many people believe Obamacare has been repealed. The federal government has made little effort this year to publicize or educate people about open enrollment, she said.
“I haven’t seen any evidence that there’s been any kind of promotion about this,” said Braun, who founded a community program that helps people understand health insurance.
Many Americans remain unaware of major changes Congress and the Trump administration made to the law over the last year.
One in four people believe there is still a federal tax penalty for foregoing health insurance, despite President Donald Trump overturning this mandate, effective 2019, when he signed the GOP tax reform bill into law late last year.
People were also unfamiliar with Trump’s move to to widen health insurance options outside of Healthcare.gov. Only 12.3% of survey respondents know short-term health plans can now last up to three years. Obamacare previously limited coverage under these plans to three months, largely since they are not subject to key provisions of the law, including coverage for pre-existing conditions.
The politicization of Obamacare from both sides of the aisle has made it difficult to discern fact from fiction, according to Timothy Jost, professor of law at Washington and Lee University.
“Republicans made an aggressive attempt to repeal the law, and also spent billions over the past eight years attacking the law in political campaigns,” he said. “And Democrats have not done a good job explaining the law to their constituents.”
Low awareness is a chronic issue
Confusion surrounding the law didn’t start with the current political climate.
“People's knowledge of the Affordable Care Act has been consistently low," said Katherine Carman, a senior economist for the Rand Corporation, a think tank.
Carman worked on a study of health care literacy published in 2014, just one year after the health care marketplaces opened. It found only half of a panel of about 6,000 respondents were aware of the existence of the health care exchanges.
Health care illiteracy isn’t confined to Obamacare. A 2016 Policygenius Survey found 96% of Americans didn’t understand basic health care terms like deductible, coinsurance, copay or out-of-pocket maximum.
This lack of knowledge makes signing up for health insurance difficult.
"People have to know about something before they act on it and if they don't know, or it's so confusing they don't understand, they're not going to act on it," said Braun.
What you should know about Obamacare 2019
For most people buying individual plans for next year, Healthcare.gov is the place to start. If you’re not sure whether you should apply on your own state’s exchange, Healthcare.gov will tell you where to go. You can also compare and buy health insurance with Policygenius.
Make sure you enroll on time. Open enrollment for the federal health insurance marketplace on Healthcare.gov lasts from Nov. 1 through Dec. 15. However, some states have longer open enrollment periods. To find out about where you live, read our guide to open enrollment in every state.
You’ll be out of luck if you miss the deadline, unless you happen to qualify for a special enrollment period. These periods are triggered by big life events, like if you move, get married or have a child.
Trying to master the basics? Read our guide to health insurance.
Finding affordable health care
All Obamacare plans come in tiers: bronze, silver, gold and platinum. The metal determines how much you’ll pay up front for health care vs. how much your health insurer will pay. So a bronze plan will have a lower premium compared to a platinum plan, but if you end up needing health care, you’ll pay more out of pocket.
If you’re looking at quotes and the prices are scarily high, don’t panic. Many people qualify for government subsidies. In fact, 83% of Obamacare enrollees qualified for premium assistance in 2018, paying an average of $89 per month for their health plan.
Subsidies are based on your adjusted gross income, which is how much money you make, minus any deductions. It’s the same calculation you make when you file your tax return, so have your latest return handy when you’re enrolling.
Not everyone qualifies for premium subsidies, but there are options to pursue if you can’t get that specific type of assistance:
Medicaid is available to low-income, needy Americans and their families, though eligibility varies, depending on where you live. See if you qualify for Medicaid in your state.
Medicare is the federal health insurance program specifically for Americans age 65 and over. It also covers younger residents with certain disabilities and diseases. Learn the Medicare basics.
Private off-exchange plans are sold directly by the health insurer, through a third-party broker or privately-run health insurance marketplace. They’re subject to basic Obamacare rules, including the 10 essential benefits and coverage for pre-existing conditions, but exempt from other provisions that make it difficult for an insurer to sell plans on Healthcare.gov. (Most notably, insurers must offer plans at all four metal tiers to participate in the exchanges.) You can’t get subsidies when you buy a plan off-exchange, but if you’re not eligible for assistance, they’re worth looking into, since the added flexibility can sometimes lead to a more affordable price tag.
Health care sharing ministries are a faith-based alternative to health insurance in which individuals and families pay a monthly “sharing amount” similar to premium and use those funds to cover ministry-approved medical expenses. Learn the difference between marketplace health insurance and health care sharing ministry plans.
Health insurance alternatives, including short-term health plans, limited benefit plans and prescription discount cards, are a option for people shut out of the marketplaces due to high prices. But vet these alternatives carefully as they often exclude pre-existing conditions or impose limits on essential benefits, like hospital stays. (Policygenius partner Agile can help you compare the costs of short-term health insurance plans across companies.)
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Graphics: Hanna Horvath