KFF Health Tracking Poll: Economic Hardship, Health Coverage, And The ACA

Key Findings

• After one month in office, a majority of the public (62%) approve of the way President Biden is handling the coronavirus pandemic – including nine in ten Democrats (92%).
• The pandemic’s economic effects continue to be felt as 37% of adults say they or another adult in their household have had trouble paying for basic expenses, such as food or housing, in the past three months. A majority of lower-income adults say they have experienced these financial difficulties, as do about half of Black and Hispanic compared to 31% of White adults.
• Amidst efforts by the Biden Administration and Democratic Congressional leaders to pass a COVID-19 relief bill by mid-March largely aimed at helping those who have been economically impacted by the pandemic, most of the public (73%) – including more than seven in ten across partisans – say Congress is not doing enough to help people who have lost jobs or income due to the pandemic. President Biden, on the other hand, receives slightly more positive ratings with similar shares saying he is doing the “right amount” (41%) as say he is “not doing enough” (45%). Democrats are more positive in their assessment of President Biden with two-thirds saying he is doing about the right amount, though half of independents and seven in ten Republicans say he is not doing enough.
• Most adults, including majorities of Democrats and independents and large shares of Republicans, support provisions included in the COVID-19 relief bill which would expand federal subsidies for people who purchase their own health insurance plans (69%) and which would provide additional federal funding to states that have not yet expanded their Medicaid program if those states expand Medicaid to cover more low-income adults (76%).
• The Biden administration recently sent a letter to the Supreme Court, disavowing the Trump administration’s questioning of the constitutionality of the Affordable Care Act and asked the Supreme Court to uphold the law. The latest KFF Heath Tracking poll finds about half of the public (54%) have a favorable view of the ACA while 39% have an unfavorable view of the law. Moreover, half of the public say they want the Biden Administration to build on the ACA while about one in four say they want the law repealed.

Biden Gets High Marks On Handling Of Coronavirus Pandemic

One month into the Biden presidency and amidst the ongoing COVID-19 vaccination rollout, a majority of the public (62%) approve of the way President Biden is handling the coronavirus pandemic in the U.S., while three in ten (30%) disapprove. An overwhelming majority of Democrats (92%) approve of the way President Biden is handling the pandemic, as do six in ten independents. However, among Republicans, nearly seven in ten (69%) disapprove of the way Biden is handling the coronavirus pandemic.

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The Biden administration and Democratic congressional leaders are hoping to pass a COVID-19 relief bill by mid-March which would include a number of provisions aimed at helping those who may have been financially affected by the economic impact of the coronavirus pandemic. Most of the public (73%) say Congress is “not doing enough” to help people who have lost jobs or income due to the pandemic. Just 6% of the public say Congress is doing too much to help those who have been financially impacted by the pandemic. There is partisan consensus that Congress is not doing enough to help those who lost a job or income due to the pandemic with majorities of Republicans (79%), Democrats (74%), and independents (74%) saying Congress isn’t doing enough.

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.Nonetheless, the partisan consensus on the shortcoming of aid to those financially impacted by the pandemic does not extend to the President. Two-thirds of Democrats say President Biden is doing about the right amount to help those who lost a job or income due to the pandemic, while half of independents and seven in ten Republicans say he is not doing enough.

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.More Than Four In Ten Say Their Household Have Lost A Job Or Income Due To The Pandemic

The economic impact of the coronavirus pandemic continues to be felt by many across the country with more than four in ten adults (44%) saying their household experienced a job or income loss due to the coronavirus outbreak – including a majority of young adults ages 18 to 29 (56%). Across racial and ethnic groups, about six in ten Hispanic adults (59%) and about half of Black adults (51%) say their household lost a job or income, compared to about four in ten White adults (39%) who say the same.

A COVID-19 diagnosis can often have negative economic impact as individuals need to take time off work to quarantine and recover. Indeed, six in ten (61%) of those who say someone in their household tested positive for COVID-19 say their household lost a job or income due to the coronavirus outbreak compared to 41% of those in a household where no one tested positive.

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.As Congress considers a COVID-19 relief bill which may provide a third round of checks sent directly to the public, 37% of adults say they or another adult in their household has had problems paying or affording household bills, medical bills or some basic expenses in the past three months. This includes about one in four who say they have fallen behind on their credit card or other bills (23%), and about one in six who say they have had trouble paying for food (17%) or have fallen behind on their rent or mortgage (16%). Additionally, a similar share say they have had trouble paying for health insurance coverage (16%) or their medical bills (16%). In July 2020, similar shares said they had fallen behind or had trouble paying these basic living expenses.

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.Adults with a household income under $40,000 are three times as likely as those with a household income of $90,000 or more to say they have had trouble paying for basic living expenses in the last three months (55% vs. 19%). Larger shares of Black and Hispanic adults report experiencing negative economic impacts with about half saying they have had difficulty paying for basic expenses in the last three months (compared to 31% of White adults).

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.Congressional Actions To Expand Health Insurance Coverage

A majority of the public, including at least half of Republicans, approve two provisions currently included in the COVID-19 relief bill aimed at expanding health insurance coverage for Americans. About seven in ten adults (69%), including majorities of Democrats (79%), independents (71%) and Republicans (55%) say they support expanding federal subsidies for people who purchase their own health insurance plans. About three in four adults support another provision which would provide additional federal funding to states that have not yet expanded their Medicaid program if those states expand Medicaid to cover more low-income adults. Large majorities of Democrats (93%) and independents (78%) and half of Republicans support this provision. Notably, seven in ten adults (71%) living in states that have not expanded their Medicaid program support the proposal to provide more federal funding to those states if they expand Medicaid to cover more low-income adults.

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.Most View The ACA Favorably, Half Want To Build On The Law

In November 2020, the Supreme Court heard arguments in the California v. Texas case challenging the constitutionality of the 2010 Affordable Care Act. On February 10, 2021, the Justice Department under the new Biden administration sent a letter to the Supreme Court, in which they changed the position of the federal respondents on the case, disavowing the Trump administration’s questioning of the constitutionality of the law and asked the Supreme Court to uphold the law. The latest KFF Heath Tracking poll finds about half of the public (54%) have a favorable view of the ACA while 39% have an unfavorable view of the law. While a majority of the public view the law favorably, partisans continue to differ in their views with three in four Republicans saying they view law unfavorably while eight in ten Democrats (82%) have a favorable view of the law. Independents are more likely to view the law favorably (54%) than unfavorably (40%).

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.Building on the ACA has been a focal point of President Biden’s health care agenda and recently, in his confirmation hearing, Health and Human Services secretary nominee Xavier Becerra stated that building on the ACA is his priority. Half of U.S. adults share this view and say they want the Biden administration and Congress to build on what the ACA does (49%). A smaller share want to keep the law as it is (13%) and about three in ten want to either scale back what the law does (8%) or repeal it entirely (23%). Partisans differ on these approaches, with three in four Democrats wanting the Biden administration and Congress to build on what the law does (77%), while two-thirds of Republicans want the law to be scaled back (16%) or repealed entirely (51%).

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This KFF Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted February 15-23, 2021, among a nationally representative random digit dial telephone sample of 1,874 adults ages 18 and older (including interviews from 506 Hispanic adults and 507 non-Hispanic Black adults), living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Phone numbers used for this study were randomly generated from cell phone and landline sampling frames, with an overlapping frame design, and disproportionate stratification aimed at reaching Hispanic and non-Hispanic Black respondents. Stratification was based on incidence of the race/ethnicity subgroups within each frame. Specifically, the cell phone frame was stratified as: (1) High Hispanic: Cell phone numbers associated with rate centers from counties where at least 35% of the population is Hispanic; (2) High Black: Cell phone numbers associated with remaining rate centers from counties where at least 35% of the population is non-Hispanic Black; (3) Else: numbers from all remaining rate centers. The landline frame was stratified as: (1) High Black: landline exchanges associated with Census block groups where at least 35% of the population is Black; (2) Else: all -remaining landline exchanges. The sample also included 190 respondents reached by calling back respondents that had previously completed an interview on the KFF Health Tracking poll at least nine months ago. Another 387 interviews were completed with respondents who had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and identified as Hispanic (n = 180; including 50 in Spanish) or non-Hispanic Black (n=207). Computer-assisted telephone interviews conducted by landline (339) and cell phone (1,535, including 1,143 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA. To efficiently obtain a sample of lower-income and non-White respondents, the sample also included an oversample of prepaid (pay-as-you-go) telephone numbers (25% of the cell phone sample consisted of prepaid numbers) Both the random digit dial landline and cell phone samples were provided by Marketing Systems Group (MSG). For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone. KFF paid for all costs associated with the survey.

The combined landline and cell phone sample was weighted to balance the sample demographics to match estimates for the national population using data from the Census Bureau’s 2019 U.S. American Community Survey (ACS), on sex, age, education, race, Hispanic origin, and region, within race-groups, along with data from the 2010 Census on population density. The sample was also weighted to match current patterns of telephone use using data from the January- June 2020 National Health Interview Survey. The weight takes into account the fact that respondents with both a landline and cell phone have a higher probability of selection in the combined sample and also adjusts for the household size for the landline sample, and design modifications, namely, the oversampling of prepaid cell phones and likelihood of non-response for the re-contacted sample. All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

This work was supported in part by a grant from the Chan Zuckerberg Initiative DAF, an advised fund of Silicon Valley Community Foundation. We value our funders. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.