How Can You Use Aca To Improve Your Customer Service

Abstract

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Issue: Since 2001, long before the passage of the Affordable Care Act (ACA), the Commonwealth Fund Biennial Health Insurance Survey has examined health coverage and consumers' experiences buying insurance and using wellness care. Goals: To examine long-term trends and to make comparisons before and after passage of health reform. Methods: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. Findings and Conclusions: There have been dramatic improvements in people's ability to buy health plans on their own following the passage of the ACA. For adults with family incomes less than $48,500, uninsured rates dropped virtually 17 percentage points below their 2010 peak. Lower-income whites, blacks, and Latinos take experienced drops this big, though Latinos are uninsured at higher rates. Amid working-age adults who had shopped for plans in the individual market and ACA marketplaces over the prior three years, the percentage who reported it was very hard to find affordable plans fell by most one-half from 2010, prior to the ACA reforms, to 2016. Coverage gains are helping working-age Americans get the care they demand: the number of adults who reported problems getting needed health intendance and filling prescriptions because of costs fell from a high of lxxx million in 2012 to an estimated 63 million in 2016.

BACKGROUND

Prior to the passage of the Affordable Care Act, the individual insurance market was a notoriously difficult place for consumers without employer-based wellness benefits to purchase insurance. It too was challenging for insurers to sell insurance without incurring large losses. As a result, insurers went to great lengths to exclude people with even balmy wellness issues. In 2010, the Republic Fund Biennial Health Insurance Survey found that more than one-third of people who tried to purchase health insurance in the individual market in the previous iii years—an estimated 9 million people—had been turned downwardly, charged a higher cost, or had a status excluded from their health plan.¹

By January 2016, virtually the end of the ACA's fourth open-enrollment period, things had inverse. The size of the individual market has most doubled since 2010.² As a result of changes that have fabricated purchasing and affording coverage easier—and with consumer protections such as bans against insurers charging people more than or denying coverage because of preexisting atmospheric condition—most ix million people take signed up for a plan through HealthCare.gov, the federal marketplace website.³ This does not include enrollment in 11 states plus the District of Columbia that operate their own marketplaces. An boosted 7 one thousand thousand are estimated to have purchased coverage in the individual market place outside the marketplaces, where insurers must comply with the same regulations as the ACA.⁴ Further, more than 16 million people have enrolled in Medicaid and the Children's Health Insurance Program.⁵ All told, more than than thirty million people are currently insured as a upshot of the ACA'southward insurance subsidies, expanded Medicaid eligibility, state and federal outreach efforts, and market place regulations.

Members of Congress and the Trump administration are currently pursuing repeal of sure provisions of the ACA. In this time of dubiousness, the Democracy Fund Biennial Health Insurance Survey, fielded nearly every other year since 2001, examines long-term trends in the stability of insurance coverage, consumers' experiences buying coverage, price-barriers to timely health care, and problems paying medical bills. The current survey was conducted from July 12 to November 20, 2016, past Princeton Survey Inquiry Associates International, with 4,186 adults ages nineteen to 64 (see "How This Written report Was Conducted" for more than data).

SURVEY FINDINGS

Number of Uninsured Continues to Fall Across All Demographic Groups

The number of uninsured U.South. adults ages 19 to 64 declined to 23 million, or 12 percent of the population, in July to November 2016 from a high of 37 million, or 20 percent, in 2010 (Exhibit i, Tabular array 1).^half-dozen,7 An estimated eighteen million adults, or x percent, were insured at the fourth dimension of the survey merely had gaps in their insurance coverage in the by 12 months—well-nigh the same as in years prior to the ACA. About 147 million adults, or 78 percentage, were insured continuously in 2016, up from a depression of 70 per centum, or 129 1000000, in 2012.

There accept been broad coverage gains since passage of the law in 2010 beyond racial and ethnic groups, age ranges, and income. People with low and moderate incomes have experienced particularly dramatic gains. For adults with family incomes less than $48,500, the uninsured rates are at present well-nigh 17 percentage points beneath their 2010 peak and 10 percentage points below 2001 levels (Showroom two). Whites, blacks, and Latinos in lower-income households have experienced drops this large. For lower-income Latinos, while the drops have been similar, they are uninsured at higher rates than whites and blacks. This is because Latinos had higher rates of uninsurance than other groups prior to the ACA, some states that have not expanded eligibility for Medicaid take big Latino populations, and undocumented immigrants are not allowed to enroll in the police force's coverage expansions.⁸ Immature adults ages 19 to 34 take made the largest gains of any age grouping since 2010 (Exhibit 3).

Private Market Reforms and Subsidies Have Fabricated Ownership Insurance Easier

Prior to the ACA, people without job-based health benefits had few affordable options. Considering public insurance programs like Medicaid and the Children's Health Insurance Program were available in most states only to children, pregnant women, and parents with very low incomes, people without job-based insurance were limited to purchasing coverage in the private market and paying total premiums. States set their ain rules for their markets; in most, people were charged premiums that reflected their health, gender, and age. They could exist denied coverage because of a preexisting condition or have conditions excluded from their programme.⁹ Once insured, they could confront annual and lifetime limits on what plans would pay and could have a policy cancelled retroactively (i.e., "rescinded") if they developed a health trouble.

One of the master goals of the ACA was to reform the individual insurance market place and then that anyone without employer wellness benefits, regardless of their wellness status, could notice and afford a plan that provided coverage at to the lowest degree as comprehensive as an employer plan. Nether the ACA, insurers in the private market place now must offer a plan to all who apply, cannot charge people more than based on health or gender, are limited in how much more they can charge an older person relative to someone younger, and are restricted from imposing lifetime or annual benefit limits and rescissions. To help consumers choose plans, all must exist sold at four tiers of coverage that vary only by premium and cost-sharing amounts. The do good bundle stays the same and must cover an essential set up of services. Finally, people with incomes between $24,000 and $97,000 for a family unit of four are eligible for premium tax credits that reduce their share of premium costs.

These changes accept fabricated a dramatic difference. In 2010, an estimated 26 million people said they either had a program or tried to purchase a health plan in the individual market over the prior three years (Exhibit iv).^ten In 2016, 44 million tried to purchase coverage either through the marketplaces or direct from an insurance company. In 2010, fewer than half (46%) of people who tried to buy a program on their own, or 12 million people, concluded upwards purchasing i. Past 2016, two-thirds (66%), or 29 million people, ended upwards purchasing a wellness plan in the preceding three years.¹¹

In 2010, 60 percent of adults who had a programme or tried to purchase a plan on their own in the private market found information technology very difficult or impossible to discover one they could afford (Showroom 4). By 2016, that percentage had fallen to virtually one-third (34%) of people. Among people with health problems, the share of those reporting difficulties finding an affordable plan dropped from 70 percent in 2010 to 42 pct in 2016. Among those with incomes less than 200 percent of poverty, the percentage who had problem finding a plan they could beget dropped from nearly 2-thirds (64%) in 2010 to i-tertiary (35%) in 2016. Adults with higher incomes as well found information technology easier to find an affordable plan in 2016 compared to 2010.

The police force's requirements for comprehensive health plans, along with bans on preexisting condition exclusions, appear to take made a significant divergence in people's ability to find plans that fit their health care needs. In 2010, 43 per centum of people buying plans on their own said they constitute information technology very difficult or impossible to notice a programme with coverage they needed; by 2016, the share had fallen to one-quarter (25%) (Showroom four). Amid those with health problems, the share who reported difficulty finding a plan that met their needs vicious from 53 per centum in 2010 to 31 percent in 2016.

Fewer Adults Reported Cost-Related Problems Getting Needed Care

Expanded insurance coverage besides is helping people get the care they demand. The number of adults who did not get needed intendance in the past 12 months because of cost declined from a high of 80 million in 2012, or 43 percentage of those surveyed, to 63 million, or 34 pct, in 2016 (Exhibit 5, Table 2). This is the everyman rate of toll-related access issues reported by adults since this measure was added to the survey in 2003.

At that place were declines in all iv cost-related admission problems asked about in the survey. The percentage of adults who said that considering of cost they had not gone to the doctor when they were sick savage from 29 percent in 2012 to 20 percent in 2016; the percentage of those who said they had not filled a prescription because of cost dropped from 27 percent in 2012 to 19 percent in 2016; the share who said they skipped a recommended test, treatment, or follow-up visit because of toll vicious from 27 percent to 18 percent; and the share who said they had not gotten needed care from a specialist brutal from 20 percent to xiii percentage (Table 2).

These population-wide declines in cost-related problems getting intendance are consistent with other recent federal surveys and reflect nationwide gains in insurance coverage.¹² Fewer people are facing the full cost of their health care. We likewise found declines in price-related problems getting intendance among the uninsured (Exhibit vi, Table iii), perhaps explained by improved economical conditions also as a significant shift in the demographic composition of the uninsured in the wake of the ACA'due south coverage expansions.¹³

All the same, every bit in past surveys, uninsured adults reported cost-related access problems at nigh 2 times the charge per unit of those insured all year (Exhibit 6). In addition, cost-related access problems amid people who had experienced gaps in coverage in the prior twelvemonth were nigh as high as those who were uninsured at the fourth dimension of the survey.

While at that place have been small-scale declines in cost-related access problems amid insured adults, rates remain high: iii of ten adults (29%) who had coverage for the full year reported not getting care considering of toll. People with private marketplace coverage continue to report toll-related admission problems at higher rates than those with employer coverage (45% vs. 28%) (Table iii).

Fewer Adults Have Issues Paying Medical Bills

There has been small merely significant improvement in the percentage of adults who report medically related fiscal difficulties. In 2012, 75 million people, or 41 percent of those surveyed, said they had issues paying their medical bills in the by 12 months or were paying off medical debt. In 2016, this figure was 70 million, or 37 percent (Showroom 7, Tabular array ii).¹⁴

From 2012 to 2016, among the iv areas of medical bill problems asked about in the survey, there was significant comeback among people's ability to pay their bills and fewer reports of calls from collection agencies most unpaid bills. The percentage of adults who said they had issues paying or were unable able to pay their bills fell from 30 percent to 23 percent (Table two). The percentage who reported they had been contacted by a drove agency near unpaid medical bills fell from xviii percent to 14 pct.

Just there has been no improvement in the share of people who are paying off medical debt over time. Nearly a quarter (24%) of adults, or an estimated 46 million people, reported they had medical bills they were paying off over time, near the same equally in 2012 (Table 2).

Defective health insurance for fifty-fifty part of the year is associated with a much college risk of medical bill problems, particularly amidst people with low incomes. Virtually two-thirds (63%) of adults with incomes of less than 200 percentage of poverty who had experienced a gap in their insurance coverage in 2016 reported difficulties paying medical bills or were in medical debt compared to just over a third (36%) of people in that income group who had been insured continuously (Showroom 8). Still, these rates are high even for insured adults.

Insurance Status Makes Marked Difference in Adults' Rates of Having a Regular Doctor and Getting Preventive Intendance

Having wellness insurance coverage paves the way for people to take a regular md and get timely medical care. In the survey, continuously insured adults are more than likely than those who were uninsured to accept a regular source of intendance and to written report receiving timely preventive care tests and cancer screenings (Exhibits 9 and 10, Table 3). Even gaps in health insurance is associated with disruptions in recommended care. For example, 72 percentage of women ages 40–64 who had been insured continuously had received a mammogram in the past 2 years, compared to 55 pct of those who had a coverage gap and merely 40 percentage of those who were uninsured at the fourth dimension of the survey.

Determination

This analysis indicates the Affordable Intendance Human action has increased health insurance coverage for U.Southward. adults of all races, ages, and income groups. These coverage gains are allowing working-age adults to become the health care they demand. In contrast, Americans who nevertheless lack wellness insurance are less likely to become to the doctor when they need to or go preventive intendance and cancer screenings. Even a gap in coverage is often associated with a lower likelihood that someone will become timely health intendance.

The Commonwealth Fund Biennial Health Insurance Survey highlights the stiff growth in the use of the individual marketplace by Americans since the ACA market place reforms and subsidies went into effect in 2014. The market has evolved from beingness a place where mostly good for you people and those with sufficient income could buy plans to 1 where all are offered comprehensive plans, regardless of factors like gender or wellness condition, with income-based financial assistance to offset costs for those eligible.

The survey does betrayal areas of weakness in the law and in U.S. health insurance coverage generally, including that offered by employers. The rates of people who cite problems affording plans in the individual market place or finding plans that meet their needs have improved but remain high. These problems could be remedied past improving the generosity of marketplace subsidies as well as ongoing efforts to assist people sympathize and compare health plans. Virtually 23 million working-age adults remained uninsured in 2016. To encompass more people, all states could movement to expand their Medicaid programs and increase outreach efforts to those potentially eligible. Clearing reform and lifting restrictions on ACA eligibility for undocumented immigrants could help lower uninsured rates amid Latinos. Finally, rates of cost-related problems getting needed care and medical bill bug remain loftier fifty-fifty among insured people in all coverage types. Reducing deductibles and other price-sharing in all private plans would help convalesce health care cost burdens for U.S. families whose incomes accept barely kept step with growth in medical costs.¹⁵ Repealing the Affordable Care Act's insurance subsidies and Medicaid expansion without an constructive replacement program will only exacerbate these weaknesses in the marketplaces and leave problems in employer-based plans unaddressed.

HOW THIS Report WAS CONDUCTED

The Commonwealth Fund Biennial Health Insurance Survey, 2016, was conducted by Princeton Survey Research Associates International from July 12 to November 20, 2016. The survey consisted of 25-minute telephone interviews in either English or Spanish and was conducted amid a random, nationally representative sample of 6,005 adults age nineteen and older living in the continental United states of america. A combination of landline and cellular telephone random-digit dial samples was used to accomplish people. In all, ii,402 interviews were conducted with respondents on landline telephones and 3,603 interviews were conducted on cellular phones, including 2,262 with respondents who live in households with no landline phone access.

The sample was designed to generalize to the U.Southward. adult population and to allow separate analyses of responses of depression-income households. This report limits the analysis to respondents ages 19 to 64 (northward=4,186). Statistical results are weighted to right for the stratified sample design, the overlapping landline and cellular phone sample frames, and disproportionate nonresponse that might bias results. The data are weighted to the U.S. adult population by age, sex, race/ethnicity, education, household size, geographic region, population density, and household phone use, using the U.Due south. Demography Bureau'southward 2016 Almanac Social and Economic Supplement.

The resulting weighted sample is representative of the approximately 187.4 million U.South. adults ages xix to 64. The survey has an overall margin of sampling mistake of +/– 1.ix pct points at the 95 percent confidence level. The landline portion of the survey achieved a 14 percent response rate and the cellular phone component accomplished a 10 percentage response rate.

We also report estimates from the 2001, 2003, 2005, 2010, 2012, and 2014 Commonwealth Fund Biennial Wellness Insurance Surveys. These surveys were conducted past Princeton Survey Research Associates International using the same stratified sampling strategy that was used in 2016, except the 2001, 2003, and 2005 surveys did not include a cellular telephone random-digit dial sample. In 2001, the survey was conducted from April 27 through July 29, 2001, and included 2,829 adults ages 19 to 64; in 2003, the survey was conducted from September 3, 2003, through January 4, 2004, and included 3,293 adults ages 19 to 64; in 2005, the survey was conducted from August eighteen, 2005, to January 5, 2006, among 3,352 adults ages 19 to 64; in 2010, the survey was conducted from July xiv to November 30, 2010, among 3,033 adults ages 19 to 64; in 2012, the survey was conducted from April 26 to August 19, 2012, among 3,393 adults ages nineteen to 64; and in 2014, the survey was conducted from July 22 to Dec 14, 2014, among four,251 adults ages 19 to 64.