These Are The Main Reasons ACA Enrollment Wasn’t Higher [Study]

affordable care act

Photo from Phalinn Ooi

Now that the Affordable Care Act open enrollment is complete, the Obama administration is taking some time to look back over the efforts that ultimately signed up eight million people on the new ACA insurance exchanges, and they’re asking the question:


Why wasn’t the number higher?

Enroll America, a non-profit organization formed to help the administration gauge its outreach efforts, conducted a recent survey to see what the top obstacles were for those who have yet to sign up. Here’s what they found.

By an overwhelming margin, Americans cited the costs as the primary reason they failed to enroll during the first open enrollment period. Thirty-nine percent, to be exact, said the cost of the insurance simply wasn’t worth it. The next closest reason cited — website problems. Around 27 percent of the non-signees became so frustrated with the issues the website experienced from October to December that they lost interest and decided it wasn’t worth it to go back until the kinks were completely knocked out. Closely following the website issues, 26 percent of survey participants stated that they didn’t sign up because “it was too confusing.” By this, they meant that it was too difficult to figure out which plans were available in their area, what coverages they were paying for, and what the costs (premiums and deductibles) would be once subsidies were factored in.

Twenty-one percent specifically cited that they “couldn’t figure out plans’ costs” as the primary motivator for sitting this enrollment period out. Nineteen percent claimed they “couldn’t get their questions answered.” Seventeen percent “weren’t sure they were eligible.” Thirteen percent simply stated they “didn’t want Obamacare.”

In the single digits, eight percent thought they had more time to apply and ended up missing the deadline. Another eight percent were not comfortable giving out personal information. And lastly, seven percent admitted they were “waiting on insurance” through their employer.


What were the key takeaways?

When you analyze the results, it becomes immediately apparent that the administration’s greatest challenge is controlling the cost of premiums and the amount that families end up paying in deductibles. One point of contention that critics of the law have continued to make is that the amount of available assistance is all or nothing. In other words, if you fall within the income eligibility range, you’ll receive varying degrees of assistance in the form of subsidies based on income. But if you go past the threshold, even by one dollar, the full weight of subsidies and premiums then becomes your responsibility. As a result, many families just past the threshold have reported significant spikes in the amount of money they would pay towards health insurance.

Of course, it’s possible the ACA’s opponents (Republicans, for the most part), have done such a good job of spreading pricing horror stories that they’ve scared many potential applicants off — perhaps even some that might have benefitted from the law. Nevertheless, it will be essential for proponents of the legislation to increase outreach in the coming months and provide concrete examples of how the law is helping Americans just like the ones who’ve yet to sign up.

That’s top priority. Coincidentally, to meet that demand, ACA outreach will have to hit on some of the other issues that kept enrollment from reaching its full potential — namely the website issues, the availability of plans, and the final costs with subsidies factored in.

By fixing some of the smaller issues from the survey, the administration could essentially take care of its biggest problem. That’s something that Enroll America president Anne Filipic is counting on.

“Today’s survey shows that education and outreach efforts will be ‘critically important’ to get people to enroll next year,” she explained. “When people know the insurance options and financial assistance that are available to them, they choose to enroll in coverage.”


In Summary

While the Enroll America survey focused somewhat on the negatives, one positive came out of it for the Obama administration. Of the participants yet to enroll, just over 84 percent of them planned to sign up with the next enrollment period. (There were a total of 853 uninsured people in the survey.) By then, most expect a clearer picture of how the law might work to control costs and benefit their families. And with any luck, next October’s signup process will go more smoothly than last October’s.

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