Poll: Many uninsured haven't explored Obamacare options

By Sarah Dutton, Jennifer De Pinto, Anthony Salvanto and Fred Backus

More than two months after the health care exchanges opened, a new CBS News/New York Times poll reveals most uninsured Americans - 58 percent - say they have not looked up information about applying for insurance, while four in 10 have done that.

Forty-nine percent of uninsured Americans who looked up information were able to get the information they needed, but about as many – 48 percent - were not.

Twenty-four percent of the uninsured have turned to HealthCare.gov, the federal government’s health care web site, and 13 percent have visited a state-run web site.

A majority of uninsureds who visited Healthcare.gov (57 percent), say they found it difficult to use. Forty-one percent said it was at least somewhat easy to use.

Ten percent of uninsured Americans in the poll say they have applied for insurance under the exchanges. Thirty-two percent say they have looked up information about the exchanges but have not applied; 58 percent have not looked up information about health insurance exchanges.

Some insured Americans have been affected by the rollout of the new exchanges as well:  they have learned that they will not be able to keep their insurance. In the poll, 13 percent of insured Americans say they’ve received a notice that their health insurance plan is being cancelled or changed because it does not meet the minimum coverage requirements under the 2010 health care law.

Concerns About the Health Care Law

Americans – and those without insurance – have real concerns about the impact of the health care law. Fifty-two percent of Americans think the law will increase the cost of their health care, but just 17 percent think there will be an accompanying improvement in the quality of the health care they receive. 

There is more optimism about access to health insurance. Overall, 35 percent think the law will make it easier for them to obtain insurance, rising to 40 percent among the uninsured.

Overall, by more than two to one Americans think the health care law will hurt them (34 percent) rather than help them (16 percent). While the uninsured are more positive than those with insurance about the law’s impact, more think the law will hurt (37 percent) rather than help (33 percent) them.

For the first time since the law was passed, more Americans now say they have a good understanding of how the law will affect them personally than find the law confusing.  Fifty-two percent say they understand it, while 45 percent say it’s confusing. 

But a majority of uninsured Americans are confused by the law. 54 percent of Americans without health insurance say they are confused about how the law will affect themselves and their family.

The Uninsured:  Will They Sign Up?

Under the Affordable Care Act, those without health insurance need to get insurance by March 2014 or pay a fine.  More than half of uninsured Americans (56 percent) plan to get insurance by then, but 35 percent say they will pay a fine instead.

Younger uninsureds are a bit more likely than those who are older to say they’ll get insurance.  Uninsured Americans who say they are in excellent or good health are just as likely as those with fair or poor health to say they’ll get insurance. 

Uninsured Americans don’t see a financial benefit to having health insurance – most (59 percent) say getting insurance will negatively impact their finances. 

But they do see a benefit to their health; 57 percent think having health insurance would improve their health. Forty percent think having insurance won’t have much effect on their health.

Among uninsured Americans who plan to get health insurance, 38 percent say they will do so because insurance is a good thing to have, followed by 28 percent who will get insurance because the health care law requires it.

Those who don’t plan to buy health insurance cite cost as the main reason (50 percent), followed by their objection to the government making it mandatory (29 percent).

Health Care Experiences: Insured vs. Uninsured

Whether it’s the financial cost, satisfaction with the health care they receive or even where they receive their care, those without health insurance have vastly different experiences with health care compared to those with insurance.

Satisfaction with Health Care

While 55 percent of Americans with insurance report they are very satisfied with the quality of the health care they receive, just 17 percent of those without insurance say the same. 

Medical Care

Uninsured Americans are more likely than those who are insured to have gone without medical treatment (55 percent to 26 percent), postponed preventative health services (65 percent to 28 percent), or not filled a prescription because of the cost (40 percent to 20 percent).  Far fewer of those with insurance report they have gone without medical care.

The poll finds health insurance status also affects where people seek medical treatment. Most insured Americans (73 percent) say they receive their basic health care at a doctor’s office – but only 32 percent of uninsured Americans say the same. The uninsured are far more likely than the insured to receive their basic health care at a clinic or health center, or a hospital emergency room.

The Financial Burden

Most insured Americans (68 percent) say basic medical care is affordable for themselves and their family, but for 74 percent of those without insurance, being able to afford medical care is a hardship.

In fact, six in 10 uninsured Americans say they or someone in their family have had problems paying medical bills in the last five years. But that’s the case for just 28 percent of insured Americans.

Four in 10 uninsured Americans say paying medical bills has had a major impact on their finances, compared to just 16 percent of those with insurance.

In contrast, most insured Americans are satisfied with the cost of their insurance.  Seventy-two percent of insured Americans are satisfied with the cost of their insurance, including 33 percent who are very satisfied.

Fully 55 percent of uninsured Americans in the poll say they have been uninsured for more than three years.  Forty-four percent have been uninsured for a shorter amount of time.

When asked why they don’t have health insurance, uninsured Americans choose cost as the top reason (47 percent), far ahead of their employer not offering it (16 percent), or feeling they don’t need it (10 percent). Eight percent volunteer that it is because they are unemployed or looking for work.

According to the poll, more than half of uninsured Americans have household incomes below $30,000, a third are under age 30, and four in 10 are between 30 and 44. A quarter are currently unemployed.

The Affordable Care Act:  The Larger Picture

Although there has been some improvement from a month ago, as reported in a CBS News/New York Times Poll last week more Americans continue to disapprove than approve of the 2010 health care law.  Americans without health insurance (53 percent) are as likely as those with insurance (51 percent) to disapprove of the law.

But most don’t think it should be repealed in its entirety: 53 percent of Americans think that while there are some good things in the law, changes are needed to make it work better.  Thirty-seven percent think the law should be repealed entirely.  Again, there are few differences between those with and without health insurance, and 33 percent of the uninsured want the law repealed.

Views are mixed on the impact the health care law will have on the nation’s health care system. A third of uninsured Americans think the law will improve the health care system, but just as many say it will make the system worse. Insured Americans are not especially optimistic either.

In particular, most Americans -- and even more of the uninsured -- don’t approve of one important provision that many think is the key to making the entire health care law financially viable:  the individual mandate.  Sixty-eight percent of Americans do not approve of requiring nearly all Americans to have health insurance coverage by 2014 or pay a penalty, and that figure rises to 77 percent among uninsured Americans – the vast majority of whom the mandate will apply to.

Americans of all ages disapprove of the individual mandate:  from those under the age of 30 (66 percent) to those 65 and older (66 percent).  Even 69 percent of Americans who say they have a pre-existing medical condition disapprove of the individual mandate. 

Nevertheless, many individual provisions of the 2010 health care law are popular with both insured and uninsured Americans alike – some very much so:

• 86 percent of Americans approve of requiring health insurance companies to cover those who may have an existing medical condition, and 84 percent approve of giving tax credits to small businesses for providing coverage to their employees. 
• 76 percent of Americans approve of providing financial help to low and moderate income Americans to help them purchase coverage on the individual market. 
• 70 percent approve of allowing young people to stay on their parents’ health insurance policies until the age of 26.
• 65 percent of Americans approve of requiring existing policies to meet higher standards of coverage, and 60 percent approve of increasing the Medicare payroll tax on earnings for higher income Americans.
• 56 percent approve of requiring employers with 50 or more employees to pay a fine if they don’t offer health insurance to their employees.

As reported in a CBS News/New York Times Poll last week, 58 percent think the sign-up for the exchanges is not going well. Just 16 percent think it is.  

The Politics of the Health Care Law

Though they remain divided, Americans are showing a little more confidence in the Obama administration’s ability to implement the 2010 health care law.  Now 48 percent are at least somewhat confident – up from 45 percent last month – while the percentage who are not confident has dropped  from 53 percent in November to 49 percent now.  Most Democrats (78 percent) are confident, while most Republicans (82 percent) and just over half of independents (52 percent) are not.

There is widespread disapproval for how Republicans in Congress are handling health care; 73 percent disapprove, and just 19 percent approve.  Approval is somewhat higher for Democrats in Congress on this issue, but still a 59 percent majority disapproves.  The public is more positive, but still divided, on how their state government is handling health care.

Looking ahead to the 2014 midterm elections, most Americans say their own member of Congress’ position on health care will have at least some effect on their vote, though just 35 percent say it will matter a lot.

Just 37 percent of Americans think employers should have to cover the full cost of birth control in the insurance plans they offer to their female employees – a provision in the health care law.  Over half think that employers should be allowed to opt out of covering birth control based on moral or religious grounds.

Women and Democrats are most likely to say employers’ insurance plans should have to cover birth control.

The Role of Government and Effect on the Country

The poll also explored what Americans perceive the role of government to be when it comes to health care.  Three out of four Americans think that providing health care to the elderly is the responsibility of the federal government; just 23 percent disagree. While majorities also say providing health care to the poor and access to affordable health care for everyone are the government’s responsibility, sizable percentages say those are not the federal government’s responsibility.

However, there are large partisan differences on these questions, especially on whether the government should provide health care to the poor and affordable care for all.

Most view lack of health insurance as having a negative impact on the country overall: seven in 10 Americans think it hurts the country when individuals don’t have health insurance.

Even though most Americans disapprove of the 2010 health care law, 63 percent still think their own state should accept federal money to expand health insurance coverage.  Most Democrats (88 percent) and independents (61 percent) think so, while most Republicans (57 percent) do not.

Although it has been reported that health care costs are growing at a slower rate over the past three years than they did previously, 50 percent of Americans think costs are growing at a faster rate than they have in the past, and just 5 percent think they are growing at a slower rate. Thirty-four percent don’t know enough to say.

The general population portion of this poll was conducted by telephone December 5-8, 2013 among 1,000 adults nationwide. The error due to sampling for this portion of the poll could be plus or minus 3 percentage points.

An additional sample of people age 19-64 without health insurance was also interviewed, for a total of 702 interviews with the uninsured. Those interviews were conducted by telephone December 4-15. 2013.  The data was weighted to reflect the demographic and regional distribution of the uninsured according to the U.S. Census Bureau.  The margin of error for the sample of the uninsured is plus or minus 5 percentage points.

The sample size for those with health insurance is 895; the margin of error for this group is plus or minus percentage 3 points.

For both the general population and uninsured portions of the poll, phone numbers were dialed from samples of both standard land-line and cell phones. Interviews were conducted in English and Spanish.  Data collection was conducted on behalf of CBS News and the New York Times by Social Science Research Solutions of Media, Pa.  This poll release conforms to the Standards of Disclosure of the National Council on Public Polls.