Helping uninsured Americans with health problems was one of the main reasons Congress started working on the Patient Protection and Affordable Care Act in the first place.

Fear of what covering those people might cost is one of the reasons some carriers are raising rates in advance of Jan. 1, when PPACA will require carriers to sell individual policies on a guaranteed-issue basis, without using information about pre-existing conditions to set prices.

Now InsuranceQuotes.com, a Web-based insurance quote service, says uninsured people with health problems are uncertain about whether they want to use their expanded access to health coverage.

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When InsuranceQuotes.com commissioned a telephone survey of 3,005 U.S. adults living in the continental United States in July, it found only 18 percent of the uninsured participants said they would definitely buy health coverage either before or after Jan. 1.

About 68 percent said they are not sure what they will do, and 14 percent said they plan to stay uninsured.

Eighty-five percent of the participants said Americans need more information about how PPACA will work.

Laura Adams, a senior analyst at the quote service, said she was surprised to see how few people with pre-existing conditions are planning to buy health coverage.

Some PPACA watchers have wondered whether the exchanges will sign up enough healthy new customers to keep the ratio of claims to revenue at a reasonable level.

The new research "suggests that we should also be worried about unhealthy Americans failing to enroll," Adams said.

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Allison Bell

Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.