Most Americans, Including those Without Health Insurance, are Unprepared to use the New Health Insurance Exchanges

However, almost half of Americans believe that they may be able to find a health plan on an exchange that meets their needs at a reasonable price; Navigators expected to be helpful

Sep 24, 2013, 05:00 ET from Harris Interactive

NEW YORK, Sept. 24, 2013 /PRNewswire/ -- As the new health insurance exchanges prepare to open for business, a new Harris Poll provides more evidence of how few Americans understand how they will work. Large majorities of the public, including the uninsured Americans who are supposed to use the exchanges, know little or nothing about them. They do not know how the exchanges will operate or how they should use them. They think the exchanges will be difficult to understand and that the insurance they provide will be expensive. Furthermore, only one third of those who are now uninsured expect that they will buy insurance rather than pay the penalty for being uninsured, while over half of them are unsure what they will do.

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These are some of the findings of a new Harris Poll of a nationwide cross-section of 2,044 adults (including 340 who are currently uninsured) surveyed online between September 13 and 17, 2013 by Harris Interactive. (Full findings, including data tables, can be found here)

The main findings of this Harris Poll are:

  • Only 9% of the public report that they are extremely or very familiar with the term health insurance exchange, while another 21% are somewhat familiar. Fully 70% are not at all or not very familiar with it. Those without health insurance are even less familiar (with 73% not at all or not very familiar).
  • Those who have insurance today would be more likely to buy on the Exchange than those currently without coverage. 
    • When asked what they would do if their employer did not provide insurance, over half (59%) of those with employer-provided coverage say that they would purchase insurance through the exchanges (as opposed to paying a penalty).
    • The numbers are similar for those already buying insurance on the Individual market, with over half (52%) anticipating they will purchase health insurance through the exchange.
    • However, only one-third (33%) of those who are currently uninsured said they would do so, with over half (54%) not sure and more than one in ten (13%) who say they would just pay the penalty.
  • Further evidence of how unprepared most people are to use the exchanges is provided by those who agree with the following statements:
    • 71% of all adults, and 70% of the uninsured, believe health insurance exchanges will be difficult to understand (and, in reply to another question, only 7% of the public think it will be very easy to understand).
    • 74% of adults, and 72% of the uninsured, believe that health insurance purchased through an exchange will be expensive (and, in reply to another question, 32% of all adults and 34% of the uninsured think that it will be very expensive).
  • However, on a more positive note, about half of both Americans overall (49%) and the uninsured specifically (53%), believe that they will be able to find a health plan on an exchange that will meet their needs at a reasonable price.
  • There is a perceived positive impact of the "navigators" who are intended to help people find health plans and sign up for them. Most people, when asked about them, think they would be very (27%) or somewhat (40%) helpful, as do similar proportions of the uninsured (29% and 41%, respectively).

"As health insurance exchanges go live, consumers will have the opportunity to evaluate and select the health insurance plan and benefits that best fit their medical needs and wallet," says Debra Richman, Senior Vice President, Healthcare Strategy, and Co-Chair of Strategic Health Perspectives. "These findings suggest that unless knowledge and understanding of the exchanges begin to grow, particularly among those who aren't covered today, some of consumers may be slow to utilize them. Health insurers must first understand these new individual customers and work to close the huge consumer education gap." 

"We see a fairly high percentage of Americans that actually believe the exchanges will enable them to find affordable health insurance that will meet their needs. This offers health plans a strong opportunity to engage consumers," Richman adds. "The key to a plan's success will be the ability to address consumers' exchange familiarity and also understand the important differences in consumer preferences and purchasing behaviors."

Important Differences Among States with Different Types of Exchanges:

States fall into three categories, with different types of public exchanges.  In some, mostly blue, states (controlled by Democrats), there are state run exchanges. In other, mostly red, states (controlled by Republicans who have not opted to start state exchanges), there are Federal exchanges. And in a third group of states, the Federal government is partnering with the states to run their exchanges. 

Surprisingly perhaps, the replies given by people in these three different categories of states are virtually identical.

  • Only slightly more people in the states with their own exchanges agree that they will be able to find a health plan that will meet their needs at a reasonable price than in the states with hybrid (i.e. state and federal) exchanges or federal exchanges (52% compared to 48% and 47% respectively).
  • A similar trend exists for perceptions that the process of enrolling in health insurance on an exchange is going to be easy to understand, with those in states with their own exchanges (37%) more likely to agree with this than those in hybrid (31%) or federal exchange (30%) states.

This new Harris Poll shows how difficult it may be, at least initially, to get many of the uninsured to buy insurance through the health insurance exchanges. Those with an interest in promoting the use of the new exchanges – including health insurance companies, as well as the exchanges themselves – have a lot of heavy lifting to do in order to get across the basic concept of what an exchange even is.

Consumer decisions are likely to be impacted by how information and choices are presented. "In the current environment of consumer unpreparedness, it will be vitally important for health plans to take a role in structuring plan options with the aim of helping consumers make better choices," states Richman.

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This Harris Poll was conducted online within the United States between September 13 and 17, 2013 among 2,044 adults (aged 18 and over). Figures for age, sex, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents' propensity to be online.

All sample surveys and polls, whether or not they use probability sampling, are subject to multiple sources of error which are most often not possible to quantify or estimate, including sampling error, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments. Therefore, Harris Interactive avoids the words "margin of error" as they are misleading. All that can be calculated are different possible sampling errors with different probabilities for pure, unweighted, random samples with 100% response rates. These are only theoretical because no published polls come close to this ideal.

Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the adult population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated.

These statements conform to the principles of disclosure of the National Council on Public Polls.

The results of this Harris Poll may not be used in advertising, marketing or promotion without the prior written permission of Harris Interactive.

The Harris Poll® #65, September 24, 2013
By Humphrey Taylor, Chairman, The Harris Poll, Harris Interactive

About Harris Interactive
Harris Interactive is one of the world's leading market research firms, leveraging research, technology, and business acumen to transform relevant insight into actionable foresight. Known widely for the Harris Poll® and for pioneering innovative research methodologies, Harris offers proprietary solutions in the areas of market and customer insight, corporate brand and reputation strategy, and marketing, advertising, public relations and communications research. Harris possesses expertise in a wide range of industries including health care, technology, public affairs, energy, telecommunications, financial services, insurance, media, retail, restaurant, and consumer package goods. Additionally, Harris has a portfolio of multi-client offerings that complement our custom solutions while maximizing our client's research investment. Serving clients in more than 196 countries and territories through our North American and European offices, Harris specializes in delivering research solutions that help us – and our clients – stay ahead of what's next. For more information, please visit

Harris Interactive's Strategic Health Perspectives is a mid-term policy forecasting service, providing research based insight to companies in the health care industry as they plan for change. Strategic Health Perspectives is a subscription based service, blending primary market research and consulting from industry experts. For more information on SHP, please contact Sharon Albert at

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