Even With Obamacare, Americans Find Health Insurance Too Expensive

U.S. President Barack Obama delivers remarks on the fifth anniversary of the Affordable Care Act, commonly known as Obamacare, in the Eisenhower Executive Office Building on the White House campus on March 25. Jonathan Ernst/Reuters

The fate of Obamacare remains in the hands of the U.S. Supreme Court. At the end of the month, the court will decide whether Congress has overstepped its authority by requiring both state and federal marketplaces to provide subsidies that allow millions of Americans to have health insurance.

If the court rules against the federal government, residents in 34 states with federally run marketplaces could lose their subsidies. This puts 6.4 million Americans at risk of once again being uninsured.

But a new report from the Commonwealth Fund indicates that despite the subsidies, many Americans still perceive health insurance as unaffordable. According to the report, 60 percent of respondents said they hadn't visited their state's marketplace for health insurance because they didn't think they could afford the monthly premium or out-of-pocket cost. Additionally, 54 percent of Americans surveyed said they were unaware that financial assistance is available to pay for health insurance, and 53 percent weren't aware that the health care reform law expanded Medicaid access in some states.

For its report, the Commonwealth Fund, a private foundation that conducts independent research on health and social issues, conducted phone interviews with 4,881 Americans ages 19 to 64 who had obtained health insurance either through state and federal marketplaces or Medicaid expansion. The interviews were conducted between March and May of this year and then compared with findings to two prior phone surveys—one conducted from April to June 2014 and the other from July to September in 2014.

The rollout of the Affordable Care Act has faced numerous political and technical challenges. But one that's often overlooked is the task of finding the right way to encourage Americans to sign up, especially in rural and isolated communities. Simply sending the public to a website proved to be counterproductive. A report from the Kaiser Family Foundation evaluated the experience of programs for health care sign up and found nearly all consumers who sought help didn't understand the marketplace or simply felt too intimidated by the process to sign up on their own.

The good news, however, is that despite the perception of high cost, the percent of uninsured Americans continued to go down, from 20 percent in in 2013 to 13 percent in 2015. Nearly 70 percent said they used their new insurance for health care, and 62 percent of that group said they would not have been able to get care if their health insurance wasn't subsidized. More than half of adults currently enrolled in marketplace plans and 66 percent who obtained health insurance through Medicaid expansion were previously uninsured, according to the Commonwealth report.

Young adults ages 19 to 34 saw the most gains in obtaining coverage. In 2013, 28 percent were uninsured compared with 19 percent in 2015. However, a little more than a quarter of Americans with incomes below the federal poverty level ($11,670 for an individual and $23,850 for a family of four) remained uninsured, a rate that hasn't changed since 2014.

"Compared with the overall adult population, those who remain uninsured are disproportionately younger, poorer, and Latino," write the researchers of the Commonwealth report. "One factor behind these higher rates of uninsurance in these groups may be the decision by 22 states not to expand eligibility for Medicaid."

The report also suggests that millions of people will remain uninsured in states that have not expanded their Medicaid coverage. Even in the best of circumstances—if the Supreme Court rules in favor of the federal government—more reforms and outreach must take place since many Americans still don't have health insurance or believe they could afford it. This would require Medicaid expansion in more states, as well as further efforts by state governments to educate the public on how the marketplace works and what the actual cost of health insurance will be with subsidies.