AFFORDABLE CARE ACT TRACKING SURVEY

Awareness of Medicaid expansion

Percent responding "Yes, I am aware" of Medicaid expansion

	October 2013	December 2013	April–June 2014
	n=682	n=622	n=1,497
Total	55%	54%	54%

Who Are the Remaining Uninsured?

DISTRIBUTION of uninsured adults ages 19–64 years

	July–September 2013	April–May 2014	March–May 2015	February–April 2016	March–June 2017
	n=1,112	n=894	n=702	n=642	n=739
By Age
19–34	46%	41%	47%	48%	40%
35–49	29%	32%	31%	28%	33%
50–64	23%	25%	21%	23%	23%
By Race
White	50%	52%	42%	41%	43%
Black	13%	16%	18%	12%	15%
Latino	29%	26%	33%	40%	36%
Other	6%	5%	5%	6%	4%
By Income
<100% FPL, non-expansion state	17%	23%	26%	22%	20%
<100% FPL, expansion state	16%	14%	15%	16%	10%
100–137% FPL	18%	15%	16%	18%	20%
138–249% FPL	30%	29%	28%	26%	27%
250–399% FPL	12%	13%	10%	11%	11%
400%+ FPL	6%	5%	5%	6%	12%
By Employer Size*	n=619	n=494	n=395	n=352	n=439
1–24 employees	48%	51%	52%	57%	54%
25–99 employees	19%	19%	19%	18%	15%
100+ employees	28%	27%	26%	21%	26%

*Employer size only includes adults who are employed full or part-time.

Are Americans Aware of the Health Insurance Marketplaces?

QUESTION WORDING:
Under the health reform law, also known as the Affordable Care Act, there are marketplaces in each state where people who do not have affordable health insurance through a job, can shop and sign up for health insurance. Are you aware of these marketplaces, also known as HealthCare.gov?

	July–September 2013	April–June 2014	March–May 2015	February–April 2016	March–June 2017
	n=1,112	n=894	n=702	n=642	n=739
Total	31%	57%	59%	62%	59%
Under 250% federal poverty level	28%	54%	56%	57%	56%
250% federal poverty level or more	42%	73%	78%	83%	71%

Awareness of financial assistance to pay for health insurance

QUESTION WORDING:
Many people without affordable health insurance through a job may be eligible for financial help to pay for their health insurance in these marketplaces, also known as HealthCare.gov. Are you aware that financial assistance for health insurance is available under the reform law?

	July–September 2013	April–June 2014	March–May 2015	February–April 2016	March–June 2017
	n=1112	n=894	n=702	n=642	n=739
Total	29%	47%	46%	52%	51%
Household Income
Under 250% federal poverty level	21%	43%	45%	47%	45%
250% federal poverty level or more	7%	64%	54%	74%	72%

Are Americans Using the Health Insurance Marketplaces?

QUESTION WORDING:
Have you ever visited a marketplace to shop for health insurance? This could be on the Internet, by phone, or in person.

RATE of adults ages 19–64 years who responded “Yes” to visiting the marketplaces

	April–June 2014	March–May 2015	Feb.–April 2016	March–June 2017
	n=4,425	n=4,881	n=4,802	n=4,813
Total	22%	25%	25%	28%
Age
19–34	22%	29%	22%	26%
35–49	21%	23%	28%	31%
50–64	23%	22%	25%	25%

How Easy Is It for People to Use the Marketplaces?

BASE: Adults ages 19–64 years who visited the marketplaces and are eligible for marketplace coverage*

Mar.–June 2017 (n=1,042)	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
Compare the premium costs	12%	17%	35%	31%
Compare the benefits covered of different insurance plans	15%	23%	34%	22%
Compare the potential out-of-pocket costs from deductibles and copayments	18%	22%	32%	24%
Compare the doctors, clinics, hospitals available	20%	30%	24%	17%
Find a plan you could afford	30%	22%	26%	20%
Find a plan with the type of coverage you need	18%	23%	33%	23%
Feb.–April 2016 (n=897)	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
Compare the premium costs	14%	22%	37%	24%
Compare the benefits covered of different insurance plans	16%	31%	33%	16%
Compare the potential out-of-pocket costs from deductibles and copayments	20%	25%	33%	17%
Compare the doctors, clinics, hospitals available	20%	31%	23%	15%
Find a plan you could afford	33%	24%	26%	15%
Find a plan with the type of coverage you need	24%	24%	32%	18%
March–May 2015 (n=905)	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
Compare the premium costs	14%	23%	35%	21%
Compare the benefits covered of different insurance plans	17%	23%	39%	15%
Compare the potential out-of-pocket costs from deductibles and copayments	20%	26%	33%	13%
Compare the doctors, clinics, hospitals available	22%	26%	25%	13%
Find a plan you could afford	33%	23%	23%	16%
Find a plan with the type of coverage you need	24%	22%	34%	17%
Apr–June 2014 (n=772)	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
Compare the premium costs	18%	21%	31%	25%
Compare the benefits covered of different insurance plans	25%	26%	27%	17%
Compare the potential out-of-pocket costs from deductibles and copayments	25%	23%	28%	18%
Compare the doctors, clinics, hospitals available	26%	21%	25%	12%
Find a plan you could afford	37%	20%	20%	19%
Find a plan with the type of coverage you need	30%	23%	26%	18%

Adults ages 19–64 who went to the marketplace and are marketplace eligible*

*Marketplace eligible includes adults in expansion states who are above 138% FPL
and adults in non-expansion states who are above 100% FPL.

How Do Visitors Describe their Marketplace Visits?

	Apr–May 2014	Mar–May 2015	Feb–Apr 2016	Mar–June 2017
	n=1,103	n=1,254	n=1,230	n=1,446
Excellent	11%	10%	13%	11%
Good	27%	31%	26%	31%
Fair	27%	29%	32%	30%
poor	35%	29%	28%	26%

Lower-Income Adults with Marketplace Plans More Likely to View Their Premiums as Affordable Than Adults with Higher Incomes

March–June 2017	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
All adults
Marketplace Coverage	18%	34%	30%	18%
Employer Coverage	5%	19%	34%	40%
<250% FPL
Marketplace Coverage	17%	18%	36%	29%
Employer Coverage	9%	34%	34%	22%
250% FPL or more
Marketplace Coverage	19%	47%	25%	9%
Employer Coverage	4%	16%	34%	44%
Feb–April 2016	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
All adults
Marketplace Coverage	15%	36%	30%	19%
Employer Coverage	6%	18%	35%	40%
<250% FPL
Marketplace Coverage	16%	36%	27%	21%
Employer Coverage	12%	24%	32%	30%
250% FPL or more
Marketplace Coverage	13%	36%	32%	17%
Employer Coverage	4%	16%	36%	44%
March–May 2015	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
All adults
Marketplace Coverage	16%	30%	34%	19%
Employer Coverage	6%	17%	38%	38%
<250% FPL
Marketplace Coverage	19%	27%	36%	19%
Employer Coverage	13%	21%	42%	23%
250% FPL or more
Marketplace Coverage	13%	37%	31%	18%
Employer Coverage	3%	15%	37%	44%
April–June 2014	Very difficult or impossible	Somewhat difficult	Somewhat easy	Very easy
All adults
Marketplace Coverage	17%	34%	32%	17%
Employer Coverage	5%	18%	39%	38%
<250% FPL
Marketplace Coverage	9%	32%	37%	22%
Employer Coverage	11%	25%	37%	26%
250% FPL or more
Marketplace Coverage	25%	36%	27%	12%
Employer Coverage	3%	16%	39%	42%

Adults ages 19–64 who pay all or some of premium and are aware of their premium amount.

FPL refers to federal poverty level.

Bars may not sum to indicated total because of rounding; segments may not sum to 100 because of "don't know" responses or refusal to respond

Cost-Sharing Subsidies Have Lowered Deductibles for Lower-Income Adults with Marketplace Plan

	Apr–May 2014			Mar–May 2015			Feb–Apr 2016			Mar–June 2017
	Amount of Deductible
	$0	$1-$999	$1000 or more	$0	$1-$999	$1000 or more	$0	$1-$999	$1000 or more	$0	$1-$999	$1000 or more
Total	12%	32%	53%	13%	41%	43%	18%	33%	45%	20%	31%	47%
Under 250% FPL	17%	47%	34%	16%	42%	39%	25%	41%	30%	28%	40%	28%
250% FPL or above	7%	17%	72%	8%	39%	52%	8%	21%	68%	11%	21%	67%

Adults ages 19–64 with marketplace coverage.

What Are People Paying for Health Coverage?

QUESTION WORDING:
About how much do you/does someone else in your family pay every month in premiums on this plan including any amount deducted from a paycheck? Do you pay… BASE: Percent adults ages 19–64

March–June 2017	Pays Nothing	$1 to Less Than $125	$125 or More	Don’t Know or Refused
All adults
Marketplace Coverage	23%	28%	46%	3%
Employer Coverage	16%	38%	32%	14%
<250% FPL
Marketplace Coverage	30%	41%	25%	4%
Employer Coverage	17%	31%	25%	27%
250% FPL or more
Marketplace Coverage	13%	11%	75%	1%
Employer Coverage	16%	41%	34%	8%

Feb.–April 2016	Pays Nothing	$1 to Less Than $125	$125 or More	Don’t Know or Refused
All adults
Marketplace Coverage	20%	36%	41%	2%
Employer Coverage	19%	41%	30%	10%
<250% FPL
Marketplace Coverage	26%	40%	32%	2%
Employer Coverage	16%	43%	24%	16%
250% FPL or more
Marketplace Coverage	10%	28%	58%	3%
Employer Coverage	21%	39%	34%	6%

March–May 2015	Pays Nothing	$1 to Less Than $125	$125 or More	Don’t Know or Refused
All adults
Marketplace Coverage	12%	48%	38%	2%
Employer Coverage	17%	39%	32%	13%
<250% FPL
Marketplace Coverage	14%	57%	26%	3%
Employer Coverage	17%	39%	27%	17%
250% FPL or more
Marketplace Coverage	7%	25%	69%	0%
Employer Coverage	16%	39%	35%	10%

April–June 2014	Pays Nothing	$1 to Less Than $125	$125 or More	Don’t Know or Refused
All adults
Marketplace Coverage	13%	38%	40%	8%
Employer Coverage	26%	35%	23%	15%
<250% FPL
Marketplace Coverage	18%	48%	27%	8%
Employer Coverage	32%	31%	18%	19%
250% FPL or more
Marketplace Coverage	5%	19%	66%	10%
Employer Coverage	22%	38%	27%	13%

Adults ages 19–64 with single policies

FPL refers to federal poverty level. 250% of the poverty level is $29,425 for an individual
or $60,625 for a family of four.

Bars may not sum to 100 percent because of rounding.

How adults visited the marketplaces

On the Internet	83%
By phone	30%
In person	19%
By mail	12%

Percent who received personal assistance by phone or online chat

Yes, got personal assistance	38%
Did not get personal assistances	62%

Over One of Three Adults Who Switched Marketplace Plans Did So Because Their Old Plan Was No Longer Being Offered

QUESTION WORDING:
What is the main reason you changed plans?

BASE: Adults ages 19–64 years who changed marketplace plans*

	March–June 2017
Old plan no longer offered	35%
New plan has lower premium	21%
New plan has more doctors/hospitals that you want	10%
Some other reason	34%

*42% of adults ages 19–64 who have had marketplace coverage since before January 2017 switched plans since enrolling.

Nearly Two of Five Adults Stayed in the Same Marketplace Plan Because They Were Satisfied With It

QUESTION WORDING:
What is the main reason you kept the same plan?

BASE: Adults ages 19–64 years with marketplace coverage who stayed in the same plan*

	March–June 2017
You are satisfied with your plan	38%
You like your doctors and didn't want to change	10%
It was easier to stay in your same plan	32%
Some other reason	19%

*55% of adults ages 19–64 years who had marketplace coverage since before January 2017 stayed in the same plan since enrolling.

Are Americans Enrolling in Affordable Care Act Health Plans?

QUESTION WORDING:
Did you select a private health plan or enroll in Medicaid through the marketplace? (asked of those who visited the marketplaces)

	Total	19–34	35–49	50–64
Selected a private plan	29%	21%	29%	36%
Enrolled in Medicaid	19%	26%	17%	16%
Selected a plan but not sure if private or Medicaid	2%	1%	3%	3%
Did not select a health plan or enroll in Medicaid	46%	47%	49%	42%

Uninsured rates in the United States

RATE of being uninsured among all adults ages 19–64 years

	July–September 2013	April–May 2014	March–May 2015	February–April 2016	March–June 2017
TOTAL	19.9%	14.8%	13.3%	12.7%	14.0%
Age
19–34	28.4%	18.5%	19.5%	18.1%	16.4%
35–49	18.1%	14.9%	13.0%	11.3%	15.1%
50–64	14.0%	11.2%	8.1%	9.1%	9.9%
Income
Less than 100% of federal poverty level	33.2%	26.4%	26.3%	25.2%	23.9%
100%–137% of federal poverty level	37.8%	20.3%	21.2%	22.1%	29.0%
138%–249% of federal poverty level	32.1%	21.8%	16.5%	16.2%	18.1%
250%–399% of federal poverty level	12.1%	10.1%	7.3%	8.0%	8.5%
400% of federal poverty level or more	4.0%	2.7%	2.2%	2.4%	5.0%

The majority of new enrollees in marketplace or Medicaid had been long-term uninsured

QUESTION WORDING:
At the time you got your marketplace or Medicaid coverage, how long had you been uninsured?

DISTRIBUTION among adults ages 19–64 years who were uninsured before gaining their marketplace or Medicaid coverage

	Total	Enrolled in a health plan through the marketplace	Enrolled in Medicaid
	n=538	n=179	n=357
3 months or less	12%	13%	11%
4-11 months	19%	22%	17%
1-2 years	19%	22%	18%
More than two years*	45%	38%	49%

*Includes those who reported never having had insurance

Over half of adults continue to be insured through the employer

QUESTION WORDING:
What type of health insurance do you currently have that helps pay for the cost of your health care?

	July–Sept. 2013	April–May 2014	March–May 2015	Feb.–April 2016
Uninsured	20%	14%	13%	13%
ESI	56%	52%	54%	53%
Medicaid	9%	13%	13%	13%
Marketplace	-	7%	8%	8%
Individual	5%	5%	3%	4%
Medicare	6%	6%	5%	6%
Other	4%	4%	4%	4%

Status of current marketplace and Medicaid enrollees prior to getting new plan

QUESTION WORDING:
What type of health insurance did you have prior to getting your marketplace or Medicaid coverage?

DISTRIBUTION among adults ages 19–64 years who are currently enrolled in marketplace or Medicaid coverage

	March–May 2015	February–April 2016	March–June 2017
	n=811	n=881	n=1,173
Uninsured	59%	53%	45%
Employer coverage	25%	27%	33%
Individual coverage	8%	8%	6%
Medicaid	2%	2%	1%
Marketplace coverage	1%	3%	4%
Other	1%	1%	1%

Percent adults ages 19–64 with incomes below 100 percent of poverty who were uninsured

	July–Sept. 2013	April–May 2014	March–May 2015	Feb–April 2016
Expanded Medicaid (28 states + D.C.)	28%	17%	16%	COMING SOON
Did not expand Medicaid (22 states)	40%	39%	38%	COMING SOON

Likelihood of going to/going back to marketplace by March 31, 2014

QUESTION WORDING:
The enrollment period for health insurance in the marketplaces ends March 31, 2014. How likely are you to go to/go back to the marketplace by March 31, 2014, to enroll in a health plan or find out if you are eligible for financial help to pay for your plan or for Medicaid?

	Very unlikely		Somewhat unlikely		Somewhat likely		Very likely
	Oct	Dec	Oct	Dec	Oct	Dec	Oct	Dec
Total	27%	28%	11%	8%	24%	23%	34%	36%
Age
19–34	21%	30%	17%	10%	28%	25%	32%	33%
35–49	30%	27%	9%	7%	20%	26%	36%	35%
50–64	33%	31%	5%	9%	22%	16%	36%	39%
Health Status
Excellent, very good, or good	27%	33%	11%	8%	23%	22%	34%	33%
Fair or poor	29%	18%	10%	10%	26%	25%	35%	42%

QUESTION WORDING:
Have you used your new health insurance plan to visit a doctor, hospital, or other health care provider, or to pay for prescription drugs?

BASE: Adults ages 19–64 years who have marketplace or Medicaid coverage

	Apr–June 2014	Mar–May 2015	Feb–Apr 2016	Mar–June 2017
	n=631	n=811	n=885	n=1,220
Yes	60%	68%	72%	79%
No	34%	31%	27%	21%
Plan has not yet gone into effect	6%	1%	1%	0%

*For 2014, 2015, and 2016 we include adults who had Medicaid since January 2014. For 2017 we include all adults with Medicaid.

QUESTION WORDING:
Prior to getting your new health insurance plan, would you have been able to access and/or afford this care?

BASE: Adults ages 19–64 years who have marketplace or Medicaid coverage and have used their new health insurance plan

	Apr–June 2014	Mar–May 2015	Feb–Apr 2016	Mar–June 2017
	n=367	n=581	n=633	n=999
Yes	36%	37%	38%	32%
No	62%	62%	61%	65%
Don't know or refused	2%	2%	1%	2%

*For 2014, 2015, and 2016 we include adults who had Medicaid since January 2014. For 2017 we include all adults with Medicaid.

QUESTION WORDING:
How easy or difficult was it for you to find a new primary care doctor or general doctor?

BASE: Adults ages 19–64 who have marketplace or Medicaid coverage and have tried to find new primary care or general doctor

	Apr–June 2014	Mar–May 2015	Feb–Apr 2016	Mar–June 2017
	n=124	n=159	n=207	n=302
Very easy	39%	47%	35%	42%
Somewhat easy	36%	30%	23%	22%
Somewhat difficult	10%	9%	23%	17%
Very difficult	7%	7%	14%	12%
Could not find a doctor	7%	6%	5%	6%
Don't know or refused	NA	1%	0%	1%

*For 2014, 2015, and 2016 we include adults who had Medicaid since January 2014. For 2017 we include all adults with Medicaid.

QUESTION WORDING:
Overall, how satisfied are you with your health insurance?

BASE: Adults ages 19–64 who have marketplace or Medicaid coverage*

	Apr–June 2014	Mar–May 2015	Feb–Apr 2016	Mar–June 2017
	n=631	n=812	n=881	n=1,204
Very satisfied	43%	40%	44%	51%
Somewhat satisfied	35%	45%	38%	38%
Not very satisfied	6%	6%	8%	6%
Not at all satisfied	8%	5%	6%	4%

*For 2014, 2015, and 2016 we include adults who had Medicaid since January 2014. For 2017 we include all adults with Medicaid.

6 of 10 Adults With Marketplace Coverage Were Somewhat or Very Confident They Could Afford Care They Needed

QUESTION WORDING:
How confident are you that if you become seriously ill you will be able to afford the care you need...?

BASE: Adults ages 19–64 years, March-June 2017

	Not at All Confident	Not Too Confident	Somewhat Confident	Very Confident
Afford the care you need	18%	14%	32%	33%
Employer	9%	12%	36%	41%
Marketplace	22%	16%	32%	28%
Medicaid	17%	16%	35%	29%
Uninsured	54%	19%	14%	9%

The Commonwealth Fund