News Release

Poll: The ACA’s Pre-Existing Condition Protections Remain Popular with the Public, including Republicans, As Legal Challenge Looms This Week

As Health Care Costs Remain on Top of Voters’ Minds, Americans Cite Unexpected Medical Bills as Their Top Problem, Ahead of Premiums, Deductibles and Drugs

Public Not Confident in President Trump’s Calls on Drug Companies to Lower Prices

As a federal court considers a challenge to the Affordable Care Act’s constitutionality, the public, including most Republicans, wants protections for people with pre-existing conditions preserved, the latest Kaiser Family Foundation tracking poll finds.

Large majorities of Americans say it is “very important” to retain the ACA provisions that prevent insurance companies from denying coverage based on a person’s medical history (75%) and from charging sick people more (72%). This includes majorities of Democrats, independents and Republicans, as well as majorities of those with and without people with pre-existing conditions in their households.

The ACA’s pre-existing condition protections have emerged as a hot topic in some key Congressional races in part because of a pending legal challenge filed by 20 state attorneys general. The Trump Administration has opted not to defend the law’s pre-existing condition protections in the case, and a federal district court in Fort Worth, Texas is scheduled to hear arguments on the challenge today. Republican Senators also introduced a bill to address the issue if the ACA were overturned, though some analysts say its protections fall short.

Four in 10 Americans (41%) say they are “very worried” that they or a family member will lose coverage if the Supreme Court overturns the ACA’s pre-existing condition protections. In addition, half (52%) are “very worried” they or a family member will have to pay more for coverage.

Americans Cite Unexpected Medical Bills as Their Top Health Cost Concern

The public overall also sees health costs as a major problem – with six in 10 (58%) saying they are “very concerned” about increases in what people pay for health care. 

When given a list of possible worries, unexpected medical bills tops the list that includes other health care costs such as premiums, deductibles and even drug costs. Two-thirds (67%) say they are at least “somewhat” worried about affording an unexpected medical bill – more than say the same about their deductibles (53%), drug costs (44%) or premiums (42%). 

Unexpected medical bills also ranked higher than other pocketbook concerns such as gasoline or transportation costs (46%), monthly utility bills (43%) and rent or mortgage (41%).

Overall, 39 percent of insured adults ages 18-64 say that in the past year they have received an unexpected medical bill – either from a doctor, hospital, or lab that they thought was covered and their health plan either didn’t cover the bill at all or covered less than they expected. For 10 percent of insured adults ages 18-64, the surprise bill was related to care received from an out-of-network provider.

Half (50%) of those who had an unexpected medical bill say the amount they were expected to pay was less than $500 overall. Smaller shares say the amount was between $500 and $999 (16%), between $1,000 and $1,999 (12%); or $2,000 or more (13%).

Partisans Split on Effectiveness of Trump Administration’s Efforts to Lower Drug Prices

President Trump recently has publicly criticized several drug companies and called on them to lower the cost of their prescription drugs. A majority (55%) of the public say that this strategy of publicly calling on drug companies to lower their costs will not be too effective or at all effective. Fewer (42%) say it will be very or somewhat effective.

There are large partisan differences. Three-fourths of Democrats (74%) say this strategy will not be effective, while two-thirds of Republicans (67%) say it will be effective. More independents say it will not be effective than will be effective (57% v. 41%).

In addition, 38 percent of Americans say they are either “very” or “somewhat” confident that President Trump and his administration will be able to deliver on his promise that Americans will pay less for prescription drugs than they pay now. This number remains virtually unchanged since March 2018, before the administration released its “American Patients First” plan aimed at lowering drug prices.

The public debate over drug prices appears to having an impact on the public’s views of drug companies. When asked about the reasons behind rising health care costs, an increasing share of the public blames prescription drug companies. Eight in ten (78%) say drug companies making too much money is a “major reason” why people’s health care costs have been rising, up from 62 percent in 2014.

Other top causes in the public’s mind include fraud and waste in the health care system (71%), hospitals charging too much (71%), and insurance companies making too much money (70%). About six in 10 (62%) say a major reason for rising costs is due to the expense of new drugs, treatments, and medical technologies.

Fewer, but still about half, say doctors charging too much (49%), an aging population (47%), and medical malpractice lawsuits (45%) are “major reasons” for rising costs. Less than half blame people getting more services than they really need (41%), the Affordable Care Act (39%), the Trump administration’s recent actions on health care (38%), or people not shopping for lower-priced services (28%).

Across Parties, Costs Top Voters’ Health Care Concerns Heading into the Midterm Elections

The poll finds corruption in Washington, health care and the economy and jobs are what voters want to hear candidates discuss on the campaign trail ahead of November’s midterm election. Fielded after of the indictment of Michael Cohen and initial trial of Paul Manafort, this is the first time the KFF poll included corruption in Washington, D.C. in the list of possible campaign topics, and the issue jumped to the top of the list.

Three in 10 of voters (30%) say Washington corruption is the “most important” topic for candidates to discuss, with health care (27%) and the economy and jobs (25%) close by. In June, when Washington corruption wasn’t offered as an option, health care and the economy topped the list of topics voters want to hear candidates discuss.

Battleground voters – those living in states and districts that the Cook Political Report rates as having the most competitive House, Senate and gubernatorial races – rank campaign topics similarly, with corruption (32%), the economy and jobs (27%) and health care (26%) topping their list of “most important” topics.

When voters are asked what health care issue they most want to hear the candidates discuss, a quarter (27%) mention health care costs – three times the share that mention any other health care issue, such as increasing access (9%), universal coverage (8%), Medicare or senior concerns (7%), or prescription drug costs (7%). Health care costs are the top health care issue mentioned by Democratic voters (29%), independent voters (29%), and Republican voters (25%).

Half of Public Views the ACA Favorably This Month

This month marks the 90th time that KFF has asked about the public’s perception of the Affordable Care Act on a poll since April 2010. This month, half (50%) of the public holds a favorable view of the law, while 40 percent hold an unfavorable view. Similar shares of Republicans hold unfavorable views (78%) as Democrats hold favorable views (77%). Half (50%) of independents holds favorable views toward the ACA, while 39 percent hold unfavorable views.


Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from August 23-28, 2018 among a nationally representative random digit dial telephone sample of 1,201 adults. Interviews were conducted in English and Spanish by landline (301) and cell phone (900). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.


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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.