Preparedness of Americans for the Affordable Care Act
Preparedness of Americans for the Affordable Care Act
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DOI：
10.1073/pnas.1320488111
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发表时间：
2014-04-15
影响因子：
11.1
通讯作者：
Goldman, Dana
中科院分区：
文献类型：
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作者：
Barcellos, Silvia Helena;Wuppermann, Amelie C.;Goldman, Dana
本文调查了个人是否有足够的信息来做出合理的选择在健康保险交易所建立的平价医疗法案（ACA）。我们记录了医疗改革的知识、医疗保险素养和医疗保健的预期变化，在引入交换之前的5周内对美国人口进行了全国代表性的调查，特别关注了最有可能受到ACA影响的亚群体。结果表明，相当一部分人还没有准备好驾驭新的交易所。一半的受访者不知道这些交易所，42%的人无法正确描述一项免赔额。那些收入在联邦贫困水平（FPL） 100-250%的人平均正确回答了11个关于医疗改革的问题中的4个，以及7个关于医疗保险的问题中的4.6个。相比之下，高收入阶层（400%的FPL或更高）分别有6.1和5.9个正确答案。即使在控制了潜在的混杂因素之后，低收入人群在ACA知识问题上得分高于中位数的可能性比高收入人群低31%，在健康保险知识问题上得分高于中位数的可能性低54%。没有保险的受访者在健康保险知识方面得分较低，但他们对ACA的了解与总体人口相似。我们建议简化选择、决策辅助和健康保险产品设计，以解决对健康保险合同的有限理解，这将是ACA成功的关键。
This paper investigates whether individuals are sufficiently informed to make reasonable choices in the health insurance exchanges established by the Affordable Care Act (ACA). We document knowledge of health reform, health insurance literacy, and expected changes in healthcare using a nationally representative survey of the US population in the 5 wk before the introduction of the exchanges, with special attention to subgroups most likely to be affected by the ACA. Results suggest that a substantial share of the population is unprepared to navigate the new exchanges. One-half of the respondents did not know about the exchanges, and 42% could not correctly describe a deductible. Those earning 100-250% of federal poverty level (FPL) correctly answered, on average, 4 out of 11 questions about health reform and 4.6 out of 7 questions about health insurance. This compares with 6.1 and 5.9 correct answers, respectively, for those in the top income category (400% of FPL or more). Even after controlling for potential confounders, a low-income person is 31% less likely to score above the median on ACA knowledge questions, and 54% less likely to score above the median on health insurance knowledge than a person in the top income category. Uninsured respondents scored lower on health insurance knowledge, but their knowledge of ACA is similar to the overall population. We propose that simplified options, decision aids, and health insurance product design to address the limited understanding of health insurance contracts will be crucial for ACA's success.