Kaiser Health Tracking Poll: April 2013

As government officials, community organizations and advocates gear up the consumer information and assistance efforts that will surround this fall’s open enrollment for the health insurance exchanges created under the Affordable Care Act (ACA), much of the public remains confused about the status of the health law, according to the April Kaiser Health Tracking Poll. Four in ten Americans (42 percent) are unaware that the ACA is still the law of the land, including 12 percent who believe the law has been repealed by Congress, 7 percent who believe it has been overturned by the Supreme Court and 23 percent who don’t know whether or not the ACA remains law. And about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households. When it comes to where they are getting information about the law, Americans most commonly cite friends and family, “newspapers, radio news or other online news sources”, and cable news. About one in ten report getting information from a health insurer, their doctor, an employer, or a non-profit organization. Similar shares say they have gotten information from “federal agencies such as the Department of Health and Human Services” or “state agencies such as your state Medicaid office”.

Heading Into Open Enrollment: Personal Conversations, News Media Have Been Main Sources Of Public’s ACA Info Thus Far

As the federal government, state governments and other stakeholders gear up for public information campaigns tied to the October start of open enrollment in the ACA’s health insurance exchanges, Americans report that thus far they have been relying most heavily on their own personal networks and the news media for information about a law that continues to be only dimly understood by many. The most commonly cited sources of information in Kaiser’s April Health Tracking Poll are friends and family (named by 40 percent), “newspapers, radio or other online news” (36 percent), and cable news (30 percent).

Thus far, about one in ten Americans report getting any information from a health insurance company, their doctor, an employer, or a non-profit, and few name any of these as their most important source of information. About the same share (9 percent) report having gotten information from “federal agencies such as the Department of Health and Human Services,” with little difference across demographic groups. Eight percent say they have gotten some ACA information from “state agencies such as your state Medicaid office or health department,” a share which doubles among African Americans (17 percent). The poll provides a rough baseline before more intensive public information and consumer assistance begins.

At this point, uninsured Americans and those with lower incomes are less likely to report having gotten information about the ACA across a wide variety of sources. ¹ For example, 30 percent of those with lower incomes say they have learned something about the ACA from newspapers, radio, or online sources, compared to 48 percent of those with incomes upward of $90,000. Similar gaps are seen between the insured and the uninsured: 46 percent of the insured have chatted with family members or friends about the law, compared to 32 percent of the uninsured.

Despite the fact that the uninsured and lower income are less likely to have learned about the ACA from friends or the news media when compared to higher income, insured Americans, personal conversations along with the news media still remain the most commonly reported sources of information among these groups.

FIGURE 2: ACROSS A VARIETY OF SOURCES, LOWER INCOME, UNINSURED LESS LIKELY TO HAVE GOTTEN ACA INFO
Percent who say they have gotten any information about the health care law from each of the following in the past 30 days		BY ANNUAL HOUSEHOLD INCOME			BY INSURANCE STATUS
	Total	Less than $40,000	$40,000-$89,999	$90,000 and higher	Insured (under 65)	Uninsured (under 65)
Conversations with friends and family	40%	34%	47%*	52%*	46%+	32%
Newspapers, radio, online	36	30	40*	48*	39+	28
Cable TV	30	25	31	39*	32+	21
National broadcast	24	20	25	31*	27+	14
Local TV	19	19	19	21	20	15
Health insurance company	11	9	12	11	11+	6
Employer	11	8	12	16*	14+	7
Doctor	11	8	11	15*	12+	7
Federal agencies	9	10	9	9	10	7
State agencies	8	10	5	8	9	5
Non-profit or community organization	8	6	8	11*	9	5
*indicates statistically significant difference from lower income +indicates statistically significant difference from the uninsured NOTE: Question wording abbreviated. For full question wording see topline (http://www.kff.org/kaiserpolls/8439.cfm).

Asked whether they had heard mostly good things, mostly bad things or a mix of the two from their primary information source, most Americans said they had gleaned a bit of both. To the extent that the information did tilt one way or the other, more said they had heard negative things about the law than positive, whether their main source of information was cable news, other news sources, or their friends and family.What about people who don’t approve of the Affordable Care Act: are they getting their information about the law from the same sources as the law’s supporters? This month’s survey finds those with unfavorable views of the law for the most part are getting their information from the same sources in the same shares as those with favorable views, though they are somewhat more likely to report getting information from friends and family (50 percent compared to 40 percent) and from cable news (37 percent compared to 29 percent). They are also nearly three times as likely to report getting information from an employer: 17 percent of ACA opponents say they have gotten ACA information from an employer, compared to 6 percent of supporters.

FIGURE 3: MAJORITY REPORT HEARING A MIX OF GOOD AND BAD ABOUT THE HEALTH CARE LAW
Thinking about the information you’ve gotten about the law from your most important source, would you say you’ve heard mostly good things about the law, mostly bad things, or a mix of the two?	Among those whose most important source on the ACA is conversations with friends and family	Among those whose most important source on the ACA is newspapers, radio, or other online sources	Among those whose most important source on the ACA is cable TV news channels, or their websites
Bad things	30%	26%	26%
Good things	9	6	7
Mix of the two	61	65	65

Early Days For ACA Ad Penetration

At this early stage, before the launch of most public campaigns, about one in four Americans already say they’ve seen or heard an ad having to do with the health care law, though more of these are being perceived as having a point of view on the law than are seen to be strictly informational in nature. Among those who said they had seen an ad, slightly more reported seeing a negative ad (19 percent of the public overall) than a positive one (12 percent of the public). About one in ten Americans report seeing an ad that provided information about how to get coverage under the health care law.

Those who reported relying mainly on cable news as their main source of ACA information were twice as likely as the public in general to report having seen an ad about the law. Those in groups targeted by the law, including the uninsured and those in low income households, were no more likely to report having seen an ad about the ACA.

Four In Ten Unaware ACA Is Still Law

Meanwhile, the April tracking survey provides continuing confirmation of the amount of confusion still surrounding the status of the Affordable Care Act, with four in ten Americans unaware that the ACA is still the law of the land and is being implemented.² This share is higher among certain populations the law was specifically designed to help; for example, six in ten of those in households making less than $30,000 a year are unable to say the law is still in force, as are half of younger Americans.

FIGURE 4: FOUR IN TEN UNAWARE ACA STILL LAW AND BEING IMPLEMENTED
As you may know, a health care bill was signed into law in March 2010. As far as you know, which comes closest to describing the current status of the health care law?	All	Ages 18-29	Annual household income less than $30,000
It is still the law of the law and is being implemented (aware of ACA status)	59%	49%	42%
Unaware of ACA status (NET)	42	51	59
It has been overturned by the Supreme Court and is no longer law	7	8	14
It has been repealed by Congress and is no longer law	12	21	16
Don’t know/Refused	23	22	29
Note: Percentages may not add to 100% due to rounding.

Not surprisingly, then, about half the public (49 percent) says they do not have enough information about the health reform law to understand how it will impact their own family, a proportion which rises to 56 percent among those non-elderly living in low-income households, and 58 percent among the uninsured. Also notable: Hispanics are more likely than whites or blacks to report they do not yet have enough information about the law to understand how the ACA will affect their families (65 percent of Hispanics say so, compared to 48 percent of blacks and 45 percent of whites).

More Favor Making Changes To Law Than Defunding It

Overall, the public remains as divided as ever when it comes to their overall evaluations of the health law. This month, 35 percent report a favorable view, 40 percent an unfavorable view, and a full 24 percent report they have no opinion on the law, continuing a recent trend of particularly high shares not offering an opinion. Partisans remain quite divided, with a majority of Democrats in favor (57 percent) and most Republicans opposed (67 percent).

In terms of the law’s political future, just over half of Americans (53 percent) continue to say that they approve of efforts by opponents to change or stop the law “so it has less impact on taxpayers, employers, and health care providers”, a view which theoretically encompasses a range of positions from hard-core repeal supporters to those who believe the law only needs minor tweaks. One in three (including more than half of Democrats) believe that the law’s opponents should accept that it is the law of the land and stop trying to block its implementation, down somewhat from January (33 percent now compared to 40 percent at the start of the year).

Still, a majority of Americans continue to oppose the idea of stopping the law by defunding it in Congress. Overall, 58 percent say they disapprove of cutting off funding as a way to stop some or all of the law from being put into place, 31 percent approve. While Republicans are significantly more likely than Democrats or independents to give their blessings to this tactic (51 percent do), 37 percent disapprove of defunding the law.

State Medicaid Expansion

With state by state deliberations on the future of the ACA’s Medicaid expansion ongoing, a somewhat larger share of Americans favor having their state expand Medicaid than favor keeping their state’s program as it is today (50 percent versus 41 percent). These percentages have been roughly stable since last summer, and even providing both sides with a counterargument currently does little to change people’s minds, as the chart in Figure 7 shows.

Americans, like their leaders, are divided on this issue by their partisan affiliation: seven in ten Democrats would like to see their state expand its Medicaid program under the ACA, while roughly the same share of Republicans would like to keep their state’s program as is, and independents are divided. Another way to look at it: among those who like the law, most (75 percent) want to expand their state’s Medicaid program. Among those who don’t like the law, most (67 percent) want to keep Medicaid’s status quo in their state.

FIGURE 8: VIEWS ON STATE MEDICAID EXPANSION DIFFER SHARPLY BY PARTISAN IDENTIFICATION
Do you think your state should keep Medicaid as it is today or expand Medicaid to cover more low-income uninsured people?		BY PARTY ID
	Total	Democrats	Independents	Republicans
Keep Medicaid as is	41%	21%	42%	68%
Expand Medicaid	50	72	47	21
Other/Neither (VOL.)/Don’t know/Refused	9	7	10	11

As experts try to keep up with the complicated decision-making going on in some states over the future of their Medicaid program, three in four Americans say they don’t know enough to say what their state’s leadership has decided on the issue.