Affordable Care Act

Who Signed Up? And Why? Decoding the Motivations Behind Obamacare

ACA supporters want to know the mindsets of people who signed up or opted out.

The Obama administration exceeded its first-year goals under the Affordable Care Act, enrolling 8 million people in the new plans in 2014.

Now supporters of the law want to know what motivated the uninsured to enroll and what blocked those who didn’t sign up.

They want to refine their outreach efforts next year, and they’ve begun delving into the mindsets of Americans – both those who picked a plan and those who chose to pass this year.  

The nonpartisan and nonprofit group Enroll America surveyed more than 1,524 people nationally, looking at the reasons why people pushed through the complicated sign-up process, and why some people gave up, or didn’t even investigate their options.  

The survey by PerryUndem found that for the people who did sign up for insurance, many things motivated them, like simply getting to see a doctor.

But 40 percent of the people who signed up also admitted they might not ever have done it except for the fact that the law requires it through the individual mandate and the associated fine.  

“It seems like there was a combination of things: the mandate, the fine, the law, but also access to care, the ability to use services, avoiding big medical bills,” said healthcare polling expert Mike Perry. “It was a mix of things, there was no single big motivation that jumped out in the study.”

Then there are the people who still don’t have insurance even now. A majority of them didn’t even try to sign up.

Many told the pollsters that they assumed they couldn’t afford it anyway, so why try.

“Here there was a clear barrier and it was the perception that they would not be able to afford insurance. So you don’t shop for insurance if you can’t pay for insurance. That was the mentality,” Perry said.

Perry says most of those people didn’t even know about the tax subsidies available to help with the cost.

Findings like that one will help focus the efforts of enrollment counselors and navigators. In November, they can start signing people up for 2015.

“The reason they didn’t take steps often was not because they didn’t want coverage but because they didn’t have the facts they needed to complete that process,” said Anne Filipic, President of Enroll America.

Filipic added that the first year of enrollment will create a “ripple effect” that will help momentum for next year’s enrollment period, which will run November 15 to February 15.

“As these millions of people have gained access to coverage, this really starts to demystify what the Affordable Care Act is all about, as friends start talking to friends, and neighbors start talking to neighbors,” Filipic added. “This helps make it more real for them as well.”

Although 8 million enrolled this time around, an estimated 20 million Americans were eligible but did not enroll. That larger group will be the focus of intense outreach by the federal government and groups like Enroll America.