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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
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
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
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%
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:
ACA signed into law on March 23, 2010
Source: Kaiser Family Foundation Health Tracking Polls
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…
Percent who say they have a favorable opinion of the health reform law:
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
Source: Kaiser Family Foundation Health Tracking Polls
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
Source: Kaiser Family Foundation Health Tracking Polls
Percent who say they have a favorable opinion of the health reform law:
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
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%
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?
ACA signed into law on March 23, 2010
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
Source: Kaiser Family Foundation Health Tracking Polls
APRIL 2010 MARCH 2011
No, don’t understand
personal impact
Yes, have enough
info
Don’t know/Refused
SLIDE 12
44%
1%
55%
No, don’t understand
personal impact
Yes, have enough
info
Don’t know/Refused
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
Don’t know/Refused
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
Don’t know/Refused
SLIDE 20
Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012)
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
Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012)
Effectively means end of the entire
law Some parts of the law will still be implemented
Don’t know/Refused
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