A major provision of the Affordable Care Act (Obamacare) is set to kick in today. That's when the new health insurance exchanges officially open for business. These are online marketplaces that are supposed to make it easier and less expensive for people without health insurance to buy coverage that would begin to take effect January 1, 2014.

Unfortunately, many Americans are do not understand the ACA, and many misunderstand it, according to a report released yesterday by the Commonwealth Fund, a private foundation interested in the health system. For example, only 47% of adults were aware that health insurance carriers are now banned from denying coverage to people with a preexisting condition.

While people do favor expanding Medicaid in their state, there's quite a bit of confusion about whether their state will do so, with 85% of people unsure what their state has decided

Because of the incredible amount of disagreement and political wrangling about the ACA, the Fund wanted to know how well people actually understood it. They surveyed people's thoughts and attitudes about the Act between July and September 2013. Their report is just out, and there are four major findings:

  • 76% of all Americans are aware that the law means that people must now own health insurance.
  • Only 43% of Americans are aware of the new health insurance exchanges that are opening this week or of the financial assistance available to help the uninsured buy health insurance.
  • And only 32% of the uninsured (an estimated 48 million Americans currently have no health insurance), the very people the marketplaces were created for, are aware of them, with only 31% aware of the financial subsidies available to them.
  • 68% of all adults are somewhat or strongly in favor of expanding Medicaid in their state.

The findings highlight a significant information gap, especially among those who need to buy health insurance. Starting 2014, people will be required to own health insurance or be subject to fines.

“These survey findings demonstrate that people who need the health insurance coverage the marketplaces will offer want to shop for plans and find out if they are eligible for financial help,” Commonwealth Fund vice president Sara Collins, Ph.D., the study's lead author, said in the report.

“However, more work needs to be done to ensure that people who may be eligible are aware of the marketplaces and the subsidies. State and federal efforts to educate people about the marketplaces during the six-month enrollment period beginning in October need to be intensive enough to help close the information gaps this survey highlights.”

Expanding Medicaid: Support and Confusion
One thing Americans do agree about is expanding Medicaid. One provision of the ACA allows states to enroll more people in Medicaid, with the Federal government paying for the expansion. It's up to the individual states to opt in or out of this expansion, with about half expected to eventually opt in.

While people do favor expanding Medicaid in their state, there's quite a bit of confusion about whether their state will do so, with 85% of people unsure what their state has decided. Of those who are aware, 68% living in states that are expanding Medicaid approve of the decision.

Only 38% of those who know that their state is not expanding Medicaid approve of that decision.

Commonwealth Fund president David Blumenthal, M.D., sums up the study results in a statement: “This study also shows that there is a great deal of work to be done to ensure that Americans have a clear, accurate view of the law and what it offers the American people. ”

Anyone who is interested in seeing more of these findings can read the full report, which is freely available.