A principal goal of the Affordable Care Act of 2010 was to reduce the number of Americans who lack health coverage. To do that, the law calls for the creation of regulated healthcare exchanges where the uninsured can purchase insurance, and a system of subsidies and penalties to encourage and assist them to buy.
But will they? There have been estimates of the demographics and health status of the uninsured, but little real knowledge. We have known far too little about their attitudes, preferences, and needs in regard to healthcare—factors that could have a great impact on how well the system works and how the exchanges should be designed and regulated.
To find out, Oliver Wyman conducted what we believe to be the first major market survey of the consumers most likely to purchase coverage in the under-65 healthcare exchanges in their first few years of operation. Part of the project consisted of detailed surveys of about 800 currently uninsured individuals. We asked about their health status, their income, and their attitudes toward the health system. To discover how they would make buying decisions we presented them with a battery of choice scenarios, featuring realistic descriptions of the sort of products we expect to see offered when the exchanges open in 2014. These fictional offerings carried actuarially appropriate pricing, subsidies that reflected respondents’ actual income levels, and the penalties consumers would actually pay if they chose not to buy. They included a variety of coverage options, including some innovative ones, such as discounts for losing weight, options for patient-centered medical homes, 24/7 access, Web-based doctor visits, and so forth.
The results show a system that has better prospects of success than many had predicted—but also some serious challenges.