March 2013 Public Opinion on Health Care Issues ThreeyearsafterthepassageofthePatientProtectionandAffordableCareAct(theACA),butstillmanymonthsawayfromthe implementationofmostofitsmajorprovisions,thelatestKaiserHealthTrackingPollfindsthatamajorityofAmericansareunsure howthelawwillimpactthem,andfewarepayingattentiontothedetailsofstateleveldecisionsaboutimplementation.Though opiniononthelawoverallremainsnearlyevenlydivided,opponentsattacksseemtohavetakenatollonthepublicsexpectations, andAmericansarenowmorelikelytothinkthelawwillmakethingsworseratherthanbetterfortheirownfamilies.Whilemostof thelawsindividualprovisionsremainpopular,manyofthemostwelllikedelementsaretheleastwellknownamongthepublic. PublicknowledgeoftheACAsprovisionshasnotincreasedsince2010,andawarenessofsomekeyprovisionshasdeclinedsomewhat sincethelawspassagewhenmediaattentionwasatitsheight.

t.Onanotherhealthpolicytopicthathasbeeninthenews,while nationaldatashowsthathealthcarecostgrowthhassloweddowninrecentyears,amajorityofthepublicperceivesthatthe countryshealthcostshavebeengoingupfasterthanusual. PUBLICNOTPAYINGMUCHATTENTIONTOSTATEDECISIONSONEXCHANGES,MEDICAIDEXPANSION WhilestateandfederalpolicymakersarebusymakingdecisionsabouttheMedicaidexpansionandworkingoutthelogisticsoftheir healthinsuranceexchangesbefore2014,thepublicatlargehasntbeenpayingmuchattentiontoeitherofthesetopics.Askedhow muchtheyhaveheardabouttheirownstatesdecisiononwhethertocreateastaterunexchange,roughlyhalfthepublic(48 percent)reportshearingnothingatall,whilejustoveroneinfivehaveheardalot(7percent)orsome(15percent).Further, whenaskedwhattheyknowabouttheirgovernorsdecisiononwhethertoexpandMedicaidintheirstate,thevastmajority(78 percent)saytheyhaventheardenoughtosaywhetherthegovernorhasannouncedadecisionorwhatthatdecisionis.Thisis equallytrueinstateswherethegovernorhasstatedthattheywillexpandMedicaid(80percentsaytheyhaventheardenoughto say)andinthosewhosegovernorhassaidtheywillnotmoveforwardwiththeexpansion(74percent).

Few Have Heard About State Decisions on Exchanges and Medicaid Expansion
How much, if anything have you heard about your states decision on whether to create a state-run health insurance exchange or marketplace where people who dont get coverage through their jobs can shop for insurance? As far as you know, has your states governor announced that your state will expand Medicaid, announced that your state will not expand Medicaid, not announced their decision, or have you not heard enough about this to say?
Has not announced decision Announced 6% state will not expand Medicaid 7% Announced state will expand Medicaid 7%

Dk/ Ref. 2%

A lot 7% Some 15% Nothing at all 48% Only a little 29%

Not heard enough to say 78%

SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

Whenaskedwhethertheythinktheir stateshouldimplementtheMedicaid expansion,withthefederal governmentpickingupmostofthe cost,thesurveyfindsthatmore Americansareinfavorofexpanding Medicaidintheirstate(52percent) thanopposeit(41percent),sharesthat haveremainedsimilarsincelastJuly.A familiarpartisandivideisevident,with twothirdsofRepublicanswantingto keeptheirstatesMedicaidprogramas itistoday,threequartersofDemocrats wantingtoexpandit,and independentsnearlyevenlydivided.

More Favor Expanding Their States Medicaid Program Than Oppose

As you may know, the health care law expands Medicaid to provide health insurance to more low-income uninsured adults. The federal government will initially pay the entire cost of this expansion, and after several years, states will pay 10 percent and the federal government will pay 90 percent. The Supreme Court ruled that states may choose whether or not to participate in this expansion. What do you think your state should do? Keep Medicaid as it is today Total 41% Expand Medicaid to cover more low-income people 52%

Democrats

20%

76%

Independents

46%

44%

Republicans

67%

26%

NOTE: Other/Neither (vol.) and Dont know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

PUBLIC:WHATHEALTHCOSTGROWTH SLOWDOWN? Public: What Health Cost Growth Slowdown? Analysisofnationaldatahasshownthat, while healthcarecostgrowthcontinues Would you say the amount you and your family are Over the past few years, would you say the cost of tooutpaceinflation,therateofgrowthin paying for health care and health insurance has been health care for the nation as a whole has been going going up over the past few years, going down, or staying up faster than usual, going up slower than usual, or nationalhealthexpenditureshasslowed about the same? (If going up) Would you say your health going up abut the same amount? markedlyinrecentyears.1Thepublics care costs have been going up faster than usual, slower than usual, or about the same amount? Going up perceptionofthecosttrajectoryisquite slower than Going down different,however.Nearlysixinten Dk/Ref. usual 2% 4% 4% adults(58percent)saythatoverthepast Dk/Ref. fewyears,thecostofhealthcareforthe 7% nationasawholehasbeengoingup Going up faster than fasterthanusual,whilejust4percentsay usual Going up ithasbeengoingupslowerthanusual 34% Staying faster than Going up about the usual and threeinten(31percent)thinkits about the same 58% same been goingupbyaboutthesame 32% amount as Going up usual amount. about the 31% same amount as Whenitcomestotheirownexperiences Going up usual slower than withrisingcosts,aboutathirdof 24% usual Americans(34percent)reportthattheir 2% SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013) ownfamilyshealthcarecostshavebeen goingupfasterthanusual,whileroughly aquartersaytheyvebeengoingupaboutthesameamountasusual(24percent),and32percentsaytheircostshaveheldsteadyin recentyears.Onlysmallsharessaytheircostshavebeengoingupmoreslowlythanusual(2percent)orthattheircostshave actuallycomedown(2percent).

MHartman,ABMartin,JBenson,ACatlin,andtheNationalHealthExpenditureAccountsTeam,NationalHealthSpendingin2011:Overall GrowthRemainsLow,ButSomePayersandServicesShowSignsofAcceleration,HealthAffairs,January2013,32:8799.
2

PUBLICOPINIONONTHEACAREMAINS DIVIDEDAT3RDANNIVERSARY At Three Years, Opinion On ACA Remains Divided SincetheACAwassignedintolawin March2010,overallopinionofthelaw As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform hasstayedwithinarelativelynarrow law, do you have a generally favorable or generally unfavorable opinion of it? band,withroughlyequalproportions ACA signed into law sayingtheyfeelfavorableand on March 23, 2010 80% Favorable Unfavorable Don't know/Refused unfavorabletowardsit.Thisdivisionof opinioncontinuesonthe3rdanniversary oftheACA,with37percentholdinga 60% 51 50 50 favorableviewand40percent 49 48 48 46 46 46 45 44 44 44 44 43 44 43 44 43 45 43 43 43 44 43 43 44 unfavorable.Theshareofthepublicwho 42 42 42 41 41 41 40% 40% declinedtoofferanopiniononthelaw 43 43 42 42 42 42 41 41 41 41 42 42 42 40 41 41 40 40 41 41 40 40 39 38 38 38 39 37 37 37 37% remainshighthismonth,at23percent. 36 35 34 20% 23 23% Askedaboutthereasonsbehindtheir 19 19 19 19 18 19 19 19 18 18 18 17 16 17 17 views,themostcommonresponse 15 15 15 15 15 14 14 14 14 14 13 12 11 12 10 9 8 amongthosewhoviewthelawfavorably 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Feb Mar hastodowithexpandedaccesstohealth 2010 2011 2012 2013 careandinsurance(58percent),while thosewhoviewthelawunfavorablyare SOURCE: Kaiser Family Foundation Health Tracking Polls mostlikelytocitecostconsiderations(30 percent),oppositiontotheindividual mandate(15percent),andconcernsaboutgovernmentinvolvementinhealthcare(13percent).

Three Years Later, Public Still Divided by Party

Percent who say they have a favorable opinion of the health reform law:
ACA signed into law on March 23, 2010

80%

78

72

69

73 68

75 69 68 69

Democrats 73 66 71 64 72 65 64

Independents

Republicans 66 70 62 71 69 64 72 64 57 58% 72

65 60 52

62

64

62

64

60%

49 48
40%

36 37

41 42 34

43 37 37 34 37

41 35 33

38 33

36

40 40 39 34 33 32 30 34

38

41 35 34 32

37

32

31%

20%

23 13

21 16

21 11 15 12 12 11 9 12

17

20

24 16 19 14 11 12 12 16 12 12 16 8 10 18% 12 12
Feb Mar 2013

0%

8
2010

7 8 7

Apr May Jun Jul AugSep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul AugSep Oct Nov 2011 2012

LastmonthsdropintheshareofDemocratsviewingthelawfavorablyleveledoffthismonth,andviewsbypartycontinuetobeas dividedasever,withmostRepublicans(68percent)viewingthelawunfavorably,amajorityofDemocrats(58percent)viewingit favorably,andindependentsmorenegativethanpositive(31percentfavorable,45percentunfavorable).Theintensityofopinionon thelawstilllieswiththeGOP,anotheraspectofopinionthathasbeentruethroughoutthelastthreeyearsofKaiserpollingonthe ACA.AbouthalfofRepublicans(53percent)saytheyhaveaveryunfavorableview,comparedtothreeintenDemocrats(31 percent)whosaytheyhaveaveryfavorableview.

SOURCE: Kaiser Family Foundation Health Tracking Polls

MOSTREPORTNOPERSONAL EXPERIENCEWITHLAWYET Thusfar,mostAmericansreport havingnodirectexperience,either positiveornegative,withtheACA.A littleovertwointensaysomeonein theirfamilyhasbeennegatively affectedbythelaw(22percent),with themostcommonlycitedreason beingincreasedcosts,followedbycuts tobenefits.Aslightlysmallershare feeltheyvepersonallybenefited(17 percent),eitherthroughexpanded benefitsandaccesstocare,lower healthcarecosts,ortheprovisionthat allowsparentstokeeptheirchildren undertheageof26ontheirinsurance plan.Still,themajorityofthepublic 62percentreportsthattheyhave notfeltanyimpacteitherway,a numberthathasstayedrelatively steadysinceDecember2010.

Most Report No Experience With Law So Far

So far, would you say you and your family have [personally benefited from/been negatively affected by] the health reform law, or not?
Percent who say someone in their family has personally benefited from the health reform law Percent who say someone in their family has been negatively affected by the health reform law Percent who say they have not been personally impacted yet 71% 68% 72% 67% 64% 62%

80%

60% 66%

69%

68%

40%

20%

20%

20% 17% 14% 13%

Feb Mar

18% 14%
May

18% 15%

18%

21%

19% 19%

22%

15%
0%

11%
Nov

14%
Mar 2012 Aug 2013

17%

Dec 2010

Jul 2011

Mar

SOURCE: Kaiser Family Foundation Health Tracking Polls

TABLE1:INTHEIROWNWORDS Amongthe17%whosaytheirfamilyhaspersonallybenefitedfrom thehealthreformlaw:Inwhatwayswouldyousayyouhave benefitedfromthehealthreformlaw? Mybirthcontrolisnowfree We'vebeenabletocontinuecoverageforourchildthathas graduatedfromcollegeandwedon'thavetopaycopaysforwell visits Greatdifference,Idon'thavetopayasmuchasIdid ThereisaprovisionwherepeoplewithMedicaregetawellness annualcheckupandIthinkthat'sagoodidea.AndIhavehadmine anditwasveryhelpful Justeaseofmind BecauseIdidn'thaveinsuranceandnowIdo Makesbusinessesgiveinsurancetoemployees Yearlyincreasehasbeenlowerthaninthepast10years Removalofsomecapsofnumberofvisitsayear,specificallyfor mentalhealth Iwouldhavebeendeniedinsuranceforapreexistingcondition andnowImnot

Amongthe22%whosaytheirfamilyhasbeennegativelyaffectedby thehealthreformlaw:Inwhatwayswouldyousayyouhavebeen negativelyaffectedbythehealthreformlaw? Don'tcareforthegovernmentintrusion MydoctorwillnolongertakeMedicarepatientslikehedidbefore. NowhelimitsthetimehewillseeMedicarepatientsandtheydon't payaswellastheydidbefore IreceivedabillforbloodworkwhichIhaveneverreceivedbefore Mymotherisasmallbusinessownerandshecannotaffordtopay forhealthcarefortheemployeeseventhoughtheemployees alreadyhavehealthcare Itscostingmemoremoneyforlesscoverage TakingthemoneyoutofMedicaretohelpObamaCare Someofmyfamilymembershourshavebeencutsothebusinesses don'thavetoparticipate Whenmyhusbandgetshischecksitkeepstakingoutmore Thetaxpayerswillhavetopaywhethertheyarecoveredornot,we arecoveredweshouldnotpay Becausewedon'thaveallthedetailsyet

PARTSMOREPOPULARTHANTHEWHOLE Whilethepublicisdividedonthelawasacompletepackage,manyofitscomponentpartsarequitepopular,someonabipartisan basis.Majoritiesofthepublicarefavorabletowardsthelawstaxcreditsforsmallbusinesseswhooffertheiremployeesinsurance (88percent,including53percentveryfavorable),closingtheMedicaredoughnuthole(81percent,52percentveryfavorable),and theprovisionallowingyoungadultstostayontheirparentshealthplansuptoage26(76percent,54percentveryfavorable).Three ofthehallmarkfeaturesofthelawthehealthinsuranceexchanges,subsidiestohelpindividualspurchaseinsurance,andthe Medicaidexpansionarealsopopular,withbetweensevenandeightintenAmericansfavoringeach(80percent,76percent,and 71percent,respectively).Butconsistentwithpreviouspolls,theindividualmandatefallsatthebottomofthislist,withsixinten feelingunfavorableaboutthisprovisionofthelaw.

EvensomeofthelawsmostferventopponentslikemanyofthethingstheACAhasdoneorwilldo.AmajorityofRepublicansfeel favorabletowardssevenofthe11provisionsaskedaboutintheMarchpoll,withsevenintenormorefavoringtaxcreditstosmall businesses,closingtheMedicaredoughnuthole,andtheexchanges.LesspopularamongtheGOP:thehighlypoliticizedMedicaid expansion(42percentfavorable),increasedMedicarepayrolltaxforthosewithhigherincomes(37percent),theemployerand individualmandates(36percentand21percent,respectively).

TABLE2:MANYELEMENTSOFACACONTINUETOBEPOPULARACROSSPARTIES Percentwhosaytheyfeelfavorableabouteachofthefollowingelementsofthe healthreformlaw Total Dem Ind Rep Taxcreditstosmallbusinessestobuyinsurance 88% 96% 87% 83% CloseMedicaredoughnuthole 81 90 80 74 Createhealthinsuranceexchanges 80 87 78 72 Extensionofdependentcoverage 76 84 79 68 Subsidyassistancetoindividuals 76 91 69 61 Medicaidexpansion 71 88 70 42 Guaranteedissue 66 75 67 56 Medicallossratio 65 72 60 62 IncreaseMedicarepayrolltaxonupperincome 60 80 54 37 Employermandate/penaltyforlargeemployers 57 79 54 36 Individualmandate/penalty 40 55 39 21 Note:Questionwordingabbreviated.Forfullquestionwording,seetopline:http://www.kff.org/kaiserpolls/8425.cfm.

GAPSINKNOWLEDGEPERSIST Threeyearsafterpassage,amajorityofAmericans(57percent)saytheydonothaveenoughinformationabouttheACAto understandhowitwillaffectthem.Perhapsmoreimportantly,thissharerisestotwothirdsamongsomeofthekeygroupsthelaw wasdesignedtohelp:theuninsured(67percent)andthosewithincomesbelow$40,000(68percent).

Majority Say They Dont Understand How ACA Will Impact Them, Including Two-Thirds of Uninsured and Low-Income
Do you feel you have enough information about the health reform law to understand how it will impact you personally, or not? Yes, have enough information No, do not have enough information

Total

41%

57%

Uninsured (under age 65)

33%

67%

Household income less than $40,000

30%

68%

NOTE: Dont know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

Whileamajorityofthepublichasanaccurateperceptionofhowmuchofthelawhasbeenimplemented(67percentsaythatsome provisionshavebeenputintoplacethusfar),manycontinuetohavefalseimpressionsaboutwhichprovisionsareactuallyincluded inthelawandwhicharenot. Amongthepublic,themostwidelyrecognizedelementistheunpopularindividualmandate,whichthreequarters(74percent)of thepublicsayispartofthelaw.Theemployerrequirement,thatcompanieswith50ormorefulltimeemployeesofferinsuranceor payafine,closelyfollows(71percent).Largesharesarealsoawarethatthelawallowsadultchildrentostayontheirparents insuranceuntilage26(69percent),providessubsidiestohelplowandmoderateincomeAmericanspurchaseinsurance(62 percent),givesstatestheoptionofexpandingtheirMedicaidprogram(59percent),andcreatesinsuranceexchangeswherepeople canshopforcoverage(58percent). Amongtheitemsthatarelessfamiliartothepublic:justabouthalfrecognizethatthelawincreasestheMedicarepayrolltaxfor upperincomeAmericans(54percent);prohibitsinsurancecompaniesfromdenyingcoveragetopeoplewithpreexistingconditions (alsoknownasguaranteedissue,53percent);andprovidestaxcreditstosmallbusinesseswhocovertheirworkers(52percent). EvenlesswellknownarethelawsprovisionstoclosetheMedicareprescriptiondrugcoveragegap,ordoughnuthole(46percent) andthemedicallossratioprovisionthatrequiresinsurancecompaniestogiverebatestocustomersiftheyspendtoolittleonhealth careservicesandtoomuchonadministrativecostsandprofits(40percent).
TABLE3:AWARENESSOFPROVISIONSINCLUDEDINTHEHEALTHCARELAW(TRUESTATEMENTS) INCORRECT CORRECT Tothebestofyourknowledge,wouldyousaythehealthreformlaw Yes,lawdoes No,lawdoes DontKnow/ doesordoesnotdoeachofthefollowing? this notdothis Refused Individualmandate/penalty 74% 17% 9% Employermandate/penaltyforlargeemployers 71 17 11 Extensionofdependentcoverage 69 20 11 Subsidyassistancetoindividuals 62 29 9 Medicaidexpansion 59 25 17 Healthinsuranceexchanges 58 29 13 IncreasetheMedicarepayrolltaxonupperincome 54 27 19 Guaranteedissue 53 36 11 Taxcreditstosmallbusinessestobuyinsurance 52 26 22 CloseMedicaredoughnuthole 46 31 22 Medicallossratio 40 37 23 Note:Questionwordingabbreviated.Forfullquestionwording,seetopline:http://www.kff.org/kaiserpolls/8425.cfm.

Atthesametime,manyAmericansholdmisimpressionsaboutthelawscontents.Justundersixinten(57percent)mistakenlythink thelawcreatesagovernmentrunhealthplan(thesocalledpublicoption).Andclosetohalf(47percent)saythelawallows undocumentedimmigrantstoreceivefinancialhelpfromthegovernmenttobuyhealthinsurance,wheninfacttheyarenoteligible forsubsidies.Many(40percent,including35percentofseniors)continuetoholdontothemyththatthelawallowsagovernment paneltomakedecisionsaboutendoflifecareforpeopleonMedicare(thesocalleddeathpanels)andanothertwointenarent sure(21percent).

TABLE4:MISPERCEPTIONSABOUTPROVISIONSNOTINCLUDEDINTHELAW(FALSESTATEMENTS) INCORRECT CORRECT Tothebestofyourknowledge,wouldyousaythehealthreformlaw No,lawdoes Yes,lawdoes DontKnow/ doesordoesnotdoeachofthefollowing? notdothis this Refused CutbenefitsforpeopleinMedicare 43% 44% 14% Establishagovernmentpaneltomakedecisionsaboutendoflife 39 40 21 careforpeopleonMedicare Allowundocumentedimmigrantstoreceivesubsidiestopurchase 33 47 21 insurance Publicoption 28 57 15 Note:Questionwordingabbreviated.Forfullquestionwording,seetopline:http://www.kff.org/kaiserpolls/8425.cfm.

AspreviousKaiserpollshaveshown,someofthemostpopularprovisionsofthelawareamongtheleastwidelyrecognized,andvice versa.Forexample,threequartersofAmericansrecognizethattheindividualmandateispartofthelaw,butonlyfourintenhavea favorableview.Largersharesreporthavingpositiveviewsoflesswellknownprovisions.Forexample,88percentofAmericansfavor providingtaxcreditstosmallbusinessesthatofferhealthinsurance,whilejustabouthalf(52percent)areawarethelawincludes suchaprovision.

Most Popular Provisions Among Least Widely Recognized (And Vice Versa)
Percent who say they feel favorable about each of the following and percent who say they are aware each is included in the health reform law:
Percent with a favorable view of element Tax credits to small businesses to buy insurance Close Medicare "doughnut hole" Create health insurance exchanges Extension of dependent coverage Subsidy assistance to individuals Medicaid expansion Guaranteed issue Medical loss ratio Increase Medicare payroll tax Employer mandate/penalty for large employers Individual mandate/penalty 40% 40% 62% 59% 53% Percent who are aware element is included in ACA 52% 46% 58% 69% 81% 80% 76% 76% 71% 66% 65% 60% 54% 57% 88%

71% 74%

Publicknowledgeabouttheseprovisionshasnotincreasedsince2010,andawarenessofsomeofthemostpopularprovisionshas actuallydecreased.Forexample,comparedwithApril2010,theshareswhorecognizethatthelawincludestaxcreditstosmall businessestobuyinsurance,subsidyassistanceforindividuals,andguaranteedissueofhealthinsurancearedown14,13,and11 percentagepoints,respectively.

TABLE5:DECLINESINAWARENESSOFSOMEKEYPROVISIONS Percentwhosaythehealthreformlawdoeseachofthefollowing: April2010 March2013 Taxcreditstosmallbusinessestobuyinsurance 66% 52% Subsidyassistancetoindividuals 75 62 Guaranteedissue 64 53 Medicaidexpansion 64 59 Healthinsuranceexchanges 62 58 Medicallossratio 37 40 Extensionofdependentcoverage 70 69 Individualmandate/penalty 71 74 Note:Questionwordingabbreviated.Forfullquestionwording,seetopline:http://www.kff.org/kaiserpolls/8425.cfm.

NOTE: Items asked of separate half samples. Question wording abbreviated. See topline (http://www.kff.org/kaiserpolls/8425.cfm) for complete wording. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

EXPECTATIONSOFTHELAWSIMPACT ThreeyearsaftertheACApassed,and monthsawayfromtheimplementationof mostofitsmajorprovisions,apluralityof Americans(40percent)saytheydont expectthelawtomakemuchdifference fortheirfamiliesoverall.Thosewhodo expecttoseeanimpactaremorelikelyto sayitwillleavethemworseoff(29 percent)ratherthanbetter(21percent). Likefavorability,expectationsofthelaws personalimpacthavealsobounced aroundwithinanarrowband,butinmost monthssince2011,thosesayingthey expecttobeworseoffhave outnumberedthoseexpectingtobe betteroff,withthelargestsharesaying theyexpecttoseelittledifferenceintheir ownlives.

Trend in Opinion on Personal Impact of ACA

Do you think you and your family will be better off or worse off under the health reform law, or dont you think it will make much difference?
ACA signed into law on March 23, 2010

80%

Better off

Won't make much difference

Worse off

60%

40%

20%

41 41 39 37 35 36 32 32 34 34 34 33 32 33 32 31 30 33 29 3028 3230 28 28 31 31 32 32 33 32 33 27 33 32 34 31 31 31 31 31 30 28 28 29 28 29 29 28 29 27 28 27 27 26 26 26 26 26 25 23 25 24 24 23 20 18 39 38 39 37 38 35 39 37 34

44

44

37 37 32 30

33 33 31 32

40% 36 32 29% 24 21%

25 26 26 26

0%

Apr May Jun Jul AugSep Oct Nov Dec Jan Feb Mar Apr May Jun Jul AugSep Oct Nov Dec Jan Feb Mar Apr May 2010 2011

Jul AugSep Oct 2012

Feb Mar 2013

NOTE: Dont know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Polls

Expectations for ACAs Impact on Cost and Quality More Negative Than Positive
Under the health reform law, do you think each of the following will get better, worse, or will it stay about the same?
Worse 55% 45% 39% 28% 24% Stay about the same 18% 26% 36% 40% Better 21% 24% 16%

NATIONAL IMPACTS
The cost of health care for the nation as a whole The quality of health care in the nation Consumer protections for the average person with private health insurance Access to health care for the uninsured

PERSONAL IMPACTS
The cost of health care for you and your family The quality of your own health care Your ability to get and keep health insurance 49% 34% 28% 33% 48% 46% 15% 15% 20%

NOTE: Items asked of half sample. Dont know/Refused answers not shown. SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)

Drillingdownfurtherintothespecifics, thelatestpollfindsAmericans expectationsaboutthelawsimpactson healthcarecosts,quality,andconsumer protectionsarealsomorenegativethan positive.Thebiggestareaofconcernis costs;morethanhalf(55percent)saythe costofhealthcareforthenationasa wholewillgetworseunderthelaw,and nearlyasmany(49percent)saythesame abouttheirownpersonalhealthcare costs.Americansarealsomuchmore likelytosaythingswillgetworserather thanbetterintermsofqualityofcarein thenation(45percentvs.24percent) andconsumerprotectionsforthe averagepersonwithhealthinsurance(39 percentvs.16percent).Whenitcomesto thequalityoftheirowncareandtheir abilitytogetandkeepinsurance,nearly halfdontexpecttoseemuchchange,but largersharesexpectthingstogetworse ratherthanbetter.

Theoneareaaskedaboutinthesurveywherethepublicsexpectationsaremorepositiveisaccesstohealthcarefortheuninsured: 40percentexpectittogetbetterunderthelaw,while28percentexpectittogetworse.

Notsurprisingly,expectationsaboutthelawsimpactsineachoftheseareasarealsodividedsharplybyparty,withRepublicansfar morelikelythanDemocratstothinkthingswillgetworse,bothforthemselvesandforthenation.Forexample,while73percentof Republicanssaythequalityofcareinthenationwillworsen,fourintenDemocrats(39percent)expectittogetbetterunderthe law.Similarly,morethanhalf(53percent)ofDemocratsexpecttheuninsuredwillhavebetteraccesstocare,whileRepublicansare dividedastowhetheraccesswillgetbetter(31percent)orworse(33percent). Itsworthnoting,however,thatevenDemocrats,whofavorthelawforthemostpart,aredividedastowhetherthelawwillmake thingsbetterorworseintermsofnationalhealthcarecosts(37percentbettervs.34percentworse),consumerprotections(27 percentvs.24percent),andtheirownfamilieshealthcarecosts(23percentvs.26percent),withsubstantialsharessayingitwont makemuchdifference.

TABLE6:PARTISANDIFFERENCESINPERCEPTIONSOFLAWSIMPACTS Underthehealthreformlaw,doyouthinkeachofthefollowing willgetbetter,worse,orstayaboutthesame? Total NATIONALIMPACTS Thecostofhealthcareforthenationasawhole Better 21% Worse 55 Stayaboutthesame 18 Thequalityofhealthcareinthenation Better 24 Worse 45 Stayaboutthesame 26 Consumerprotectionsfortheaveragepersonwithprivate healthinsurance Better 16 Worse 39 Stayaboutthesame 36 Accesstohealthcarefortheuninsured Better 40 Worse 28 Stayaboutthesame 24 PERSONALIMPACTS Thecostofhealthcareforyouandyourfamily Better 15 Worse 49 Stayaboutthesame 33 Thequalityofyourownhealthcare Better 15 Worse 34 Stayaboutthesame 48 Yourabilitytogetandkeephealthinsurance Better 20 Worse 28 Stayaboutthesame 46 Dem 37% 34 26 39 25 34 27 24 40 53 21 21 23 26 46 25 16 55 34 17 43 Ind 16% 57 21 18 55 22 13 33 44 36 28 30 10 59 28 11 39 48 14 31 52 Rep 6% 83 8 5 73 17 8 69 14 31 33 22 10 72 18 6 54 35 9 42 42

EXPEC CTATIONSOFCHANGESRELATEDTOINDIV VIDUALMAND DATE Inano othermeasure eofpeoplesex xpectationsab boutthelaw,th hesurveyfinds sthatjustunde erthreeinten nAmericans(28 8percent)say theye expecttomakesomesortof fchangetothe eircurrenthealthinsurancea arrangementsasaresultoftheACAsindiv vidual mand date.Ofthosewhosaytheywill w havetoma akedifferenthealthcarearra angements,mo ostexpectthosechangestocomeinthe formofneedingtogetnewcover rageorpayingmorefortheircurrentcover rage.Notsurpr risingly,thegro oupthatismostlikelytosay expecttochan ngetheirarrangementsareth hosewhoarecurrently c unins sured(62perc cent,versus22percentofthe einsured). theye all,peoplearemorelikelytosaythesechan ngeswillleave ethemworseo off(19percent t)thanbetter(7percent).Ho owever,the Overa unins suredaresome ewhatmoreev venlydividedon o theimpactof o thesenewh ealthcarearra angements2 23percentsaythechanges willle eavethembett teroff,comparedto34percentwhosayth hechangeswil lleavethemw worseoff.
TA ABLE7:EXPECTA ATIONSOFIMPA ACTSRELATEDTO T INDIVIDUALMANDATE M Wh hentherequirem mentthatnearly yallAmericanshave h healthinsurancegoesinto effect in2014,doyouthinkyouwillhave etochangeyour rcurrenthealthinsurance arr rangements,ornot?Doyouthin nkthatchangewill w leaveyoube etterofforworse eoff? Yes,willhavetoch hangehealthins surancearrangements Betteroff Worseoff Wontmakemuch m differenceeither e way(VOL L.) Dontknow/Re efused No o,willnothaveto t change Do ontknow/Refus sed Insured (underage65) 22% 4 16 1 1 73 5 Uninsured (u underage65) 62% 23 34 1 3 32 6

T Total 2 28% 7 19 1 1 66 6

ThisKaiserHealth hTrackingPollwas w designedandanalyzedbypublicopinionres searchersatthe eKaiserFamilyF Foundationledb byMollyann B Brodie,Ph.D.,inc cludingLizHame el,ClaudiaDeane e,SarahCho,andBiancaDiJulio .ThesurveywasconductedMa arch510,2013,amonga nationallyrepresentativerandom mdigitdialtelep phonesampleof1,204adultsag ges18andolder, ,livingintheUn nitedStates,includingAlaska andHawaii(note e:personswithoutatelephonecould c notbeincl ludedintheran domselectionp process).Compu uterassistedtele ephone in nterviewscondu uctedbylandline e(602)andcellphone p (602,including315whoh hadnolandlinetelephone)were ecarriedoutinEnglishand SpanishbyPrince etonDataSource eunderthedire ectionofPrinceto onSurveyResea archAssociatesInternational.Th hecombinedlan ndlineand ce ellphonesamplewasweightedtobalancethesample s demogra aphicstomatch Censusestimat tesforthenation nalpopulationo onsex,age, education,race,Hispanicorigin,nativity(forHisp panicsonly),reg gion,andtelepho oneusage.Allst tatisticaltestsof fsignificanceaccountforthe effectofweightin ng.Themarginof o samplingerrorincludingthedesign d effectfor rthefullsampleisplusorminus s3percentagep points.For re Notethatsamplingerrorisonly esultsbasedonothersubgroups s,themarginofsamplingerrormaybehigher.N yoneofmanypo otential so ourcesoferrorinthisoranyoth herpublicopinio onpoll. Thefullquestionwordingandme ethodologyofth hepollscanbeviewed v onlineat t:http://www.kf ff.org/kaiserpolls/8425.cfm.

This publication (#8425-F) is available on the Kaiser Family Foundations website at www.kff.org. The Henry J. Kaiser Family Foundation: Headquarters 2400 Sand Hill Road, Menlo Park, CA 94025 Phone: 650.854.9400 Fax: 650.854.4800 Washington Offices and Barbara Jordan Conference Center: 1330 G Street N.W., Washington, DC 20005 Phone: 202.347.5270 Fax: 202.347.5274 www.kff.org

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