Here's a potential snag in the success of health reform: Almosttwo-thirds of uninsured Americans haven't yet decided whether theywill purchase health insurance by the Jan. 1 deadline.

That's the finding from InsuranceQuotes.com, which surveyed some1,000 Americans.

What's behind the indecision? Most uninsureds don't think thePatient Protection and Affordable Care Act will make health careany more affordable. More than three in five uninsured Americanssay the main reason they currently lack health insurance today isbecause they can't afford it.

And that's a fear among the majority of all Americans, thesurvey found. Most, 61%, say they're concerned that PPACA willcause health care costs to increase, while only 26% predict adecrease.

There's good reason for concern. A recent report from Milliman consulting firm found that healthinsurance premiums, on average, could rise by 40 percent underPPACA.

The success of the PPACA mainly relies on uninsured Americansbuying into a plan. Beginning Jan. 1, uninsured Americans will beforced to pay a penalty of either $95 or 1% of income, whichever isgreater, if they don't buy insurance. The fine increases with eachyear.

Without participation, experts warn health care costs may surgebecause not enough healthy people will participate to offsetbenefits payouts.

Only 19% of the uninsured surveyed by InsuranceQuotes.com saidthey will get coverage by the deadline, while 10% said they plan tostay uninsured and pay the penalty. The rest haven't decided,despite the fact that open enrollment under state exchanges thatare selling coverage is set to begin in a few months.

The new survey also found widespread confusion — and skepticism— about the law's provisions. More than half of those questioned(58%) said they aren't sure whether they are eligible for the law'shealth subsidies. And those with an annual income under $30,000 arethe least likely to be aware of their eligibility (68% said theyaren't sure).

Laura Adams, senior insurance analyst for InsuranceQuotes.com,said the number of Americans still unsure of how PPACA will affectthem is “shocking.”

“Uninformed consumers risk missing key deadlines,” Adams said.“The health exchanges will begin accepting applications in fewerthan four months.”

This article was originally posted at BenefitsPro.com, a sister site of CreditUnion Times.