Consumer Assistance in Health Insurance: Evidence of Impact and Unmet Need

The Kaiser Family Foundation (KFF) Consumer Assistance with Health Insurance Survey is based on interviews with a probability-based sample of 2,049 respondents between the ages of 18 and 64 who reported having health insurance purchased from a state or federal marketplace (the “Marketplace” group); being covered by Medicaid, excluding those who receive Supplemental Security Income (the “Medicaid” group); or not being covered by health insurance (the “Uninsured” group). Interviews were administered online from March 28 through April 14, 2020 in English and Spanish. The survey was designed and analyzed by researchers at KFF, and KFF paid for all costs associated with the survey.

Ipsos conducted sampling, interviewing, and tabulation for the survey using the KnowledgePanel, a representative panel of adults age 18 and over living in the United States. KnowledgePanel members are recruited through probability sampling methods using address-based sampling. Panel members who do not have internet access are provided with a netbook and internet service.

For this study, certain types of panelists were selected at disproportionately higher rates in order to allow for subgroup analysis, including those with Marketplace coverage, those living in states with state-based Marketplaces, those living in states that have not expanded Medicaid, and African Americans.

The combined results have been weighted to adjust for the fact that not all survey respondents were selected with the same probability, to address the implications of sample design, and to account for systematic nonresponse along known population parameters. In the first weighting stage, the sample of all respondents selected for the survey (prior to any termination due to ineligibility) was weighted to match the demographic makeup of the 18-64 year-old population by sex, age, race/ethnicity, education, household income, region, metro status, and language proficiency (for Spanish-speaking respondents). Demographic targets came from the Census Bureau’s 2018 Current Population Survey, except for language proficiency which was derived from the 2018 American Community Survey.

In the second weighting stage, eligible respondents were separated into 3 groups (Marketplace, Medicaid, and Uninsured), and the first stage weight was used to create demographic benchmarks for each group. Qualified respondents were then weighted to the resulting benchmarks.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. All statistical tests of significance account for the effect of weighting. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

The estimates of the number of people helped and the number of people who sought help but did not get it were calculated by first estimating the universe for the target population, which is comprised of nonelderly adults enrolled in marketplace plans as of March 2020 who are in a new plan or actively renewed their 2019 plan; non-elderly who enrolled in Medicaid in the past year or actively renewed their Medicaid coverage, and who were not receiving SSI benefits as of that date; and nonelderly uninsured who actively sought coverage in the past year.

Marketplace enrollees. According to the Early 2020 Effectuated Enrollment Snapshot, 10.7 million people selected or were reenrolled in a marketplace plan as of March 15, 2020. In addition, based on data from the 2020 Marketplace Open Enrollment Data, 880,000 adults enrolled in the Basic Health Plan (BHP) in New York and Minnesota for a total of 11.6 million marketplace and BHP enrollees. From the survey, 72% of marketplace enrollees are either in a new plan for 2020, or actively renewed their 2019 plan. Total marketplace enrollees newly enrolled or actively renewed in 2020 was 8.4 million.

Medicaid enrollees. Current Medicaid enrollment data that separate non-elderly, nondisabled adults are unavailable. Using 2018 data from a KFF analysis of Medicaid enrollees with disabilities, there are an estimated 25.5 million nonelderly, non-disabled adults on Medicaid. To include all the individuals helped, the children of adults on Medicaid were also included. According to the survey 47% of Medicaid enrollees reported one or more children was also enrolled in Medicaid at the time of the survey. Estimating one child per adult is about 12 million children. Total Medicaid enrollees in the sample universe was 37.5 million. This total was then reduced to include only those who enrolled in the past 12 months (20% from the survey or 7.5 million) or who actively renewed their coverage (39% from survey or 14.6 million) for a total of 22 million in the target population.

Uninsured individuals. Using data from 2018, there were 27.9 million nonelderly individuals without health coverage. According to the survey, 29% of people who were uninsured actively looked for coverage for a total of 8.1 million.

Summing the estimates results in 38.5 million people who could have been helped. According to the survey, 18% of people who could have been helped, actually got help or about 7 million people. Additionally, 12% of people who could have been helped sought help but didn’t get it or nearly 5 million people.