TransUnion Survey: Half of Americans will switch healthcare providers if the Supreme Court eliminates subsidies

The upcoming Supreme Court ruling on King v. Burwell may result in more than half of Americans looking for a new healthcare provider that offers more transparent costs and billing, according to a new TransUnion Healthcare survey of insured consumers released today. If the Supreme Court rules to eliminate the subsidies, more than half (51 percent) of Americans will look for new providers, according to the survey.

The importance of healthcare cost transparency is clear. Americans say the opportunity to review cost estimates prior to undergoing treatment is just as important as bedside manner when selecting a healthcare provider, according to the survey. An identical 80 percent of respondents listed upfront cost estimates and bedside manner when asked which experiences would make them more likely to use a clinician.

The same number of respondents (80 percent) also identified clear billing processes as a major factor, highlighting the growing importance of cost transparency and clarity in determining where patients choose to receive care. In fact, the lack of clarity regularly leads to patient confusion and surprise. Despite improvements in overall billing experience, 61 percent of insured consumers say they are always (17 percent) or sometimes (44 percent) surprised by their out of pocket healthcare costs, and 55 percent are always (10 percent) or sometimes (45 percent) confused by the bills they receive.

“This survey suggests that cost and billing experiences significantly influence how patients view their provider and highlights the continued confusion about healthcare bills,” said Gerry McCarthy, President of TransUnion Healthcare. “As consumers become more sophisticated in understanding healthcare costs, providers must be prepared to answer financial questions they were rarely asked 10 or even five years ago.”

The annual survey, fifth in the series of reports that examine patient billing experiences, found patients continue to be cost conscious and savvier shoppers of health insurance and treatment. The survey found that Americans showed an increased interest in selecting alternative payment plans. The share of those who thought an installment plan would be extremely helpful in paying medical bills rose to 47 percent from 40 percent the previous year. Cost transparency when selecting a provider remained particularly important for patients. On a one-to-seven scale measuring the importance of attributes when choosing healthcare providers (with one as most important and seven as least important), consumers ranked cost transparency as a “4” in both 2014 and 2015.

“Today’s healthcare patients increasingly expect cost transparency and front-end estimates when selecting a provider, and it’s incumbent on the provider to have the technology in place to provide accurate, clear and fair estimates before treatment,” said McCarthy.

More than two-in-five respondents (44 percent) requested estimates of healthcare costs before a treatment in 2015, up 6 percent from 2014. And, most respondents (85 percent) reported that receiving information about their plan coverage before treatment would be either helpful (31 percent) or extremely helpful (54 percent). In turn, this correlates to likelihood of payment with nearly eight in 10 (79 percent) reporting that receiving estimated out-of-pocket costs before treatment would make it more likely for them to pay their medical bills on time.

Patient satisfaction with overall quality continues to be correlated with positive billing and payment experiences. More than eight in 10 patients (83 percent) who gave high ratings to their quality of care over the past year also said their billing and payment experiences were usually positive. Providing cost information and payment options also correlates with positive billing and payment experiences. Two-thirds (66 percent) of respondents reported positive billing experiences if they received upfront cost estimates without asking. In comparison, only 53 percent of those who did not receive upfront cost estimates without asking reported positive billing experiences.

Healthcare cost transparency and billing varies by state

According to the survey, larger states* (top one-third most populous states) are generally better at providing front-end cost estimates and information on alternative payment options. In fact, 31 percent of respondents in large states reported receiving front-end cost estimates without asking compared to just 26 percent in smaller states.

Nearly half (47 percent) of respondents in small states (bottom one-third populous states) reported it somewhat (28 percent) or very difficult (19 percent) to find upfront cost information, compared to 43 percent who find it somewhat (27 percent) or very difficult (16 percent) in large states. For example, 51 percent of insured patients in California reported it somewhat (30 percent) or very easy (21 percent) and 47 percent in New York reported it somewhat (30 percent) or very easy (17 percent) to find upfront cost information, compared to the national average of 43 percent.

While large states were generally better at sharing front-end cost estimates, a few exceptions emerged. Specifically, an above average number of respondents in Colorado (57 percent) and Massachusetts (50 percent) reported difficulty in accessing up front cost estimates compared to 43 percent on average nationally.

Overall, respondents nationally demonstrated more concern about out-of-pocket costs, and respondents of Illinois, Georgia and Virginia, in particular, cited a higher level of concern for out-of-pocket expenses on a year-over-year basis.

  • 42 percent of Illinois respondents said they were more concerned about out-of-pocket costs compared to 36 percent in 2014.
  • 41 percent of respondents in Georgia were concerned about out-of-pocket costs compared to 35 percent last year.
  • 37 percent of those in Virginia claimed to be more concerned about out-of-pocket costs versus 33 percent in 2014.

For more information about the survey, visit

About the survey
The survey (fielded from May 5 – May 16, 2015) included responses from 7,382 insured household decision-makers who had either personally received medical care, or had a family member on their policy receive care in the past two years. Respondents included a representative sample in each of the 50 U.S. states and the District of Columbia. The survey sample was representatively distributed among different types of insurance plans:

  • Employer-sponsored health insurance made up 57 percent of the sample (compared to the actual U.S. Census figure of 55 percent)
  • Individual plans made up 16 percent (as compared to the actual 2012 census figure of 9.8 percent, which has likely increased substantially given the implementation of health reform)
  • Medicare accounted for 14 percent (compared to the census figure of 16 percent)
  • VA/military health plans accounted for 3 percent (in line with the census figure of 4 percent for 2012)
  • The only type of health insurance that significantly under-sampled was Medicaid, which came in at 9 percent, compared to the census figure of 16percent (given the profile of online survey takers, Medicaid recipients are simply not reachable in large numbers).


Government Perspectives, King v. Burwell, provider, survey, TransUnion Healthcare


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