NJ residents trail nation in understanding key feature of Obamacare

Andrew Kitchenman | September 30, 2013 | Health Care
On eve of marketplace launch, ignorance about individual mandate could stem from the fact that the state did not mount an awareness campaign

Jeff Brown and David Knowlton of the New Jersey Health Care Quality Institute.
Compared with residents of other states, New Jerseyans are not as aware of a new federal mandate requiring them to purchase individual health insurance, a central provision of the 2010 Affordable Care Act.

Only 56 percent of New Jersey residents know that that they have to buy insurance or pay a fine starting in 2014, according to a new poll released by the Monmouth University Polling Institute and the New Jersey Health Care Quality Institute. That compares with the 74 percent of Americans who said they were aware of the mandate in a March Kaiser Health Tracking Poll.

“They really don’t know what’s going to happen,” said polling institute Director Patrick Murray, regarding the public mandate.

The ACA mandates that residents have insurance or pay a penalty beginning in 2014. The size of the penalty will grow over the next three years.

Of those polled, 11 percent said they were uninsured. When informed of the mandate, 62 percent of these uninsured respondents said they planned to get health coverage, while 24 percent said they planned to remain uninsured despite the penalty and 13 percent said they were uncertain what they would do.

In 2014, the penalty will be $95 per adult and $47.50 per child, or 1 percent of family income, whichever is greater. In 2015, the penalty will be $325 per adult and $162.50 per child or 2 percent of family income, whichever is greater. In 2016, the penalty will be $695 per adult and $347.50 per child or 2.5 percent of family income, whichever is greater.

“We’re speculating here, but obviously there hasn’t been a statewide awareness campaign,” Murray said. “That seems to be the most likely culprit” in the lack of knowledge about the mandate.

Gov. Chris Christie opted for a federally operated marketplace, rather than a state-run exchange, citing the potential cost to the state and a lack of information from federal officials. Healthcare advocates have pointed out that the decision has left New Jersey with tens of millions of dollars less in federal funding to publicize the marketplace.

Maryland, despite a smaller population than New Jersey, has received $24 million for public outreach, compared with $2.02 million that New Jersey received for nonprofit organizations that will help residents enroll for insurance. Federal officials have said that public outreach will increase in the coming weeks, adding that they decided against a publicity campaign before insurance was actually available through the marketplace.

New Jerseyans have a somewhat more positive view of the law than has been recorded in national polls. Of those polled, 45 percent said they had a favorable view of the ACA, while 40 percent had an unfavorable view, and 16 percent had no opinion. A Kaiser national poll in August found that 37 percent of Americans had a favorable view and 42 percent had an unfavorable one.

New Jersey residents had a similar view as those in national polls about how the law will affect their own healthcare. Just under half, or 49 percent, feel the quality of their healthcare won’t be affected by the ACA, while 30 percent think it will worsen, and 13 percent said it would improve. That compares with national figures of 48 percent believing they won’t be affected, 34 percent saying their healthcare would be worse, and 15 percent saying it would be better.

The mandate is a key provision of the ACA. If healthier people don’t pay for insurance, healthcare costs are borne by the less healthy, pushing the price of insurance up, and causing fewer people to buy it.

Without having all Americans — including younger and healthier citizens — paying into the healthcare system, it becomes more difficult for the other parts of the ACA to function. Those include the provision that all residents have access to health insurance regardless of any pre-existing illnesses or conditions that they may have.

Murray said the lack of awareness of the mandate “is going to put a lot of New Jerseyans behind the eight-ball,” when they have to pay the penalty.

Tomorrow marks the beginning of open enrollment for the new health insurance marketplace or exchange for individuals to purchase insurance that will be effective beginning on January 1. This marketplace is intended to serve as a one-stop shop for residents to buy insurance and learn whether they are eligible for federal tax credits to subsidize it.

Subsidies will be targeted toward those with incomes between 138 percent and 400 percent of the federal poverty line, which currently amounts to between $15,856 and $45,960 for a single resident and between $32,499 and $94,200 for a family of four. The open enrollment period will last until March 31, 2014.

The open enrollment period in coming years is expected to be the same as open enrollment for making changes to Medicare, which is October 15 through December 7.

Residents won’t feel the pinch of the federal mandate until they file their 2014 income taxes. The deadline for filing — and for paying the penalty — won’t be until mid-April 2015, more than four months after the end of the marketplace open enrollment period for 2015. Murray said residents who choose to pay the relatively low penalty for 2014 may be in for a rude awakening when the penalty goes up in 2015, which they may not learn until they file their tax returns in 2016.

“Public officials want to get the word out,” Murray said, noting that they may face upset constituents.

The mandate is one of several pieces of the law that state residents are not yet familiar with, according to the poll. Of those surveyed, 18 percent feel they understand the ACA healthcare reforms very well, while 49 percent said they understand them somewhat well. That’s in contrast to 19 percent who said they don’t understand them too well and 12 percent who said they don’t understand them well at all. Just 34 percent said they heard a lot or something about the marketplace/exchange, similar to national surveys.

The new poll is the first in a new partnership between the Monmouth University Polling Institute and the New Jersey Health Care Quality Institute, a nonprofit dedicated toward linking healthcare delivery with quality, safety, accountability, and cost containment. The poll, named the Health Matters Poll, will be done on a quarterly basis. Some questions will be asked repeatedly, while new subjects will also be introduced.

Institute President and Chief Executive Officer David L. Knowlton said the survey “will take much of the guesswork out of understanding” what the public thinks about healthcare concerns.

Knowlton likened public interest in the ACA to interest in elections.

“As we get closer and closer to the date that people will have to be concerned with this historic new law, they will pay more attention and gain and better and more accurate understanding of it,” he said. “I am not at all surprised by the level of understanding at this point.”

Institute chief of staff Jeff Brown said it would be important to watch state residents’ attitudes toward the law evolve as they begin to see and feel its effects.

“New Jerseyans are clearly divided about the ACA but remain uninformed,” about key provisions like the mandate, Brown said. He noted poll findings that 27 percent of self-insured and uninsured residents said they were very interested in shopping for insurance on the exchange, while 19 percent said they were somewhat interested and 14 percent said they were a little interested.

“Even with the lack of knowledge about the exchange, it seems that people are interested” in checking it out, Brown said.

“I think the debate has been so politicized and there’s really just been talking points flying at people from both sides,” Brown said. “It’s been really hard for people to cut through that debate and that noise to get at what actually is in the law.”

Brown noted that public opinion in Massachusetts — the first state to mandate insurance and a model for the national law — improved after its law went into effect.

He added that the message from the federal government hasn’t reached residents yet.

“I don’t think they’ve done a good job so far at disseminating easily digestible information to consumers,” Brown said.

The Republican-majority U.S. House of Representatives passed a short-term government funding bill yesterday that would delay implementation of the mandate, the marketplace. and other ACA features. That could lead to a shutdown of the federal government tomorrow, since the Senate’s Democratic majority supports the long-scheduled implementation of the healthcare law.