Why Do People Opt Out of Health Insurance? It's Not Affordable, Stupid.


Spanish version of Obamacare. How embarrassing.

As the Obama administration works to meet its new, down-scaled target of enrolling 9.9 million Americans in health insurance for next year, it faces a number of obstacles. One of the biggest is convincing the people who opted out last time around that they should reconsider.

As The Hill points out, reaching the still-uninsured is a tall task. Remember, we're talking about people who already had one opportunity to sign up for coverage through Obamacare. Each one had his or her own reasons for choosing to go without during the last open enrollment period. But survey research conducted mostly on behalf of pro-Obamacare groups like Enroll America can clue us in to what these individuals, who were eligible for coverage but eschewed it anyway, were thinking.

The short answer is that health insurance is still too damn expensive.

Despite the passage of the optimistically named Affordable Care Act (ACA), millions of Americans are as convinced as ever that health insurance is unaffordable. Before last October's Obamacare rollout, a Kaiser Family Foundation study found that the main reason people had no health insurance was cost. Then, midway through the first enrollment period, the polling firm PerryUndem again asked individuals who hadn't signed up for Obamacare why they were uninsured. Seven in ten said, simply, "I can't afford it."

This makes sense when you realize that a lot of these individuals are barely getting by on many fronts. The Kaiser poll also found that 71 percent were very or somewhat worried they wouldn't be able to pay their rent or mortgage. Some 61 percent said they were struggling to afford gas or transportations costs, while 45 percent said the same about affording food.

Eight in 10 agreed insurance generally is "something I need." But given the opportunity, they still weren't buying it. It seems that the type of "comprehensive" health policies Obamacare requires people to purchase are viewed as a luxury among this population. 

Forced to choose between health coverage and staying in their homes or putting dinner on their tables, some people decide insurance is the lower priority. This should not surprise us. Perhaps if they had the option to buy a simpler, bare-bones catastrophic policy, some of them would make a different choice. In that Kaiser study, the "eligible uninsured" were far more likely to be "very worried" about paying for medical bills in the event of a serious illness or accident (76 percent) than about paying for routine care (50 percent).