Why Millions Of Uninsured Americans Aren’t Enrolling in Medicaid or Marketplace Coverage

Researchers from the Urban Institute explain why we’re facing a health insurance information drought

According to a January report by the Urban Institute’s Health Policy Center, millions of uninsured Americans who could benefit from Medicaid and the Affordable Care Act (ACA) Marketplace aren’t taking advantage of these programs due to an information deficit. Authors Jennifer Haley and Erik Wengle used data from the Urban Institute’s Coronavirus Tracking Survey to uncover a worrisome truth: many uninsured adults are unfamiliar with available insurance assistance and are not actively seeking out information on Marketplace plans, despite knowing that such support exists.

These findings are particularly important because, with increasing numbers of Americans losing their employer-sponsored insurance due to the COVID-19 pandemic, awareness of insurance assistance options has never been more critical. Such an information drought could have dire long-term consequences for public health.

Readers will want to gain two key takeaways from this piece.

First, many Americans have low health insurance literacy. Whether this is caused by a lack of health-related financial education in schools or the average financial assistance program being littered with political jargon, Haley and Wengle’s findings make it clear that health insurance terms and concepts are widely misunderstood.

Many Americans are also slipping into dire financial situations during the pandemic, and as a result of this information drought, they are unable to find help. Programs such as Medicaid or the Children’s Health Insurance Program (CHIP) exist to assist low-income Americans, but the study reveals that almost two-thirds of uninsured adults have not attempted to obtain Medicaid/CHIP assistance.

Second, the solution to this information drought may lie in certain federal policy choices. For example, the Trump administration chose to cut back on outreach and enrollment funding over the past four years, specifically funds that were allocated for advertising insurance coverage availability. The Urban Institute researchers say that the Biden administration could restore these funds to at least their prior amounts in an effort to increase awareness.

Efforts to repeal the ACA over the last four years could also be confusing Americans, Haley and Wengle suggest. People may be deterred from seeking ACA Marketplace coverage during years marked by congressional debates over “repeal-and-replace” legislation. It will be necessary for the new administration to devise a targeted messaging plan emphasizing the benefits of Medicaid/CHIP coverage and how to enroll.

How do the numbers look?

The graph below depicts awareness of ACA Marketplace coverage options and financial assistance among uninsured adults. It uses data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, collected between September 11th and 28th, 2020.

Image Source

These results were based on responses to two questions, paraphrased as, “How much have you heard about health insurance Marketplaces?” And, “How much have you heard about individual health care subsidies?” The graph reveals that over fifty percent of uninsured adults surveyed knew very little, or nothing at all, about these health insurance options.

Where do we go from here?

The Urban Institute report stresses the importance of ensuring that all Americans have equal access to reliable financial information. “Access” shouldn’t simply mean the ability to retrieve this information, but rather the ability to easily find, understand, and enroll in these programs. And during a pandemic, it’s even more important that we turn to our elected leaders and policymakers to address this information drought.

This piece was submitted as part of our Ambassador Writing Program and authored by Daniela Kabeth, a Free the Facts Ambassador at the University of Michigan.

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