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Affordable Care Act and the Exchanges are Emotionally Charged

The Health Insurance Exchanges opened on October 1, 2013, ushering in a new era consumer-directed health care. This event was not without its teething pains, however, as Internet traffic overwhelmed the servers and the Exchange websites and supporting customer service numbers were inaccessible for a period of time. The positive in this may be that millions of American citizens are becoming engaged in the Affordable Care Act (ACA) and will begin to understand how the ACA affects them, personally.

The ACA has been a polarizing subject for the American public since the legislation was passed in 2010 and upheld by the Supreme Court in 2012. A percentage of the population supported the ACA, while others opposed it, with a plurality somewhere in the middle. The c2b Consumer Diagnostic market research study (n = 4,184 representative sample of adults aged 18+) measured the public’s stance on the ACA in early 2013, before the run-up to the Exchanges, and found a third of the public supported the ACA while 28% opposed it.

how much do you support oppose the affordable care act resized 600

Until consumers become actively engaged (and gain their own understanding) of the particulars and requirements of the ACA, their perceptions and opinions are formed by assumptions, the media, and peer influence. The c2b Consumer Diagnostic also asked respondents the degree to which they were aware — and understood — the ACA. While the majority were aware of the ACA, few admitted to completely understanding the legislation:

aware of affordable care act  understand affordable care act


Consumer Reaction to a Description of the Health Insurance Exchanges

The c2b Consumer Diagnostic sought to determine the impact on consumer feelings toward the ACA if they understood how the legislation and the Exchanges work. Note, the c2b Consumer Diagnostic is an extensive study on the U.S. healthcare consumer and covered many topics related to health & wellness.  Because of the depth and breadth of questions in the survey, a description of the Health Insurance Exchanges could not cover all the details and complexities of how the Exchanges would be implemented. Thus, respondents to the survey were presented a description of the Exchanges that was balanced for detail and simplicity, to which they would react:

Health Insurance Exchange Scenario

Starting January 1, 2014, the Affordable Care Act establishes Health Insurance Exchanges where consumers may choose from a selection of health insurance companies from an internet website managed by a governmental agency.

Consumers who are near poverty level and without health insurance will have their coverage paid for through these Exchanges with public funding (taxes). For everyone else, an employer may choose to continue providing health insurance to its employees. However, employers may also stop providing health insurance and require employees to shop for health insurance on the Health Insurance Exchange. Those employers may (or may not) provide vouchers to employees to help pay for some or all of these costs.

Unless a consumer is near poverty level, the law requires that he/she will have to get health insurance from his/her employer or purchase health insurance on the Health Insurance Exchange. If a consumer chooses not to get health insurance, he/she must pay a penalty up to 2% of his/her household income.

To gauge consumer reaction to this description of Health Insurance Exchanges, c2b solutions teamed with Ipsos, a leading market research company with a worldwide presence.  Ipsos-ASI’s Emoti*Scape® methodology was employed to help people describe their emotions evoked by the description of the Exchanges, by having respondents select up to two words/pictures from the Emoti*Scape® map that best capture their feelings.

Ipsos Emoti*Scape®

ipsos emotiscape


A Little Knowledge Can Be Dangerous

After selecting the emotional descriptors that best captured their response to the description of the Exchanges, over half of the participants responded negatively:  

Emotional Grouping/Clusters


 Upsetting/Dislike  39%
 Skeptical/Confused  23%
 Unengaged/Bored  5%
 Engaged/Curious  11%
 Relaxed/Calm  12%
 Warm/Trust/Happy  5%
 Turned-On/Eager  9%
 No particular feeling  22%
 Overall Positive  30%
 Overall Negative  56%

56% of respondents expressed overall negative feelings, while 30% felt positively overall. Interestingly, 1 in 5 respondents indicated they had no particular feeling about the description of the Exchanges; whether these respondents did not believe the Exchanges affected them directly or they would simply ignore the Exchanges and cross that bridge when they came to it is unclear.

The c2b Consumer Diagnostic also examined the differences in emotional reaction by gender, age, education, income, health condition, political affiliation, c2b Psychographic Segment and many other variables. There were marked differences among the different consumer types, as some were very positive toward the Exchanges while others were highly negative. The c2b Consumer Diagnostic also probed attitudes and beliefs across a significant list of attributes related to the ACA, including its impact on:

  • Access to care for the uninsured
  • Personal finances and time
  • Access to physicians and time to get a doctor appointment
  • Costs to employers, health insurance companies, and the U.S. healthcare system
  • Over 50 other aspects of the ACA

Take Away Thoughts

Admittedly, the description of the Health Insurance Exchanges to which consumers responded was limited in its ability to convey all the details and characteristics of this key element of the ACA. However, this exercise is useful to anticipate consumer reaction when more of the population is faced with shopping for insurance on the Exchanges. Consumer could strongly value an organization that helps them navigate the Exchanges and alleviate confusion.

Because of the wealth of data on consumer attitudes toward the ACA captured by the c2b Consumer Diagnostic, future articles will offer additional insights on this topic. In fact, if a reader of this article has a request for a topic or a focus on a specific set of data from the c2b Consumer Diagnostic, we invite this input for an upcoming edition.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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