Health Insurance Hotbuttons: Trust, Access, Cost

As our team works with clients on upcoming enrollment periods and adjusting to federal changes in health insurance marketplace eligibility and coverage, it’s a good time to assess public sentiment in the health insurance space. A review of secondary research, along with our own primary research, reveals a complex mix of attitudes and expectations.

Public distrust and skepticism

As expected, across the U.S., public opinion toward health insurers is shaped by skepticism, frustration, and a sense that the system is stacked against consumers.

A July 2025 Pew Research Center survey found that 69% of adults believe health insurance companies have too much influence over public health policy debates — more than any other group measured. Only 9% believe insurers have the right amount of influence, and another 9% think they don’t have enough. 

Still, affordability remains the primary issue. A June 2023 Kaiser Family Foundation (KFF) survey found that 55% of adults with Marketplace plans and 46% of those with employer-based coverage rate their insurance negatively when it comes to premiums. Almost half say they have skipped or delayed care due to cost. 

That same survey reveals that personal experience reinforces mistrust. 

• A majority (58%) say they have experienced difficulty using their health insurance coverage in the past year. 
• Two thirds (67%) of adults in fair or poor health say they have experienced difficulties with their insurance. 
• More than a quarter of respondents reported being frustrated, and in some cases angry, with their insurer.

These findings are rooted in real coverage barriers such as denied claims, network limitations, or preauthorization delays. 

Political sentiment

Support for existing government programs remains strong. As of June 2025, Medicaid’s favorability hit an all-time high of 83%, while the Affordable Care Act (ACA) is viewed favorably by about two-thirds of Americans, continuing a steady upward trend (KFF).

The “One Big Beautiful Bill” was opposed by 64% of Americans, especially after they learned it would increase the uninsured rate, cut funding for Medicaid and ACA exchanges, and weaken hospitals and community health resources.

Insights from our own research: affordability first

Recent focus groups we’ve conducted for clients confirm that the process of signing up for a health insurance plan can be anxiety-inducing. 

They also confirm that affordability — specifically, low monthly premiums and low deductibles that maintain access to needed specialists — remains the top priority across all consumer segments.

A strong secondary priority is comprehensive network access, including a wide choice of in-network providers, prescription coverage, and specialty benefits such as dental and vision care.

Group participants stressed the importance of being able to speak directly with someone at their exchange and/or carrier. They also value having multiple access points: online, in-person, and by phone.

Group participants offered consistent guidance on what resonates. They seek clear, direct messaging without overly cute or salesy creative. Health coverage is a serious topic and, in many cases, a significant frustration for people. 

Implications for enrollment season

In formulating your outreach strategy and communications tactics, be sure to:

• Highlight support resources clearly and prominently. This includes promoting brokers or navigators as an available and free option to help find and enroll in a plan that fits best. 
• Clearly state open enrollment dates in bold, prominent calls to action with assurances of support to reduce sign-up anxiety. 
• Use authentic imagery featuring diverse, real people in real situations — with contextual details to enhance authenticity.
• Support outbound communications with opportunities and resources for consumers to learn and engage more to find the best coverage for them. 
• Clearly and directly explain recent federal changes and their impact via your website, customer communications, paid media, and perhaps even in-person events.
• Build a strong community presence with outreach, events, multilingual fliers, and other communications channels.
• Engage consumers with transparency and responsiveness at every step.

What this means for your communications

In this environment of distrust and frustration, insurers and state exchanges must communicate that they are partners in care, not just payers. Messaging should be relational in tone and substance, rather than purely transactional. Communicate that you will be there for your customers as they come to terms with new changes in the health insurance marketplace. 

Contact us if you would like to brainstorm new strategies and tactics as the health insurance landscape continues to shift.