Satisfaction with the Affordable Care Act exchanges "may be waning," according to Transamerica Center for Health Studies' Seventh Annual U.S. Healthcare Consumer Survey.

More than a quarter (26 percent) of U.S. adults surveyed by TCHS who are insured via an exchange say there has been a decrease in the quality of health insurance plans they have access to, and nearly the same percentage (23 percent) say the number and variety of health insurance options they have access to has decreased.

In contrast, not as many people insured outside of the exchanges saw a decrease in the quality of health insurance plans they have access to–11 percent of respondents insured via an employer plan feel this way, as do 11 percent insured via an individual plan and 9 percent insured via a public plan.

But as far as the quality of the care they receive, 84 percent of all of the 3,760 respondents surveyed say they are very or somewhat satisfied with the quality of their health care–no matter if they buy health insurance on the exchanges or not.

More are leveraging technology to supplement their health care, including using telemedicine (10 percent); asking their doctor about a diagnosis or treatment they found online (34 percent); using mobile health technology to help monitor or diagnose a health condition in the past 12 months (26 percent); and insisting on receiving a treatment, medication or test against their doctor's recommendation after researching online (17 percent).

However, affordability remains an issue for many, according to the survey. Being able to pay for necessary care is the most important component of health care (32 percent); 30 percent say their premiums have increased and 26 percent say their deductibles have risen. For those who did not enroll in health insurance, nearly a quarter (24 percent) say they did not obtain health coverage due to the cost.

While a majority (82 percent) of the respondents say they can afford routine health care expenses, more than a quarter (27 percent) have canceled an appointment due to the expected costs, most commonly Latinos (37 percent), Gen Zers (33 percent) and millennials (31 percent). More than a third (37 percent) of all of the respondents say they have been hit by an unexpected bill they thought was covered by insurance, and nearly a quarter (22 percent) say they have not taken prescribed medications in the past 12 months due to the expense.

Privately insured adults are more likely to pay out-of-pocket expenses with savings (37 percent vs. 18 percent), credit cards (36 percent vs. 19 percent), disposable income (28 percent vs. 16 percent), or 401(k) withdrawals (10 percent vs. 4 percent) compared to those covered by public plans.

"Health costs can be very expensive, particularly for the 66 percent of Americans reporting a physical or mental health condition," says Hector De La Torre, executive director of TCHS. "Even for those without a health condition, there is always a concern that they or their loved ones may someday require health care that can devastate their finances."

Other key survey findings include:

The percentage of adults reporting they are uninsured remains consistent with last year, holding at 13 percent. Adults who say they are uninsured tend to be younger, people of color, have lower household incomes, and report being in poorer health. Newly insured adults are increasingly covered by state-funded programs. Of those who did not previously have health insurance, the most common sources of coverage are employers (41 percent) and state programs (28 percent up from 18 percent in 2018).
More than two in five Americans have a positive impression of the ACA (42 percent), furthering the trend since 2017. Blacks are more likely to have a very positive impression of the ACA (35 percent vs. 17 percent White, 25 percent Latino, 19 percent Asian/Pacific Islander and 18 percent Other).
The majority (67 percent) are at least somewhat aware of potential health care policy changes from Washington. Among those who are aware of potential changes, more than half (53 percent) are concerned about these potential changes.
Younger adults are more likely to say they are aware of potential policy changes and are most likely to believe the government should have an individual mandate for insurance coverage. Gen X and Baby Boomers are more likely to be not at all/somewhat aware (80 percent GenXers and 82 percent baby boomers vs. 66 percent Gen Zers and 70 percent millennials).
If the employer mandate is removed, the most desired reaction among employed adults (30 percent) is for companies to not make any changes in coverage. When asked about fears associated with health policy changes, around a quarter or more say losing health care due to a pre=existing condition (31 percent), a reduction in Medicare (29 percent) and Medicaid (26 percent), no annual out-of-pocket limits (24 percent), and no lifetime limits (23 percent) are their biggest fears.

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How happy are consumers with their health insurance plans?

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