Kaiser Health Tracking Poll - May 2017: The AHCA's Proposed Changes to Health Care

KEY FINDINGS:

• With Congress currently discussing the American Health Care Act (AHCA), a plan that would repeal and replace the 2010 health care law, this month’s Kaiser Health Tracking Poll finds that more Americans have an unfavorable view of the plan than a favorable one (55 percent vs. 31 percent, respectively). The share with favorable views of the AHCA is about 20 percentage points lower than the share with favorable views (49 percent) of the 2010 Affordable Care Act (ACA). The majority of Republicans (67 percent) have a favorable view of the AHCA.
• This month’s survey finds the public has increasingly negative views of how their health care will be affected by proposed changes. In December 2016, after the presidential election but before the release of the Republican plan, less than one-third of the public thought their health care would get worse if the 2010 health care law was repealed. This month’s survey, fielded after House Republicans passed the AHCA, finds larger shares say the cost of health care for them and their family (45 percent), their ability to get and keep health insurance (34 percent), and the quality of their own health care will get worse if Congress passes the AHCA (34 percent).
• About one in ten (8 percent) think the Senate should pass the AHCA as is, without making any changes to the plan passed by the House. Similar shares – about one-fourth of the public – think the Senate should make either major changes to the legislation (26 percent) or minor changes to it (24 percent), while about three in ten (29 percent) say they do not think the Senate should pass this bill.

The American Health Care Act

On May 4, 2017, the U.S. House of Representatives passed the American Health Care Act (AHCA), the House Republicans’ plan to repeal and replace the Affordable Care Act (ACA).¹ With the Senate currently debating the plan and discussing their own approach, the most recent Kaiser Health Tracking Poll finds more Americans have an unfavorable view of the AHCA than a favorable one (55 percent vs. 31 percent, respectively). There is also a considerable enthusiasm gap with a larger share saying that they have a “very unfavorable” view (40 percent) than saying they have a “very favorable” view (12 percent).

Majority of Republicans Hold A Favorable View of the AHCA

The AHCA has solid support among the Republican base. Two-thirds of Republicans say they have a favorable view of the plan including three in ten (29 percent) who say they have a “very favorable” view.

Few See AHCA As Fulfilling President Trump’s Promises About Health Care

Three-fourths (76 percent) of the public thinks the health care plan recently passed by the House does not fulfill most of the promises President Trump has made about health care while 14 percent say it fulfills most or all of his promises.

This viewpoint is shared regardless of party identification with majorities of Democrats (86 percent), independents (79 percent), and Republicans (59 percent) saying the AHCA fulfills some or none of the promises President Trump has made about health care.

Table 1: Majorities of Democrats, Independents, and Republicans Do Not Think the AHCA Fulfills Most of President Trump’s Health Care Promises
Do you think that the health care plan that recently passed the House fulfills all, most, some, or none of the promises President Trump has made about health care?	Total	Democrats	Independents	Republicans
All/Most (NET)	14%	8%	11%	30%
All	4	3	4	6
Most	10	4	7	24
Some/None (NET)	76	86	79	59
Some	40	27	46	51
None	35	59	33	8
Don’t know/Refused	11	7	10	12

More Americans View The ACA Favorably Than The AHCA

The Kaiser Family Foundation has been tracking public opinion on the ACA since its passage in 2010. This month’s survey continues to find the public leans more favorable than unfavorable in their views of the 2010 health care law, with 49 percent expressing a favorable view of the ACA compared to 42 perecent expressing an unfavorable view.

In fact, more of the public is favorable in their overall views of the ACA than in their views of the Republican plan to replace the 2010 health care law. About half of Americans have a favorable view of the ACA compared to about three in ten who have a favorable view of the new Republican plan.

Partisanship is the main driver behind support for either the ACA or the AHCA, with a majority of Republicans viewing the AHCA favorably (67 percent), while a majority of Democrats view the ACA favorably (78 percent). More independents view the ACA favorably (48 percent) than view the AHCA favorably (30 percent).

Despite the lack of support for the House Republican plan, a majority of the public (74 percent) say they think it is either “very likely” (37 percent) or “somewhat likely” (36 percent) that the president and Congress will repeal and replace the ACA. About one-fourth of the public say it is either “not too likely” (15 percent) or “not likely at all” (9 percent).

Most Americans Want Changes to the AHCA Before Senate Passes the Bill

About one in ten (8 percent) think the Senate should pass the AHCA as is, without making any changes to the plan passed by the House. Similar shares – about one-fourth of the public – think the Senate should make either major changes to the legislation (26 percent) or minor changes to it (24 percent), while about three in ten say they do not think the Senate should pass this bill.

Attitudes toward what the Senate should do when it comes to the AHCA are largely driven by partisanship with most Republicans (60 percent) saying they think it should pass as is (15 percent) or with minor changes (45 percent) while half of Democrats (51 percent) say the Senate should not pass this bill. Independents are more divided but one-third (34 percent) say the Senate should make major changes to the bill.

Table 2: Most Republicans Want the Senate to Pass Bill As Is or Make Minor Changes to It, While Democrats Do Not Want the Senate to Pass It
A health care plan, known as the American Health Care Act, recently passed the U.S. House of Representatives and is now being debated by the Senate. Do you think the Senate should pass this bill as is, make minor changes to it, make major changes to it, or not pass this bill?	Total	Democrats	Independents	Republicans
Pass this bill as is	8%	6%	5%	15%
Make minor changes to it	24	15	22	45
Make major changes to it	26	22	34	17
Not pass this bill	29	51	25	5
Don’t know/Refused	13	7	14	17

Attitudes Towards AHCA Provisions

The AHCA – like other health care plans – includes complex policies that the public may not fully understand or pay attention to. In an effort to examine general attitudes towards several of the more well-known provisions, we ask respondents whether after hearing about the specific provision they are “more likely” or “less likely” to support the plan. Much like overall attitudes towards the AHCA, various provisions of the law asked about in this survey do not garner large levels of support from the public. When asked whether individual elements of the Republican replacement plan would make them “more likely” or “less likely” to support the plan, none of the elements receive a majority of the public saying it would make them “more likely” to support it.  The only provision that has a larger share of the public saying it makes them “more likely” than say it makes them “less likely” to support the law is allowing states to implement a Medicaid work requirement (42 percent compared to 28 percent).

There are several provisions currently included in the plan that a majority of the public say makes them “less likely” to support the legislation. These include allowing states to decide if health insurance companies can charge sick people more than healthy people if they haven’t had continuous coverage (65 percent), eliminating the individual mandate and instead allowing insurance companies to charge people 30% higher premiums for a year if they haven’t had continuous coverage (62 percent), allowing states to eliminate the essential health benefit requirement (60 percent), and making changes that would generally decrease what younger people pay for insurance and increase what older people pay (58 percent).

Table 3: Individual Elements of AHCA Affect Likelihood of Support for Plan
I’m going to read you several specific elements included in the health care plan that passed the House. Please tell me if each makes you more or less likely to support the plan, or does not make much difference.	More likely to support	Less likely to support	Does not make much difference
Allows states to require adults without disabilities to be working or looking for work in order to get health insurance through Medicaid	42%	28%	27%
Provides federal funding for states to cover people with pre-existing conditions through separate high-risk pools	36	32	31
Cuts federal funding that was included in the 2010 health care law for states that expanded Medicaid to cover more lower-income people	23	43	34
Changes Medicaid so that instead of matching state spending, the federal government reduces what it pays states and gives states more flexibility to decide who and what services to cover	23	42	32
Stops federal payments to Planned Parenthood clinics for health care services provided to people on Medicaid for one year	22	48	30
Allows states to let health insurance companies cut back on the benefits they cover so they could sell cheaper plans that do not cover benefits like hospitalization, prescription drugs, maternity care, and mental health services	20	60	20
Eliminates the taxes and tax increases on higher-income people imposed by the Affordable Care Act	18	49	30
Decreases the financial help available to lower-income people who buy their own insurance and increases the financial help available to middle- and upper-income people	15	51	32
Makes changes that would generally decrease what younger people pay for insurance and increase what older people pay	14	58	28
Allows states to decide if health insurance companies can charge sick people more than healthy people if they haven’t had continuous coverage	12	65	22
Eliminates the requirement for nearly all Americans to have health insurance but allows insurance companies to charge people 30% higher premiums for a year if they haven’t had continuous coverage	12	62	24
NOTE: Items asked of half samples. Don’t know/Refused responses not shown.

Republican Support for Some Aspects of the AHCA

There is some support for aspects of the AHCA among Republicans. For example, a majority of Republicans say that the Medicaid work requirement (75 percent) and federal funding for states to set up high-risk pools (59 percent) makes them more likely to support the plan. In addition, about four in ten Republicans say the same about the provisions which stop federal Medicaid payments to Planned Parenthood (45 percent), change Medicaid funding to a per capita cap or block grant system (45 percent), allow states to change the essential health benefits (42 percent), and end the funding for Medicaid expansion (40 percent).

Perceived Effects of the AHCA

Overall, about half of Americans say the quality of their own health care (48 percent) and their own ability to get and keep health insurance (47 percent) will stay about the same if the president and Congress pass the health care plan currently being discussed. When it comes to the cost of health care for them and their family, almost half say it will get worse (45 percent) while about one-third say it will stay about the same (36 percent) and 16 percent say it will get better.

Immediately following the 2016 presidential election and prior to the release of the Republican plan, most Americans thought that their health care would stay about the same if the 2010 health care law was repealed. Yet, in this month’s survey which was fielded after House Republicans passed the AHCA, larger shares say the cost of health care for them and their family, their ability to get and keep health insurance, and the quality of their own health care will get worse if Congress passes the AHCA.