Many Don't Understand Obamacare or Health Insurance, Survey Finds

By Amy Norton
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- As the deadline looms for Americans to enroll in "Obamacare" this year, a new study finds that many people -- especially the uninsured and those with lower incomes -- know little about the new health care law, known as the Affordable Care Act.

Most significantly, researchers found, Americans show little understanding of the cornerstone of the reform -- the online marketplaces, or "exchanges," that have been set up to help people shop for an insurance plan, and find out if they're eligible for Medicaid or subsidies to help pay for their health insurance.

Overall, half of the 6,000 U.S. adults surveyed did not even know what an exchange was, and among the uninsured, a full 64 percent didn't know. In addition, over 40 percent of survey respondents did not know what an insurance deductible was, including nearly 60 percent of the uninsured.

Experts were concerned by the findings, reported in the March 24 online edition of the Proceedings of the National Academy of Sciences. But they were not shocked.

"No, this doesn't surprise me at all," said Dr. Kavita Patel, a fellow at the Washington, D.C.-based Brookings Institution.

Low "health literacy" -- people's understanding of health information and ability to use it -- is a well-known problem, and not limited to health care reform, noted Patel, who was not involved in the study.

To be fair, the new report is based on a survey done in August and September of last year -- before the state and federal exchanges were up and running, and before the troubled federal website was grabbing headlines everywhere.

By now, Americans may know more, according to Silvia Barcellos, an economist at the University of Southern California who led the study.

She said she and her colleagues are planning a follow-up survey in April to see if there has been a change.

Regardless, Barcellos said, the current findings are worrisome, especially the lack of awareness among the uninsured.

"These are the people everyone is counting on to enroll," she noted.

And the problems go beyond awareness of the exchanges. "Many people lack a basic understanding of how health insurance works," Barcellos said.

March 31 is the deadline for enrolling for insurance coverage for 2014 under the Affordable Care Act.

Of all survey respondents, 42 percent did not know what an insurance deductible was -- including 58 percent of the uninsured.

The same was true for 30 percent to 45 percent of those living between 100 percent and 400 percent of the federal poverty level. Many of those Americans are eligible for tax credits to help pay for insurance bought through the exchanges. They are another group that stands to benefit the most from the Affordable Care Act.

But if uninsured and lower-income people don't understand how health insurance works, Barcellos said, "how can you expect them to make informed decisions when they choose a plan?"

Sharon Long, of the Urban Institute's Health Policy Center in Washington, D.C., agreed.

"Health insurance is complicated, and we're talking about people who may never have had it in the past," said Long, who was not involved in the study. "It's ironic that we're asking people without that experience to make good choices."

Brookings' Patel pointed out that this problem was anticipated. Federal and state governments have so-called navigator programs to help applicants get through the enrollment process. Those navigators include individuals and groups -- from nonprofits to hospitals to church groups -- who are trained and certified (and paid) by the government.

"The role of the navigators is important," study author Barcellos said. But, she added, people also need to know the programs exist.

There are other potential ways to make the exchanges more user-friendly, according to Barcellos. One step, she said, could be to redesign the exchange websites to "nudge" people to the best plans -- by highlighting certain economical and better-quality plans on the first page of the site.

Barcellos said research has shown that when people have too many choices -- especially complex ones -- their tendency is to opt for whatever seems easiest.

"Or," she said, "they may make no choice at all."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Silvia Helena Barcellos, Ph.D., research scientist, University of Southern California Center for Economic and Social Research, Playa Vista, Calif.; Kavita Patel, M.D., managing director, clinical transformation and delivery, Brookings Institution, Washington, D.C.; Sharon Long, Ph.D., senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; March 24, 2014, Proceedings of the National Academy of Sciences, online

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Obamacare Loses a Round in Pennsylvania - Individual Mandate Violates Commerce Clause

HARRISBURG, Pa. -- A Pennsylvania federal judge on Sept. 13 held that the individual mandate contained in the Patient Protection and Affordable Care Act (PPACA) is an unconstitutional extension of authority granted to the federal government under the U.S. Constitution's commerce clause (Barbara Goudy-Bachman, et al. v. United States Department of Health and Human Services, et al., No. 10-763, M.D. Pa.).

Barbara Goudy-Bachman and Gregory Bachman sued the U.S. Department of Health and Human Services, Kathleen Sebelius, in her official capacity as secretary of Health and Human Services, the U.S. Department of the Treasury and Timothy Geithner, in his official capacity as secretary of the Treasury, in the U.S. District Court for the Middle District of Pennsylvania, alleging that Section 1501 of the PPACA, which requires all people to purchase and maintain qualifying health insurance, is an unconstitutional exercise of Congress' authority under the commerce clause.  The Bachmans say the individual mandate has caused them current economic and noneconomic harm, and they seek an order to enjoin enforcement of the individual mandate.

The federal government moved to dismiss the case or, alternatively, for summary judgment, saying Congress acted within its authority in passing the provision.  The plaintiffs also moved for summary judgment.

In granting summary judgment in favor of the plaintiffs, Judge Christopher C. Conner said the case is not about the need to address the country's health care system but instead concerns precise parameters of Congress' enumerated authority under the commerce clause and whether Congress can invoke its power under that clause to compel individuals to buy insurance as a condition of lawful citizenship or residency.

Congress exceeded its power under the commerce clause in enacting the mandate because the "power to regulate interstate commerce does not subsume the power to dictate a lifetime financial commitment to health insurance coverage," Judge Conner said.

"Without judicially enforceable limits, the constitutional blessing of the minimum coverage provision would effectively sanction Congress's exercise of police power under the auspices of the Commerce Clause, jeopardizing the integrity of our dual sovereignty structure," Judge Conner said.

In reaching the decision, Judge Conner rejected arguments relating to the distinction between activity and inactivity, saying such wordplay "is imprecise and unhelpful."

The extension of commerce clause power to the pre-transaction stage would eliminate "judicially enforceable boundaries," Judge Conner said.  The mandate regulates people who have not yet entered the market in anticipation of their entrance into the health care services market, and, to date, all exercises of commerce clause authority have proscribed activity by individuals already engaged in commerce who are active in the relevant interstate market.

"Congress may lawfully regulate the interstate market for health insurance and health services, but Congress cannot require individuals who choose not to purchase health insurance or individuals who are not currently seeking or receiving services in the health care market to purchase health insurance in order to stabilize the health insurance market.  Congress cannot mandate or regulate in anticipation of conduct that may or may not occur in the future," Judge Conner said.

[Editor's Note:  Full coverage will be in the Sept. 21 issue of Mealey's Managed Care Liability Report.  In the meantime, the order is available at www.mealeysonline.com or by calling the Customer Support Department at 1-800-833-9844.  Document #31-110921-007Z.  For all of your legal news needs, please visit www.lexisnexis.com/mealeys.]

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Lexis.com subscribers may also access the earlier decision of the court, and also the original complaint and initial motion to dismiss, in which the plaintiffs were found to have standing to challenge the PPACA in Goudy-Bachman v. United States HHS, 764 F. Supp. 2d 684 (M.D. Pa. 2011).

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Legal News Podcast - New Hampshire Federal Court Dismisses Challenge to Obamacare - Standing Not A Fiction

A New Hampshire federal judge dismisses a challenge to the Health Care Act by a Medicare recipient, and, a $111 million interest award is issued in a Texas federal patent case. Hear these and other stories from LexisNexis® Mealey's Publications. Copyright© 2011 LexisNexis, a division of Reed Elsevier Inc. For the latest litigation news headlines, visit www.lexisnexis.com/mealeys or www.lexisnexis.com/community.

A New Hampshire judge overseeing what he said was possibly the first case brought by a Medicare recipient to challenge the Patient Protection and Affordable Care Act (PPACA), dismissed the lawsuit on March 30, saying the plaintiff lacked standing to bring the suit (Harold Peterson v. Barack Obama, et al., No. 10-170, D. N.H.). Harold Peterson sued President Barack Obama, the United States of America, the U.S. Congress, the U.S. Senate and the U.S. House of Representatives in the U.S. District Court for the District of New Hampshire, seeking declaratory judgment and injunctive relief. Peterson, a Medicare recipient, contended that the PPACA violated the Fifth, 10th and 14th Amendments and Article 1, Section 8, and Article 6 of the U.S. Constitution because the Constitution did not empower Congress to take over the health care business.

Although the PPACA and particularly the mandate raised interesting constitutional issues, Peterson did not have standing to litigate them, Judge Joseph N. Laplante said. Medicare coverage automatically satisfies the PPACA's individual mandate requirement, so Peterson wouldnot incur any financial burdens and wouldnot need to do anything to satisfy the mandate, Judge Laplante said.

The court rejected Peterson's unique arguement that standing was a 'Fiction'. "The Constitution limits the jurisdiction of federal courts to 'Cases' and 'Controversies.' Lujan v. Defenders of Wildlife, 504 U.S. 555, 559, 112 S. Ct. 2130, 119 L. Ed. 2d 351 (1992) (quoting U.S. Const. art. III, § 2, cl. 1). To satisfy the Constitution's 'case or controversy' requirement, a party seeking relief in federal court must show that he has suffered an actual injury, which is fairly traceable to the defendant's conduct and redressable by a favorable judicial decision. Coggeshall v. Mass. Bd. of Registration of Psychologists, 604 F.3d 658, 666 (1st Cir. 2010), citing Lujan, 504 U.S. at 560-61). That is commonly known as the doctrine of 'standing.' Peterson argues that 'standing is a fiction created by the courts' and that he need not satisfy any such requirement. But the Supreme Court has called the standing requirement 'essential and unchanging,' Lujan, 504 U.S. at 560, and this court must follow Supreme Court precedent."

Lexis.com subscribers can access the enhanced version of Peterson v. United States, 2011 U.S. Dist. LEXIS 34775 (D.N.H. 2011) decision with summary, headnotes, and Shepard's.

Lexis.com subscribers can access additional Heath Care Reform Resources, including our special Health Care Reform Special Alert. The two-volume Health Care Reform Special Alert publication may also be purchased at the Store.

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LexisNexis® Legal News Podcast - Challenges to Obamacare (Patient Protection and Affordable Care Act) Rejected

The 4th Circuit finds Virginia lacked standing to challenge the Patient Protection and Affordable Care Act, Virginia ex rel. Cuccinelli v. Sebelius, 2011 U.S. App. LEXIS 18632 (4th Cir. Va. Sept. 8, 2011), and, in a separate case, finds the Anti-Injunction Act strips a court of jurisdiction to hear another challenge to the Health Care Act, Liberty Univ., Inc. v. Geithner, 2011 U.S. App. LEXIS 18618 (4th Cir. Va. Sept. 8, 2011). Hear these and other stories from LexisNexis® Mealey'sTM Publications. Copyright© 2011 LexisNexis, a division of Reed Elsevier Inc. For the latest litigation news headlines, visit www.lexisnexis.com/mealeys or www.lexisnexis.com/community.

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