The political uncertainty over the funding of public health insurance exchanges continues in Washington. But with less than two weeks to go before a shortened benefits enrollment season begins on Nov. 1, two things seem certain about consumers and the exchanges.

Namely, many consumers are unaware of the necessary details needed to renew or buy a health insurance policy online at Healthcare.gov and other public exchanges. Consumers also are going to wait until the last minute in the middle of the busy holiday shopping season to buy health insurance—if they do at all.

Despite a bipartisan marketplace stabilization deal  proposed in the Senate this week that would retain consumer subsidies for the public exchange market, a new survey from the Kaiser Family Foundation highlights key gaps in knowledge among people who are uninsured or who are current marketplace enrollees.

The Kaiser survey of 2,505 adults finds that only one in six (15%) consumers without health insurance and four in 10 (40%) marketplace enrollees know that open enrollment begins Nov. 1.  Even fewer (5% of the uninsured, 25% of marketplace enrollees) are aware of the month when open enrollment ends in their state, Kaiser says.

The Kaiser survey also finds that few of those consumers most likely to consider marketplace coverage report hearing or seeing any ads providing information about how to get insurance under the health care law broadly known as Obamacare though officially the Affordable Care Act.

Small consumer pockets of the uninsured (19%) and marketplace enrollees (12%) say they have seen ads in the past 30 days that provided information about how to get insurance. But there are fewer print, TV, radio and digital ads this year. In August the U.S. Department of Health and Human Services announced it would cut the Affordable Care Act’s advertising budget by 90% for the 2018 benefits enrollment season to $10 million, and would also reduce spending on groups that help customers find the appropriate insurance plan. The Trump administration called the cuts necessary reductions for programs that have run their course and aren’t efficient.

Due in part to fewer public awareness campaigns, slightly more than half (54%) of the uninsured say they plan to get health insurance in the next few months, while four in 10 (43%) expect to remain uninsured despite the individual mandate that imposes financial penalties for those without health insurance, Kaiser says.

In the run-up to open enrollment for health insurance on the government exchange market, many consumers are happy with the quality of their existing plans. But many are worried about being able to pay for sharply higher premiums and concerned they will have fewer insurance plans to choose from this year.

Despite reports of big insurers such as UnitedHealth Group, Aetna Inc., Anthem Inc. and others dropping out of the marketplaces, most consumers (70%) report being satisfied with their insurance choices, but nearly four in 10 (36%) say they are worried that their current insurance company will stop selling plans in their area, Kaiser says.

Other key consumer findings include:

• Three in 10 (30%) of marketplace enrollees say premiums have gone up too much and most consumers (57%) expect their premiums to increase next year, including about a quarter (28%) who say it will be a major financial burden.
• More than a third (37%) of consumers say that their deductibles and co-pays have been going up. 60% of marketplace enrollees also say they worry their co-pays and deductibles will become so high that they can’t afford to get needed care.

• Marketplace enrollees’ concerns about cost and availability in many ways are similar to those of people with employer coverage.  For example, about half (49%) of those workers with employer coverage report that their deductibles and co-pays have been going up lately.  Similarly, half (51%) say their premiums have been going up, including a quarter (25%) who say they have gone up a lot.
• The survey finds most consumers (71%), including most marketplace enrollees (79%), are aware that the Affordable Care Act’s individual mandate remains in effect and requires most people to obtain health coverage or pay a fine.  Among the uninsured, a smaller majority (59%) are aware the mandate is in effect, and one in five (18%) believe it is not while one in four (23%) are unsure.
• The vast majority (85%) of marketplace enrollees say they plan to sign up for health insurance during the 2018 open enrollment period, and most of them (54% of the total marketplace enrollees) prefer to renew their current plan if it is available next year.
• Among marketplace enrollees, one in four (26%) say the law’s requirement for them to have health insurance or else pay a fine is a “major reason” they chose to purchase coverage.

Consumers in many areas will have fewer plans to pick from for 2018 on the public exchanges, according to the Centers for Medicare and Medicaid Services. The agency projects that 1,524 counties—almost half of the counties nationwide—could have only one issuer in 2018. While many state insurance departments are still finalizing premium pricing, pricing is already up sharply in multiple regions.

For instance public exchange premiums in Pennsylvania are set to increase by 31% if Congress takes away consumer subsidies. “The president’s deliberate action and Congress’s failure to appropriate these funds despite repeated requests is forcing large rate increases on consumers in Pennsylvania and around the country,” says acting Pennsylvania insurance commissioner Jessica Altman.

With fewer choices and higher premiums many consumers are likely to wait until the last minute to purchase health insurance on a public exchange, says Kev Coleman, head of data and research for health insurance comparison website HealthPocket.com. “There is a great deal of consumer concern around this year’s open enrollment, ranging from issues of high rates for the unsubsidized to the discontinuation of cost-sharing subsidies for those who qualify,” Coleman says. “These factors may result in an extremely back-end loaded enrollment period where consumers intending to buy private health insurance wait as long as possible before enrolling.”

The process of buying insurance online will also vary widely from state to state, Coleman says. “There are strong regional differences,” he says. “There is no national and universal consumer experience.”

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