Americans and the ACA: A Quick Trip Through Two Years of Public Opinion Data Claudia Deane Assoc. Director, Public Opinion & Survey Research Kaiser Family Foundation March 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: SLIDE 1

Since Passage, Public Has Remained Largely Split On ACA As you may know, a health reform bill was signed into law in 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 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: SLIDE 3

Partisan Gap, and Intensity Gap to Boot As you may know, a health reform bill was signed into law in Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? Total Democrats Independents Republicans SLIDE 4 Note: Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 13-19, 2012) Very favorableSomewhat favorableVery unfavorableSomewhat unfavorable

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 5 RepublicansIndependentsDemocrats

A Look at Key Subgroups… Percent who say they have a favorable opinion of the health reform law: BY AGE BY RACE/ETHNICITY Source: Kaiser Family Foundation Health Tracking Polls SLIDE BY GENDER

…More Key Subgroups BY INCOME BY INSURANCE STATUS (<65) 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 8 Note: Response wording abbreviated. See Topline: for complete wording. Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted December 8-13, 2011) Employer mandate/penalty for large employers Very favorableSomewhat favorableSomewhat unfavorableVery unfavorable Health insurance exchanges Individual mandate/penalty Medicaid expansion Subsidy assistance to individuals

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 Worse offBetter offWon’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? 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 10 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? 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 11 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 12 TRUE STATEMENTS ABOUT HEALTH REFORM LAW % who recognize statement as true Employer mandate/penalty for large employers65% Subsidy assistance to individuals64 Tax credits to small businesses63 Individual mandate/penalty62 Basic benefits package, defined by government61 Rate review59 Require easy-to-understand plan summaries58 Guaranteed issue58 Medicaid expansion53 Increase Medicare payroll tax on upper income52 Health plan decision appeals51 Gradually close Medicare “doughnut hole”51 Increase Medicare premiums for higher income49 Medical loss ratio38 No cost sharing for preventative services36 Note: Items asked of separate half samples. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 10-15, 2011)

….. And No SLIDE 13 FALSE STATEMENTS ABOUT HEALTH REFORM LAW % who recognize statement as false INCORRECT % believe true Don’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. 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 14 AMONG UNINSURED AGES Yes, law will do thisNo, law will not do thisDon’t know/Refused

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.) 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 15

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 16

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 17 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? Unconstitutional Constitutional Don’t know enough to say/Refused SLIDE 18 Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012) Constitutional

Most Think Justices’ Ideology Plays A Role In Decision-Making Don’t know/ Refused SLIDE 19 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

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 20 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

IMPROVE U.S. DATA QUALITY…. TAKE A SURVEY