Survey finds the majority of insured adults are satisfied with their coverage but want more information.
Slightly more than one-quarter (27%) of working-age adults favor eliminating all private health insurance and instituting a “Medicare for All” system, but 40% say they need more information to form an opinion, according to a Commonwealth Fund survey.
The Health Insurance in America Survey, conducted between March 19 and June 9, 2019, is the newest in the Fund’s ongoing series reporting on working-age adults’ experiences with, and perspectives on, health insurance, Medicaid expansion, and current health policy proposals, including Medicare for All.
“The current debates about Medicare for All and other proposals to get us to universal coverage in the United States are important because we know that health insurance is essential to people’s health and financial security. However, this survey reminds us that it is also critical to address people’s immediate concerns about their healthcare and to educate the public on how new policies would affect them,” says David Blumenthal, MD, Commonwealth Fund president.
Other key findings of the study include:
• There is a partisan divide on replacing private insurance. Democrats are the most strongly in favor (43%) of replacing all private insurance with a public plan like Medicare for All. However, nearly the same percentage of Democrats (41%) also say they need more information on such an approach.
Republicans are among the most strongly opposed to a Medicare for All-type plan, with 60% in opposition. However, Republicans with lower incomes are much less likely to be against the proposal than wealthier members of their party (41% of lower-income Republicans versus 71% of higher-income Republicans oppose Medicare for All).
• There is strong support for Medicaid expansion in states that haven’t expanded yet. More than two-thirds of people (68%) in the 17 states that have not expanded Medicaid eligibility under the ACA favor expansion. Most Democrats (91%) and independents (74%) are in favor. Republicans are nearly evenly split, with 42% for and 48% against expanding Medicaid.
More lower-income Republicans support Medicaid expansion. More than half (57%) of Republicans with incomes under 250% of poverty-$30,350 for an individual and $62,750 for a family of four-favor Medicaid expansion in their state, compared to one-third (32%) of Republicans with incomes above that level.
“Millions of people have gained health insurance since the ACA, demonstrating that it is possible for the nation to make progress in improving healthcare. Unfortunately, states that have chosen not to expand Medicaid are leaving millions of people uninsured and unable to get the healthcare they need,” says Sara Collins, lead author of the study and Commonwealth Fund vice president for Health Care Coverage and Access. “The survey shows that most adults in those states-68%-believe that expanding Medicaid is the right thing to do. This aligns with what our survey work has historically shown about health insurance-most people want and need good coverage.”
• Since the ACA became law, fewer people lack insurance, but gains have stalled. As of June 2019, 13.8% of working-age adults were uninsured, down from 19.9% just prior to the ACA’s coverage expansions in 2014. Adults with low incomes, young adults, and Hispanics-groups that made the greatest gains in coverage in the years following the coverage expansions-continue to have among the highest uninsured rates.
One-quarter of uninsured adults who knew about the mandate penalty repeal opted not to get coverage. This year is the first since the ACA’s passage that Americans no longer face a tax penalty for not having health insurance. Among uninsured adults who knew that the penalty was no longer in effect, 24% said they chose not to get health insurance this year because of it. This translates into about 11% of all uninsured adults.
• A large majority of people are satisfied with their health coverage-with those enrolled in Medicaid among the most satisfied. Eighty-five percent of insured adults are very or somewhat satisfied with their health coverage. Satisfaction is particularly high among people with Medicaid (90%).
• People have concerns about the high cost of being sick. Thirty-eight percent of adults say they are not confident they could afford their healthcare if they were to become very sick. This includes 29% of people with employer coverage, 39% with Medicaid, and 41% with individual-market plans. Uninsured adults expressed the greatest concern about the future: nearly three-quarters (72%) are not confident they could afford their care if they became seriously ill.