• Chart of the day: It’s not just Obamacare. There’s a lot about health insurance Americans don’t get

    True, Americans don’t understand some fundamentally important details of Obamacare very well. But it’s not just Obamacare. They don’t understand lots of fundamentally important details of today’s health insurance products.

    Consider health savings accounts (HSAs). A recent survey for Fidelity Investments (PDF) found that a sample of American adults responsible for household health insurance decision-making knew very little about how they work. This is captured in the chart below; more at the link.

    HSA huh

    In light of this, apart from, say, Medicare for all (which I am not hereby advocating), it’s hard to imagine a large majority of Americans fully grasping any health insurance regime. Maybe Obamacare is about as well understood as can be expected, especially in light of obstacles to implementation and outreach.

    Details on the sample for the chart above:

    The HSA research study was conducted on behalf of Fidelity Investments by GfK Public Affairs & Corporate Communications from February 4–20, 2013, using GfK’s online KnowledgePanel. The study was conducted among a nationally representative sample of 1,836 U.S. adults between the ages of 25 to 62, with a household income of $25,000 or more, who have primary or shared responsibility for household financial decisions and receive healthcare benefits through their own or a spouse’s employer. Of the respondents, 306 self-identified as being enrolled in a high-deductible health insurance plan that allows an HSA, and another 306 self-identified as declining to enroll in the same.


    • It seems that this chart doesn’t show much shocking news. Exactly one third of sample either has or was offered a plan that included an HSA, and “one-third of the respondents understand how an HSA works and are aware of its specifics” (page 3). It would seem strange to me to find a much higher number than that. What good does it do a person to learn about a health plan that they are not offered?

    • Austin,

      Why would someone want to know about how an HSA works if they are not enrolled or thinking about enrolling in one? How much useless knowledge are people expected to carry around?

      But you don’t really think a majority of Americans understand how Medicare works, do you? I doubt even many health wonks could tell you how many SNF days are covered.

    • This goes for virtually any body of knowledge above a certain threshold of complexity and abstraction. Thankfully – as life has become increasingly complex, entire professions have emerged in order to help people navigate unfamiliar territory.

      Most people don’t have more than a rudimentary understanding of how to buy a home. So they hire a realtor. Virtually no one understands how the law works in this country, much less how to capably represent themselves in court. So they hire an attorney. The probably don’t understand the technical aspects of concrete preparation, site prep, on-site fabrication required to pour a foundation for a home. Etc x 1.0×10^18. Then there’s the vast product support industry.

      Is it really so hard to imagine that anyone who needs to understand particular aspects of insurance could avail themselves of their HR department, an insurance agent, or a help-line in the event that they have a question regarding insurance?

    • I think many of the previous comments miss the point (at least in part). An ongoing criticism of the ACA is that its too complex. We still hear complaints about how long the law is, with the clear implication that length = complexity = bad policy.

      I think Austin’s point is that this type of criticism is misguided. Laws that cover a complex subject are necessarily complex. The public doesn’t have a good understanding of health insurance. That really has nothing to do with Obamacare.

      • Sheldon,

        You waive away concerns about complexity far too quickly. With everything else held constant, increasing complexity is a very bad thing. It creates confusion, administrative burden, and opportunities for rent seeking or other perversion. Additional complexity for complexity’s sake provides no benefit unless you are a lawyer or healthcare consultant.

        The public understands WIC/foodstamps, and they are perfectly capable of understanding an HSA system if they had reason to. The ACA is far more complex than just about any reasonable single payor or consumer-driven system proposed. This is not a good thing.

        • RC, No (big) arguments. We chose (or our political leaders did) a complex, private insurance based system. Or, at least that’s the system that was politically feasible at the time. So, building on that system will be complex.

          I don’t agree that the law is complex for complexity’s sake. That’s too cynical (even for a cynic like me). And I also don’t agree that the public understands WIC, foodstamps, or most other programs (public or private).

    • I don’t think it’s realistic to compare a Health Savings Account to the ACA. A summary of benefits for a H.S.A maybe 12 pages long. The ACA is over 2,000+ with another 15,000 in explanation.
      From my experience, I would say most H.S.A holders have a higher household income.