It is unclear what Congress will do with repealing and replacing Obamacare, but consumers know exactly what they want when it comes to buying their health coverage online.

Consumers want to continue to research and buy coverage online, but many consumers find the current way of buying insurance at and other public exchanges too complex and want it simplified. Many consumers, even if they can purchase coverage online, believe it is becoming unaffordable. Consumers also like popular features of Obamacare, such as coverage of pre-existing conditions, and don’t want those changes to disappear.

Those are the chief takeaways in a new report based on a series of focus groups the Kaiser Family Foundation conducted in December in Grand Rapids, Mich.; Columbus, Ohio; and Harrisburg, Penn.

Focus group participants shared both positive experiences and concerns about their coverage through the Affordable Care Act, Kaiser says. Areas of concern included access to care, high deductibles, surprise medical bills and the cost of prescription medications.

Focus group participants also told Kaiser they have little idea what might come next. Concerned about losing coverage, consumers want repeal and replacement of Obamacare to happen at the same time.


Several key themes emerged about what they want in an ACA replacement plan: more affordable coverage with both lower premiums and deductibles, access to a broad range of doctors and hospitals, greater transparency about what their plan covers and what services would cost, continued coverage of pre-existing conditions and elimination of the individual mandate that requires everyone to have health insurance and penalizes those who don’t.

Consumers also expressed skepticism that high-deductible plans with savings accounts would be affordable options for them, Kaiser says.

The focus groups included about 50 people that bought coverage through a health exchange or were covered by MedicaidBy and large, the marketplace consumers were healthy, mostly needing only annual check-ups; however, some were dealing with more serious illnesses.  Less than a third of participants reported having an ongoing medical condition. Of those, most participants noted they had high cholesterol or blood pressure or anxiety/depression that they were managing with medications.

A few, however, had more serious conditions, including diabetes, cancer, and heart disease that required more intensive treatment. For those who were sicker, the out-of-pocket costs associated with needed care contributed to their financial stress.

Participants clearly want health insurance coverage, Kaiser says. Many focus group members told Kaiser they feel vulnerable during periods without insurance when they were unable to get needed care. They view insurance as necessary to be able to afford treatment for chronic conditions, especially needed medications. Most consumers also spoke of the financial security that insurance provides, knowing that it will cover expensive medical costs if they were to have an accident or face a major illness.


But consumers also worry that any major change to the present system of buying insurance through will make coverage too expensive. When asked what they would want in an ACA replacement plan, participants’ top priority was coverage that was more affordable with lower premiums and out-of-pocket costs.

Participants who were struggling financially or just getting by wanted more help affording their coverage, Kaiser says. Many focus group members also did not view the current premium subsidies as sufficient because they still faced large out-of-pocket costs. “While they were willing to pay co-payments when they access care, they were united in their opposition to deductibles, which they felt put them at financial risk,” says the Kaiser report. “They simply wanted to be able to take their children to the doctor when they were sick or go to the doctor themselves without having to worry about how much it would cost.”

Many consumers find the current way of buying health insurance online too complex—and in some cases overwhelming. “Three years into the implementation of the marketplaces, participants still seemed overwhelmed by their plan choices and confused about key aspects of their plans,” Kaiser says. “Focus group members described having too many plan choices and not enough information to choose a plan that meets their needs. “

While some were savvy healthcare consumers, others seemed baffled by the complexity of their plans. Some were unsure of the difference between a deductible and out-of-pocket maximum and unable to evaluate what their total costs would be if they need to go to the doctor or have a procedure done, says the Kaiser report.

Other key conclusions include:

  • Consumers are particularly frustrated by unaffordable out-of-pocket costs associated with high deductibles.
  • Prescription medications cost too much and many consumers did not believe their plan protected them from these costs.
  • Consumers are frustrated at receiving surprise medical bills for services they thought were covered.
  • Concerned about losing their coverage, focus group members wanted repeal and replacement of the ACA to happen at the same time.
  • In a replacement plan, participants wanted broader provider networks that would give them more options when choosing doctors and allow them to keep their same providers when they change insurance plans.
  • Consumers want simpler health plan choices and greater transparency from the insurance companies.
  • Many consumers oppose the requirement to have health insurance or pay a fine.
  • Many consumers want to be able to tailor coverage to fit their needs, even if it means that people who are sicker would have to pay more for more comprehensive coverage.

“Once a Republican replacement plan becomes real, working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems,” Kaiser Family Foundation president Drew Altman wrote in an opinion piece published in the New York Times. “And they will not be happy if they are asked to pay even more for their healthcare.”