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Reaching Consumers in OE3: Who Are They and What Do They Need to Hear? Takeaways From Two RWJF Studies
© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 2
Agenda
1. Introduction 2. The Uninsured 3. Marketplace Enrollees 4. What It All Means 5. Messaging Resources 6. Q&A 7. Wrap-Up
© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 3
Introduction
Mike Perry Co-Founder PerryUndem Research and Communication
Alison Betty Partner GMMB
Jessica Barba Brown National Director of Communications Enroll America
© 2015 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 4
Introduction
The Robert Wood Johnson Foundation commissioned PerryUndem to conduct two national surveys of uninsured individuals and individuals who purchased a qualified health plan (QHP) through HealthCare.gov or their state marketplace. PerryUndem worked closely with GMMB to develop the questionnaires and analyze the results. We are drawing on these two studies for this presentation today.
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The Uninsured • Survey fielded May 5-7, 2015 • National survey of N=1,270 adults ages
18-64, N=469 Latinos • All survey respondents were uninsured at
time of survey • To view the full study, go to:
http://www.rwjf.org/en/library/research/2015/06/understanding-the-uninsured-now.html
Marketplace Enrollees • Survey fielded August 11-21, 2015 • National survey of N=1,012 adults ages
18-64 • All survey respondents had purchased a
qualified health plan (QHP) through HealthCare.gov or their state marketplace
• To view the full study, go to:http://www.rwjf.org/en/library/research/2015/10/marketplace-enrollees.html
The Studies
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THE UNINSURED Section One
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Experiencing Many Challenges and Transitions
Only one-quarter say they are doing well financially.
Thinking about your finances, how would you say things are going for you these
days? Use the scale below (0-10). n=1270
Many are experiencing change. More than half of the uninsured (52%) have
experienced a life change in the last 12 months: 21% Became unemployed. 18% Moved homes. 17% Changed jobs. 16% Experienced the death of a loved one. 4% Started school. 3% Started a business. 3% Had a child.
31% have an ongoing medical condition
Not doing well (0-4)
43%
Doing well (6-10) 26%
Doing okay (5) 31%
REF 1%
Money is tight. 58% have $100 or less left over every month after paying bills.
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!56%
Optimistic (6-10)
!60%
Doing Better (+1 to +5)!
!
1% REF
But, They Are Cautiously Optimistic
Thinking about the next year, how optimistic are you that life is going to get better and easier? Use
the 0-10 scale. n=1270
Most believe life will get better soon.
When you think of your finances a year from now, do you expect to be doing about the same, better, or worse than you are now? Use a scale
of +5 (better), 0 (same) , -5 (worse). n=1270
Most also expect to be in better financial shape in a year.
20% Not Sure (5) !
23% Not Optimistic (0-4)!!
1% REF
28% Doing the Same !(0)
11% Doing Worse (-5 to -1)!
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Most Are Getting Care Without Insurance
16%
21%
21%
32%
34%
Preventive test/screening
Emergency care
Check-up
Doctor visit when sick
Prescriptions
Have you had any of the following since you have been uninsured? n=1270
54% of the uninsured have had at least one of these medical services since being uninsured.
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Most Feel They Can Manage the Costs
42%
48%
52%
53%
56%
Preventive test/screening
Emergency care
Check-up
Prescription
Doctor visit when sick
How confident are you that you could get the following care and manage the costs without health insurance? n=1270
Very/somewhat confident
46% think it is “easy” to get prescriptions without insurance.
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Four in Ten Went to the Marketplace
Yes 41%
No 47%
Not sure 10%
REF 2%
HealthCare.gov/state marketplace is a place for people to find affordable health insurance. Have you ever looked into the new
health plans available through HealthCare.gov/ state marketplace? n=1270
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Cost Is the Main Reason They Have Not Signed Up
Which of the following statements best describes why you have not purchased health insurance on your own since becoming uninsured? n=1270
6%
6%
9%
9%
61%
Getting insurance is not something I really think about.
I can get the care I need without health insurance.
I expect to have insurance soon through a job or through a spouse’s job.
Purchasing a plan on my own does not seem worth it financially.
I can’t afford health insurance.
59% of those individuals who “can’t afford” insurance do not understand or have not heard of the tax credit.
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They Consider More Than Just the Premium
59%"
47%"43%" 41%" 39%"
30%" 29%"22%"
19%"
Premium Out-of-pocket costs
Deductible Copayments Benefits covered
Penalty/fine ER costs Tax credit Doctors in network
[If has looked for insurance before]: Thinking about the last time you looked for health insurance on your own, which of the following things did you consider before deciding not to purchase a
plan? n=829
When asked to choose the two most important considerations before deciding NOT to purchase a plan, they respond: premium (57%) and
the deductible (24%).
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Six in Ten Are Confused or Have Not Heard About Tax Credits
As you may know, many people are able to get a tax credit to help purchase an insurance plan through HealthCare.gov/state marketplace. How much do you
understand about how these tax credits work? Or have you not heard about these tax credits before? n=1270
!
39%
Understand
A lot 15%/Some 24%
34% Don’t Understand
Not Much 20%/Anything 14%
25% Never Heard of
1% REF
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They Want One-On-One Help
If you were to look into buying health insurance for yourself (outside of a job) in the future, how important would it be for you to be able to talk with someone one-on-one to help you understand your options? n=1270
71%
Important Very = 39%; Somewhat = 32%
26% Not Important Not too =16%; Not at all = 10%
2% REF
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Some Say the Increasing Fine May Get Them to Enroll
The penalty or fine for not having health insurance increases to $395 or 2% of your income (whichever is higher) in 2015. Then in 2016, it
increases to $695 or 2.5% of your income (whichever is higher). Would these increased penalties or fines make you more likely to get
insurance in the future, less likely to get insurance, or do they not make a difference for you? n=1270
Those more likely to get insurance due to the increasing
fine: 39% Spanish-speaking Latinos 33% Having insurance “very” important 33% Uninsured less than two years 34% 400+% FPL 32% English-speaking Latinos
More likely to get
insurance 26%
Less likely to get
insurance 6%
No difference 42%
Not sure 24% REF
2%
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More Than Half Say They Will Go to the Marketplace
Very likely 19%
Somewhat likely 37%
Not too likely 21%
Not at all likely 21%
REF 1%
How likely would you be to look into the health plans available through HealthCare.gov/state marketplace in the
future? n=1270
• Having insurance “very” important (34%) • Spanish-speaking Latinos (31%) • Previously looked into marketplace (25%) • Those who paid a tax penalty (24%)
Who is “very likely” to go in the future:
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Four in Ten Believe They Will Get Insurance Within 12 Months
How confident are you that you will have health insurance in the next 12 months?
n=1270 More than one-quarter see themselves purchasing their own plan.
Those most likely to think they will get insurance by purchasing it on their own: • Self-employed (42%) • >400% FPL (36%) • College+ educated (33%) • 40-49 year olds (32%) • Looked into marketplace (32%)
If you get health insurance again, how do you think you will get it?
n=1270
Very confident
16% Somewhat confident
25%
Not too confident
17% Not at all confident
30%
REF 12%
1%
4%
12%
25%
25%
30%
REF
Medicare
Medicaid
Not sure
Purchase plan on own
Your/spouse's job
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MARKETPLACE ENROLLEES Section Two
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They Have an “Insurance Mindset”
Having insurance is very important to the currently enrolled—96% say having health insurance is either very important (73%) or somewhat important (23%). In addition, more than 8 in 10 say insurance is a “must have” that they will figure out how to pay for.
For some people, health insurance is something they feel they just need to have and they will figure out a way to pay for it. For others, health insurance is something they will only pay for if they feel like they
are doing okay financially. Which is closer to the way you think about insurance?
N=831
Insurance is something I need/will figure out how to pay.
Only pay for it if doing OK financially.
83%
17%
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Life Is Going Better for Current Enrollees
Thinking about your life in general, how would you say things are going? Scale: 0 (life is really difficult) to 10 (life is going really well)
57%
28%
15%
43% 38%
19%
Life going well (6-10) Life just so-so (5) Life is difficult (0-4)
Currently Enrolled N=831 Uninsured QHP Eligibles N=548
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Current Enrollees Have More Stability
Have you experienced any of the following in the past 12 months?
13% 11% 10% 9% 5% 5% 4%
60%
22% 18% 18%
13%
2% 1% 5%
48%
Changed jobs Became unemployed
Moved Death of a loved one
Started school Birth of a child Started a business
None of the above
Currently Enrolled N=831 Uninsured QHP Eligibles N=548
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Current Enrollees Are Doing Better Financially
Thinking about your finances, how would you say things are going for you these days? Scale: 0-10
45%
29% 26%
35% 31% 32%
Going well (6-10) Going so-so (5) Not going well (0-4)
Currently Enrolled N=831 Uninsured QHP Eligibles N=548
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Current Enrollees Value Insurance Much More
Given everything in your life these days, how important is it to you to have health insurance?
73%
23%
3% 0% 1%
35% 36%
19%
9% 2%
Very important Somewhat important Not too important Not at all Important REF
Currently Enrolled N=831 Uninsured QHP Eligibles N=548
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Protection From Medical Bills and the Fine/Law Are Top Motivators
30%
26%
12%
8% 7% 6% 5% 4% 2%
Protection from medical
bills
Fine/law Preventive care
Getting older See Dr when sick
Chronic condition
For family Other None of these
Please think back to when you first signed up for a health insurance plan through HealthCare.gov/state marketplace. What was the main reason you wanted health
insurance? N=831
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Many Experiencing a Health Care Need Before Enrolling
13%
18%
28%
29%
50%
Some other important medical event
Heart attack or stroke
Diagnosis of serious illness
An accident that led to the ER
Chronic medical condition
Thinking back to the time before you signed up for a health insurance plan through HealthCare.gov/state marketplace…As far as you can remember, had you or anyone close to you experienced any of
the following? N=831
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They Weighed Many Factors When Deciding to Purchase a Plan
Here is a list of things someone might consider when deciding whether to purchase a health insurance plan or to go without insurance. Thinking back to when you were
deciding whether to sign up for a plan, which of the following things did you consider? N=831
73%"
57%" 57%" 56%"52%"
42%"36%" 35%"
26%"
Premium Out-of-pocket costs
Benefits Deductible Co-payments Drs in network Tax credit ER costs Penalty/fine
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Most Feel They Chose the Best Plan for Them
How confident were you that you chose the best plan for you at the time? N=831
Very confident 30%
Somewhat confident
49%
Not too confident 14%
Not at all confident 7%
REF 1%
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Most Enrolled Online and Many Received Help
Who gave them help: (N=457)
1%"
3%"
11%"
13%"
35%"
54%"
Employer
Someone else
Trained community member
Friend/family member
Agent/broker
Customer Rep from HC.gov/SM
When they enrolled for the first time: (n=831)
Oct 2013 – Mar 2014 38%
Nov 2014 – Feb 2015 28%
Apr 2014 – Oct 2014 12%
After Feb 2015
15%
The main way they enrolled: (n=831)
Online 69%
Phone 16%
In-person 9%
Paper
2%
Getting help: More than half had enrollment help the first time they applied (54%). Those most likely to get help:
• 50-64 years old (66%); • Latinos (66%); • those with high school or less (63%); • and women (62%).
Four in 10 (40%) used a tool/calculator online to help them figure out what their premium would be before enrolling. Of
those who used a tool/calculator, 87% say it was
helpful (43% very; 44% somewhat).
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They Are Satisfied With Their Marketplace Plans
They are also satisfied with the doctors and services covered by their plan.
Overall, how satisfied are you with your current plan through HealthCare.gov/state
Marketplace? N=831
How satisfied are you with the doctors and services your current plan covers?
N=831
Very satisfied
29% Somewhat satisfied
45%
Not too satisfied
17%
Not at all satisfied
9%
Very satisfied
38%
Somewhat satisfied
43%
Not too satisfied
11%
Not at all satisfied
7%
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Affording Their Premium Is Hard for Many
When asked about their specific premium amount, half (50%) say they pay $200 or less each month.
PREMIUM AMOUNT
Very easy 18%
Somewhat easy 38%
Somewhat difficult
35%
Very difficult 9%
Given your budget, how easy or difficult is it for you to pay the monthly premium for your
current health insurance plan N=831 Q. How much is the monthly premium you pay for the plan you have through HealthCare.gov/state marketplace? Your best guess is fine. N=831
$0-$50
14%
$51-$100 15%
$101-$200 21%
$201-$400 27%
>$400 22%
REF 2%
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They Plan to Stay Insured Through the Marketplace
Also, more than 8 in 10 of those who plan to stay insured say they are likely to continue getting their insurance through the marketplace.
Thinking about 12 months from now, do you expect to continue having health
insurance? N=831
Still thinking about 12 months from now, how likely are you to continue getting your health
insurance through HealthCare.gov/state marketplace?
N=824
Will definitely have
insurance 56%
Will probably have
insurance 35%
Will probably not have insurance
2%
Will definitely not have insurance
1%
Not sure 7%
Very likely 44%
Somewhat likely 40%
Not too likely 8% Not at all
likely 7%
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The Tax Credit Is the Main Driver to Stay With the Marketplace
[If plan to stay with marketplace coverage] Why do you think you will continue getting your health insurance through HealthCare.gov/state
marketplace 12 months from now? Choose all that apply. N=709 46%"
34%"
29%"26%" 25%"
5%"8%"
Tax credit Can't find better price anywhere else
Works for me now Convenient Want to stay in my plan
Not sure Other
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They Are Sensitive to Premium Increases
Many say they might drop coverage if their premium increases. Enrollees who might consider dropping coverage (N=432) were asked about specific dollar amount increases. The results indicate that 20% might consider dropping coverage if there is a $10 increase per month and 61% might consider dropping if the increase goes up to $50 more per month.
As you may know, the monthly premium amount for insurance plans can change from one year to the
next. If your monthly premium increased during the next open enrollment period, would you consider dropping your plan and living without insurance
instead of paying the increased premium? N=831
18% Yes
!
38% Maybe
44% No
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Kept same plan 53%
Changed plans 43%
Not sure 4%
Many Changed Plans During Renewal
Of those current enrollees who renewed, 43% say their plan renewed automatically while 37% say their plan did not renew automatically and 20% are unsure. Slightly more than half kept their original plan when they renewed, but more than 4 in 10 said they changed plans.
{If renewed] Is your current plan the same as the one you had when you
first signed up through HealthCare.gov/state marketplace or did you change
plans? N=455
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Half Changed Their Plans to Pay a Lower Premium
[If changed plans] Why did you change plans? Choose all that apply.
N=191
48%"
22%"
16%"14%"
8%"6%" 6%"
3%" 2%" 2%"
Pay lower premium
Old plan not offered
Wanted more services + Drs
Pay lower deductible
No longer qualified for
the plan
Wanted to change insur.
co.
Didn't like old plan
Found more affordable
plan
Wanted to change Dr
network
Other
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Most Will Compare Plans Next Open Enrollment
Some people use open enrollment to compare all of their insurance options and make sure they are getting the best plan available for them. They could decide to change plans or renew their current plan
depending on what they learn. Other people renew their current plan without looking into all their options again because they do not have time, they are satisfied with their current plan and want to keep it, or for all kinds of other reasons. During the next open enrollment period, how likely are you to compare all of
your insurance options before making a decision about whether to renew your plan? N=831
Very likely 51% Somewhat likely
29%
Not too likely 13%
Not at all likely 7%
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WHAT IT ALL MEANS Section Three
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What it Means: Cost is Key
#1
Cost is always priority #1. Educate consumers on the tax credit and remind them that plans and rates change every year.
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What it Means: Lives Are Dynamic
People are in transition. They’re dealing with new jobs, new moves, changing finances.
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Respect the Choice
• They’re weighing costs and priorities. • This is not about telling them what they should do,
but understanding why they’re doing it. • Filling in information gaps, credibly.
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Consumers Split into Three Groups…
PEOPLE WHO
LOOKED
MAKING THE CALCULATION
PEOPLE WHO
DIDN’T
UNAWARE OF FINANCIAL HELP
PEOPLE WHO
SIGNED UP
NEED TO COME BACK AND RE-CHECK
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So, We Need to Have a Dialogue
Listen more than we talk. What are their priorities? Understand where they are.
Pushing out messages to the masses is likely wasteful. They need information:
Messages need to connect them with what’s real and relevant for them and their situation.
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MESSAGING RESOURCES
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Get Covered Communicators Guide
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The Five Messages Consumers Need to Hear
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On Renewals
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Tools on GetCoveredAmerica.org
Get Covered Calculator Get Covered Connector Get Covered Plan Explorer Financial Help In-Person Help New Plans, New Prices
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Join the Get Covered Communicators Program
www.EnrollAmerica.org/Communicators - Weekly email messaging update - Monthly messaging calls - Earned media best practices - Localized messaging
resources - Social media content
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QUESTIONS? We know you have them…
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Thank you!
Want to know more? Contact: Mike Perry at [email protected] Alison Betty at [email protected] Jessica Barba Brown at [email protected]