The World Health Organization defines universal health coverage as ensuring “that all people obtain the health services they need without suffering financial hardship when paying for them.” The Affordable Care Act will certainly decrease the number of uninsured, which is currently calculated as 57 million by the Congressional Budget Office (CBO). Yet, estimates find that many will remain uninsured — 43 million people next year, a number that is expected to drop to 31 million by 2023, according to CBO calculations.

In the short term at least, it is expected that Obamacare will fail to achieve universal health coverage. The real test will start on Oct. 1 when enrollment begins.


Reasons why some people may not be aided by Obamacare will undoubtedly vary, though it seems that some are simply unaware of the new law’s regulations. For instance, according to a Gallup poll conducted in June, currently uninsured Americans are less likely to be aware of the requirement that Americans carry health insurance or pay a fine; a full 43 percent of uninsured people — a group that generally includes, according to Gallup, Hispanics, blacks, young adults, and those in lower-income households — stated they did not know about the penalty. The penalty has been promoted as a necessary spur to bring healthy young people into the insurance pools; if too many people remain unaware of it, the first years of Obamacare may be more problematic than necessary. This poll, though, begs the question: what other Obamacare regulations are people unaware of?

Gallup also notes that 43 percent of the uninsured identify cost and affordability as the reasons they don’t purchase it. Yet, employment and type of employment also factor into the equation of whether someone buys health coverage or not. Two percent of the uninsured say they lack health insurance because they are self-employed, eight percent say they are working but their employers don’t offer benefits, and nearly a full one-quarter (24 percent) say they lack insurance because they are currently unemployed. For many, these reasons may not change with the new year. Though tax subsidies will be provided to those below certain income levels, insurance may still be too high an expense for some to consider, while others may not investigate their possible savings.

Health insurance is also not always the easiest matter to understand — even for those who have it. For instance, Forbes reports that researchers looked at two surveys of Americans between the ages of 25 and 64 who have private coverage. “Among their findings, researchers uncovered that just 14 percent of respondents had an understanding of the most basic insurance concepts of “deductible, copay, co-insurance and out-of-pocket maximum,” wrote Bruce Japsen in Forbes. Because these terms are key to understanding which plan to select on the new healthcare exchanges, such a lack of knowledge may impinge on the success of Obamacare. Although the government is extending grants to the states in order to pay navigators to explain coverage options and guide the uninsured through the online exchanges, this measure is being dispensed unevenly among the states for various reasons, including different understandings of the provision.

Many uninsured people, then, may simply not find the help they need to navigate the new healthcare landscape. Over time, awareness of regulations, knowledge of terms, and understanding of potential cost savings should spread by word of mouth, if nothing else, so that the pool of those insured gradually deepens.

Source: Loewenstein G, Friedman JY, McGill B, et al. Consumers’ misunderstanding of health insurance. Journal of Health Economics. 2013.