In U.S., 55% of Uninsured Plan to Get Health Coverage

PRINCETON, N.J. -- More than half of uninsured Americans say they plan to sign up for health coverage, a promising sign as the open enrollment period for obtaining health insurance through state and federal exchanges opens. Specifically, 55% of Americans who currently lack insurance say they plan to sign up for coverage while 35% of the uninsured say they will not get insurance and instead pay the fine as required by the Affordable Care Act, also known as "Obamacare."

The results are based on Oct. 22 through Nov. 12 Gallup Daily tracking interviews with 976 uninsured Americans.

Most uninsured Americans, 70%, say they are aware of the requirement to have health insurance or pay a fine, the "individual mandate" provision of the 2010 healthcare law that the Supreme Court upheld in a 2012 ruling. However, that leaves nearly 30% who were not aware they must have insurance or pay a fine at the time that Gallup interviewers asked them about it. This suggests that more than a year after the healthcare exchanges opened and more than four years after the healthcare law was passed, challenges remain in regards to educating uninsured Americans about the new requirements.

A key part of the law was the establishment of insurance exchanges to make it easier for Americans not eligible for employer-provided insurance or government programs to obtain insurance. And the exchanges are the preferred method for obtaining insurance among the uninsured who plan to do so, but not overwhelmingly so, at 50%. Another 29% who plan to get insurance say they will get coverage outside of an exchange, leaving 21% who are unsure of where they might get insurance.

Uninsured Americans' familiarity with the exchanges is low, with 46% saying they are "not familiar at all" with the exchanges, and another 19% claiming they are "not too familiar" with the exchanges. Eight percent say they are "very familiar" and 22% are "somewhat familiar."

Gallup asked the same set of questions of the uninsured late in 2013 and early in 2014 during the last open enrollment period. The current reported intentions to get insurance, awareness of the requirement to obtain insurance or pay a fine, familiarity with the exchanges and plans to obtain insurance through an exchange are similar to what Gallup measured before.

For example, from January through March 2014, an average of 55% of uninsured said they planned to sign up, matching the current percentage intending to do so. But from October through December 2013, an average of 61% of uninsured planned to sign up.

The decline from late last year may have as much to do with changes in the uninsured population as it had to do with changes in the uninsured's desire to get insurance. After the first wave of insurance sign-ups late last year and early this year, the uninsured population has declined to 13% of U.S. adults, down from 18% in the third quarter of 2013. Those who signed up late last year -- and who are no longer counted among the uninsured -- may have been the most eager to obtain insurance. And so, as the uninsured population gets smaller, those still in it are probably less motivated to become insured.

The fact that intentions to get insurance are similar to what they were earlier this year (at the end of the last enrollment period) is notable, given that the fine for not having insurance in 2015 will increase. So either the amount of the fine is still not high enough to compel the uninsured to get coverage -- or the uninsured may be unaware of the stiffer penalty in 2015 for being uninsured.

Politics Remains a Factor in Health Insurance Intentions

One consistent finding from Gallup's 2013-2014 tracking of health insurance intentions was that uninsured Republicans were less likely than uninsured Democrats to say they planned to get insurance. And that is still the case today, as 62% of uninsured Democrats (including Democratic-leaning independents) and 47% of uninsured Republicans (including Republican-leaning independents) say they plan to get insurance.

Uninsured Republicans' stated reluctance to sign up for insurance may reflect Republicans' overwhelmingly negative opinions of the Affordable Care Act.

Overall, 43% of uninsured Americans are Democrats or Democratic leaners, 28% are Republicans or Republican leaners and the remainder have no party preference or leaning.

Implications

A majority of Americans who lack insurance say they plan to sign up for coverage rather than pay a fine, which is an encouraging sign that more progress will be made toward the Affordable Care Act's major goal of reducing the uninsured rate. And in fact, data from the Gallup-Healthways Well-Being Index clearly show a reduction in the percentage of Americans who lack health insurance, compared with a year ago.

Importantly, though, the measures of people's current intentions may not reflect their ultimate behavior, whether that is because they have not come to a final decision, or circumstances prevent them from following through or if they just never take the necessary steps to sign up for insurance even though they say they plan to. If in fact a little more than half of uninsured Americans had signed up for coverage in the past year -- similar to their stated intentions -- then the reduction in the uninsured rate would have been closer to eight or nine percentage points than the five points Gallup estimated.

Given a current uninsured rate of roughly 13%, and with 55% of uninsured Americans saying they plan to get insurance, if all followed through on their intentions the uninsured rate would fall another seven percentage points. And while that large of reduction may not be realized, it seems that with a sufficiently large percentage of uninsured planning to get insurance that the uninsured rate should fall at least a bit in the coming year.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted Oct. 22-Nov. 12, 2014, on the Gallup U.S. Daily survey, with a random sample of 976 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia, who do not currently have health insurance.

For results based on the total sample of uninsured adults, the margin of sampling error is ±4 percentage points at the 95% confidence level.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

View survey methodology, complete question responses and trends.

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