Association for Public Policy Analysis & Management

Research Objectives: The Affordable Care Act’s coverage expansions have increased access to health insurance across the country. Ensuring marketplace and Medicaid enrollees can get timely access to their providers and other health care services is still vital. If Congress and the Trump Administration continue their fight towards repealing the ACA, it is critical for policymakers to recognize the gains in insurance that have been made because of the law, and to ensure its replacement continues to allow consumers to purchase plans with adequate coverage.

Study Design: Data for this study comes from the 2017 Commonwealth Fund Affordable Care Act Tracking Survey, a nationally representative telephone survey of adults ages 19-64. The survey firm SSRS conducted the interviews between March 28-June 20, 2017.

Population Studied: This study limits the analysis to respondents ages 19-64 years (n=4,813). Some analyses were restricted to adults who have marketplace or Medicaid coverage under the health reform law (n=1,204).

Principal Findings: Eighty-two percent of marketplace enrollees and 94 percent with Medicaid are satisfied with their health insurance. Sixty-six percent of marketplace and Medicaid enrollees who had used their insurance to get care said they would not have been able to afford or access it prior to enrolling. In terms of network satisfaction, 86 percent of adults who had either enrolled in marketplace coverage for the first time during the 2017 open enrollment period, or switched plans, reported they were very or somewhat satisfied with the doctors covered by their insurance, 68 percent said their plans had either all or some of the doctors they wanted, and 23 percent reported having their preferred doctor and/or network was the most important factor in choosing a plan. Sixty-four percent of adults with marketplace or Medicaid coverage said that it was very or somewhat easy to find a primary care doctor and nearly three-quarters were able to book an appointment within two weeks. Forty-six percent of adults with marketplace said they had the option of choosing a less expensive plan with fewer doctors and hospitals. Of this group, 45 percent chose the narrow network plan.

Conclusion: The ACA’s coverage expansions have made it possible for adults to gain insurance they are satisfied with. Through their coverage, most adults surveyed are now able to get the care they need, see the doctors they want, and book timely appointments. While the cost of insurance was the most important factor in plan selection for the majority of respondents, a quarter of adults reported that the plan’s network was the most important factor.

Policy Implications: In the aftermath of Congress’ failed effort to repeal and replace the ACA, it is critical to recognize the significant impact the law has had on providing individuals with quality health insurance. While claims have been made that the Affordable Care Act has been failing, we find that the law has provided health insurance consumers are satisfied with as well as insurance they would not have been able to get otherwise.