Americans and the ACA: A Quick Trip Through Two Years of Public Opinion Data Claudia Deane Assoc. Director, Public Opinion & Survey Research Kaiser Family

Americans and the ACA:A Quick Trip Through Two Years of

Public Opinion Data

Claudia DeaneAssoc. Director, Public Opinion & Survey Research

Kaiser Family FoundationMarch 2012

KFF Monthly Tracking Survey Since 2008 (Trust But Verify)

• Standard survey methodology = RDD(random digit dial)

• Each month interview roughly 1,200 randomly selected adults, aged 18 and over, over a 6-night field period

• Interviews conducted by telephone

― Landline

― Cell phone

• Conduct interviews in English and Spanish

• Find all our tracking surveys at: www.kff.org/kaiserpolls

SLIDE 2

http://www.kff.org/kaiserpolls

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb0%

20%

40%

60%

80%

40

44

41

35

45

40

44

40 41

5048

46

4144

4643 44 43

51

44 43 44 43%

14 1410

1412 11

1518 18

9 8

13

1814

1215

17 16 1519

1719

15%

46

41

4850

43

49

4242 42

4143 42 41 42 42 42

3941

3437

4137

42%

Since Passage, Public Has Remained Largely Split On ACA

As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?

ACA signed into law on March 23, 2010

Source: Kaiser Family Foundation Health Tracking Polls

SLIDE 3

2010

2011

2012

Don’t know/RefusedUnfavorableFavorable

Note Some Diversity In Measurement… But Basically Same Picture

Pollster.com aggregation of favor/oppose measures from various surveys accessed 2/16/12. Available at: http://www.pollster.com/polls/us/healthplan.php

SLIDE 4

http://www.pollster.com/polls/us/healthplan.php

Partisan Gap, and Intensity Gap to Boot

As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?

12%

25%

34%

25%

4%

15%

30%

17%

16%

18%

12%

16%

60%

21%

6%

27%Total

Democrats

Independents

Republicans

SLIDE 5

Note: Don’t know/Refused answers not shown.Source: Kaiser Family Foundation Health Tracking Poll (conducted February 13-19, 2012)

Very favorable Somewhat favorable Very unfavorableSomewhat unfavorable


20%

40%

60%

80%

100%

7872

6973

68

7569 68 69

73

6671

64

72

65 6460

65

52

62 64 62 64%

36 37

49 48

41 42

3437 37

34

4337

4135 33

3833

3632 34 33

30

40%

138

23 2116

21

1115

12 12 11 912

1720

16

24

1411 12

19

1216%

Partisan Gap Began Before Passage, and Has Persisted

Percent who say they have a favorable opinion of the health reform law:



SLIDE 6

RepublicansIndependentsDemocrats

2010

2011

2012

AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

Mar AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

0%

20%

40%

60%

80%

BlackHis-panicWhite

A Look at Key Subgroups…


AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

Mar AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

0%

20%

40%

60%

80%

37%

35%

18-64

65+

BY AGE BY RACE/ETHNICITY


SLIDE 7

2010

2011

2012

2010

2011

2012

AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

Mar AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

0%

20%

40%

60%

80%Men

Women

BY GENDER

2010

2011

2012

…More Key Subgroups

AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

Mar AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

0%

20%

40%

60%

80%

37%38%

39%

< $40K

$40-$90K

$90K+

BY INCOME BY INSURANCE STATUS (<65)

AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

Mar AprMay Ju

n Jul

AugSe

pOct Nov

Dec Jan Feb

0%

20%

40%

60%

80% Insured

Uninsured

2010

2011

2012

2010

2011

2012



Majority Favor Main Provisions Of ACA, Except Individual Mandate

I’m going to read you several elements of the health reform law. As I read each one, please tell me whether you feel very favorable, somewhat favorable, somewhat unfavorable, or very unfavorable about it.

SLIDE 9

Note: Response wording abbreviated. See Topline: http://www.kff.org/kaiserpolls/8265.cfm for complete wording. Don’t know/Refused answers not shown.Source: Kaiser Family Foundation Health Tracking Poll (conducted December 8-13, 2011)

17%

38%

40%

42%

42%

16%

23%

29%

33%

37%

18%

14%

14%

11%

10%

47%

23%

14%

12%

9%

Employer mandate/penalty for large employers

Very favorable Somewhat favorable Somewhat unfavorable Very unfavorable

Health insurance exchanges

Individual mandate/penalty

Medicaid expansion

Subsidy assistance to individuals

http://www.kff.org/kaiserpolls/8265.cfm

http://www.kff.org/kaiserpolls/8265.cfm


20%

40%

60%

80%

3230

28 29

30

28 2931

33 32 31 3028 28 34 29 33 32 31 31 31

33

25%

30

32

39

3336

33 3234

28

44

38 3937 38

3539

3734

4441

3935

41%

31

29

2832

2932 31

25

32

20

2826 27 28

2427

2427

18

2326 26

27%

Views Of Personal Impact? Divided

Do you think you and your family will be better off or worse off under the health reform law, or don’t you think it will make much difference?


Note: Don’t know/Refused answers not shown.Source: Kaiser Family Foundation Health Tracking Polls

SLIDE 10

2010

2011

2012

Worse offBetter off Won’t make much difference

Who Will Benefit? Uninsured, Low-Income, Chronically Ill

Do you think each of the following will be better off or worse off under the health reform law, or don’t you think it will make much difference?

22%

23%

31%

32%

35%

48%

49%

51%

27%

41%

25%

21%

22%

16%

16%

17%

32%

31%

37%

36%

36%

25%

28%

23%

19%

5%

7%

11%

7%

11%

7%

9%

The country as a whole

Lower income Americans

You and your family

People with pre-existing health conditions

Source: Kaiser Family Foundation Health Tracking Poll (conducted November 10-15, 2011)

Better off Won’t make much difference Worse off Don’t know/

Refused

SLIDE 11

Middle class Americans

The uninsured

The Medicare program

Seniors, that is those ages 65 and older

Half Still Say They Don’t Understand Law’s Personal Impact

Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not?

43%

2%

56%

47%

1%

52%

No, don’t understand

personal impact

Yes, have enough info

Don’t know/Refused


APRIL 2010 MARCH 2011


personal impact

Yes, have enough

info


SLIDE 12

44%

1%

55%


personal impact

Yes, have enough

info


NOVEMBER 2011

Do People Recognize What’s In The Law? Yes, ….

SLIDE 13

TRUE STATEMENTS ABOUT HEALTH REFORM LAW% who recognize statement as true

Employer mandate/penalty for large employers 65%

Subsidy assistance to individuals 64

Tax credits to small businesses 63

Individual mandate/penalty 62

Basic benefits package, defined by government 61

Rate review 59

Require easy-to-understand plan summaries 58

Guaranteed issue 58

Medicaid expansion 53

Increase Medicare payroll tax on upper income 52

Health plan decision appeals 51

Gradually close Medicare “doughnut hole” 51

Increase Medicare premiums for higher income 49

Medical loss ratio 38

No cost sharing for preventative services 36

Note: Items asked of separate half samples. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 10-15, 2011)

….. And No

SLIDE 14

FALSE STATEMENTS ABOUT HEALTH REFORM LAW% who recognize

statement as false

INCORRECT

% believe trueDon’t know

Create a new government run insurance plan to be offered along with private plans 31% 56% 13%

Allow a government panel to make decisions about end-of-life care for people on Medicare 53% 35% 12%

Note: Items asked of separate half samples. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 10-15, 2011)

Only Half Of Uninsured Aware Of Specific Elements Of ACA

I’m going to read you a list of specific reform proposals. For each, please tell me whether you think it was included in the health reform law, or not.

47%

51%

52%

37%

38%

41%

16%

11%

7%

Require nearly all Americans to have health insurance by 2014 or else pay a fine

Provide financial help to low and moderate income Americans who don’t get insurance through their

jobs to help them purchase coverage

Expand the existing Medicaid program to cover low-income, uninsured adults regardless of whether

they have children

Source: Kaiser Family Foundation Health Tracking Poll (conducted August 10-15, 2011)

SLIDE 15

AMONG UNINSURED AGES 18-64

Yes, law will do this No, law will not do this Don’t know/Refused

65%

59%

58%

53%

48%

42%

28%

20%

18%

17%

16%

16%

Americans Learning About The Law From A Variety Of Sources

Percent who say they have gotten information about the health reform law from each of the following:

Percent who say the following has been their MOST IMPORTANT source of news and information about the health reform law:

Conversations with friends and family

Cable news

National broadcast network news

Source: Kaiser Family Foundation Health Tracking Poll (conducted December 8-13, 2011)

Newspapers, radio, or other online sources

None of the above/Something else (vol.)

16%

10%

18%

7%

6%

4%

1%

3%

2%

1%

1%

2%

19%

Local news

Federal agencies

Health insurance company

State agencies

An employer

Republican candidates for president

President Obama/other Democratic leaders

Your doctor or another health care professional

n/a

SLIDE 16

What to Expect in Terms of Public Opinion…

• People continue to have fairly limited familiarity with what is, and is NOT, in the law

• Key stakeholders have limited familiarity with the benefits that would accrue to them in 2014

• Opinion may not change much until law is a REALITY, affecting real people’s everyday lives, rather than an ideological debate

• Given the election year climate, for the foreseeable future, health reform will be seen through a political lens… which means partisan divisions will continue

• Supreme Court debates: public opinion wild card

SLIDE 17

30%

3%

67%Favorable


As you may know, the health reform law will require nearly all Americans to have health insurance by 2014 or else pay a fine. Would you say you feel very favorable, somewhat favorable, somewhat unfavorable or very unfavorable about that provision of the law? Could you tell me in your own words what is the main reason you have a favorable/unfavorable opinion?

Unfavorable

SLIDE 18

REASONS FOR FAVORABLE OPINION (among the 30% with favorable view)

REASONS FOR UNFAVORABLE OPINION (among the 67% with unfavorable view)

Everyone needs health care/Insurance (32%)

Expands coverage (17%)

Government overreach (30%)

Insurance is too expensive (25%)

Complaints about fine (22%)

Unconstitutional (5%)

People should pay fair share (16%)

Controls costs (15%)

Supreme Court Basics: The ‘Whys’ Behind Opinion on Mandate

Note: Only the top 4 responses for each opinion listed.Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012)

More Than Half Expect Court To Find Mandate Unconstitutional

In your own opinion, do you think the Supreme Court should rule that it is constitutional or unconstitutional for the federal government to require all Americans to have health insurance, or do you not know enough to say?

17%

29%

54%Unconstitutional

Constitutional

Don’t know enough to

say/Refused

SLIDE 19

Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012)

Constitutional

28%

13%

59%

Most Think Justices’ Ideology Plays A Role In Decision-Making


SLIDE 20


In ruling on this case, do you think the Supreme Court Justices will base their decision on legal analysis without regard to ideology or politics or do you think they will let their own ideological views influence their decision?

Will let own ideological views

influence their decision

Will base decision on

legal analysis

55%

15%

30%

Most Believe Some of ACA Will Be Implemented, Even Without Mandate

If the Supreme Court rules that the federal government cannot require Americans to have health insurance, do you expect some parts of the health care law will still be implemented, or do you think this will effectively mean the end of the entire law?

SLIDE 21


Effectively means end of the entire

law Some parts of the law will still be implemented


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Americans and the ACA: A Quick Trip Through Two Years of Public Opinion Data Claudia Deane Assoc. Director, Public Opinion & Survey Research Kaiser Family