KFF Health Tracking Poll May 2023: Health Care in the 2024 Election and in the Courts
These findings were released on May 31, 2023.
- The 2010 Affordable Care Act (ACA) experienced its most recent legal challenge earlier this year in the ongoing Braidwood Management v. Becerra case. While the case challenges all ACA requirements for private health insurance to cover preventive services, the federal district court ruled that the ACA’s requirement for no cost coverage of preventive services recommended or updated by the U.S. Preventive Services Task Force (USPSTF) after March 2010 is unconstitutional and on a separate basis, the requirement to cover PrEP medications for HIV prevention violated the plaintiffs’ religious rights. The latest KFF Health Tracking Poll finds the public largely unaware of the ongoing case, but after hearing about the case – substantial shares say it could lead to increased cost for preventive care for them and their families and a large majority say that if PrEP is no longer required to be covered by insurance, it will be more difficult to reduce HIV infections.
- Views of the ACA remain partisan with large shares of Democrats and independents holding positive views of the law while many Republicans view the law unfavorably. Yet, a majority of all partisans including most Democrats (92%), independents (87%), and Republicans (72%) say they have a favorable view of the part of the law that eliminates out-of-pocket costs for many preventive services. While many haven’t heard much about the ongoing lawsuit, about one-third of adults think they will have to pay more as a result of it. About half of adults say they aren’t sure if they will have to pay more for their health care because of this ruling.
- Eight in ten adults (82%) say that if PrEP is no longer required to be covered by insurance, it will make it more difficult to reduce the number of new HIV infections in the U.S., while 18% say it won’t have an impact on infections. The share who say PrEP no longer being covered will make it more difficult to reduce new HIV infections includes a majority across groups, including partisanship, those who are lesbian, gay, bisexual, or transgender, and whether they either know someone who has or personally has HIV. In addition, almost two-thirds of adults (63%) are not sure if people in the U.S. who need medication to prevent getting HIV are able to get it.
- While few adults overall are aware of PrEP, many still view HIV/AIDS as a serious issue. KFF has been conducting polling on the HIV/AIDS epidemic in this country for nearly three decades, and the latest poll finds that still three-quarters of adults (76%) say that HIV/AIDS is a serious issue for the U.S. today, with three in ten (29%) who say it is “very serious” and almost half (47%) who say it is “somewhat serious.” This includes large shares of Black adults, Hispanic adults, and Democrats who say HIV/AIDS is a “very serious” problem in the U.S. today.
The Legal Battle Around ACA’s Preventive Care Protections and PrEP
A U.S. district judge recently ruled the Affordable Care Act’s requirement for private insurers to cover the full cost of certain preventive services recommend by the U.S. Preventive Services Task Force (USPSTF) is unconstitutional and should not be in effect. The ruling does not apply to services that were recommended by USPSTF prior to when the ACA was signed into law in March 2010, Women’s Preventive Services recommended by Health Resources and Services Administration (HRSA), or vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). On May 15th, 2023, the 5th Circuit Court of Appeals issued a stay of the ruling which means that as of now, the entire preventive services requirement is still in effect. This survey was fielded while this legal debate was taking place and asked respondents about awareness and implications of the first ruling from the district court.
A KFF analysis of claims data found that in a typical year about 6 in 10 people with private insurance, or about 100 million people, receive at least one preventive service or medication under the Affordable Care Act. As the district court ruling applies to a narrower subset of these preventive services, about 1 in 20 people with private insurance, or about 10 million people, receive at least one of the preventive services or medications potentially affected by the district court’s remedy in the Braidwood case.
While this case could have implications for some, few have heard much about the ruling, with a quarter of adults who say they’ve heard “a lot” or “some” about this ruling. Almost four in ten (37%) say they have heard “not too much,” and a similar share (38%) have heard “nothing at all.”
With few knowing about this ongoing case, about half of U.S. adults (49%) are “not sure” if they personally will have to pay more for health care because of the ruling. Around a third (32%) think they will have to pay more because of the ruling, and one in five (19%) do not think the ruling will mean they have to pay more for health care.
Larger shares of women (53%), a group more likely to need access to preventive services, say they aren’t sure if they’ll have to pay more for their health care because of the ruling than men (45%). Similarly, 55% of young adults, ages 18-29, aren’t sure if they’ll need to pay more.
This case is the latest legal battle over the 2010 health reform law known as the Affordable Care Act (ACA) or Obamacare. Overall, around six in ten (59%) adults have a favorable opinion of the ACA, including large majorities of Democrats (89%) and independents (62%). Republicans continue to view the law unfavorably, with 42% saying they have a “very unfavorable” opinion of the ACA. Click here to see more than ten years of polling on the ACA.
The ACA’s requirement for no cost coverage of preventive services has long been one of the most popular aspects of the law. The latest KFF Health Tracking Poll finds eight in ten (82%) adults have a favorable opinion of the part of the ACA that made many preventive services free to people with health insurance, including half (52%) who have a “very favorable” view. The share who view this part of the law favorably is substantially higher than the share who hold favorable views generally about the ACA in general.
More than twice as many Democrats as Republicans say they feel “very favorable” towards this part of the law (75% Democrats vs. 29% Republicans), though a majority of Republicans (72%) have at least a “somewhat favorable” opinion of the no cost preventive service coverage from the ACA.
HIV Prevention and Access to PrEP
Another aspect of the ongoing Braidwood Management v. Becerra case focuses on PrEP, a medication to prevent people from getting HIV. PrEP was among the medications covered by the preventive services provision of the ACA, requiring private insurance companies to cover it with no cost-sharing, but the district court judge also ruled that the federal government cannot require the plaintiffs who have religious objections, to offer insurance with coverage for PrEP.
Very few adults have heard about PrEP, the medication to protect people from getting HIV, with half of adults saying they have heard “nothing at all” about the medication, and 15% saying they have heard “a lot” or “some” about it. Awareness of PrEP increases to 25% among adults ages 18-29, 21% among Black adults, 32% among those who have HIV or know someone who does, and 42% of LGBT adults.
Once made aware of the medication, eight in ten adults (82%) say that if PrEP is no longer required to be covered by insurance, it will make it more difficult to reduce the number of new HIV infections in the U.S., while 18% say it won’t have an impact on infections.
Majorities across demographic groups say that if PrEP is no longer required to be covered by insurance, it will make it more difficult to reduce the number of new HIV infections. This includes nine in ten people who have HIV or know someone who does (93%), Democrats (91%), and LGBT adults (87%). At least three in four Republicans (73%), those who don’t know anyone with HIV (80%), or non-LGBT adults (81%) agree that this ruling will make it more difficult to reduce the number of new HIV infections in the U.S.
Similar shares across racial and ethnic groups say that if PrEP is no longer required to be covered, it will make it more difficult to reduce the number of new HIV infections.
Overall Awareness of PrEP and Views of HIV Epidemic
While few adults overall are aware of PrEP, many still view HIV/AIDS as a serious issue. Three-quarters of adults (76%) say that HIV/AIDS is a serious issue for the U.S. today, with three in ten (29%) who say it is “very serious” and almost half (47%) who say it is “somewhat serious.” Fewer say that HIV/AIDS is a “very serious” issue (29%) in the U.S. today than said the same in March 2019 (34%).
Larger shares of Black adults (51%) say HIV/AIDS is a “very serious” problem in the U.S. today, as do Hispanic adults (39%), and Democrats (31%). This also includes 39% of adults who say they either have HIV/AIDS or know someone who does and 47% of LGBT adults.
Conversely, smaller shares of White adults (23%) and Republicans (22%) say HIV/AIDS is a “very serious” problem today, although still large majorities think it is at least somewhat serious.
Those who see HIV/AIDS as a “very serious” problem are also more likely to say they are worried about getting HIV. At least a third of Black adults (34%) and Hispanic adults (37%) say they are at least somewhat concerned about getting HIV, as do a quarter (24%) of LGBT adults. Overall, most adults are not worried about getting HIV, with around one in six who say they’re “very” or “somewhat” concerned.
ACCESS To HIV Medications
Almost two-thirds of adults (63%) are not sure if people in the U.S. who need medication to prevent getting HIV are able to get it. Around a quarter (27%) say the people who need HIV medication can get it, while one in ten say people are not able to get the medication they need.
Majorities across demographic groups say they’re not sure if those who need HIV medication in the U.S. are able to get it, including 67% of independents, 61% of Democrats, and 60% of Republicans.
Around half of LGBT adults (53%) and those who either have HIV or know someone who does (49%) are unsure of whether people with HIV can get medication, with 22% of LGBT adults and 37% of those who have HIV or know someone who does reporting that people with HIV are able to get medication for it.
Majorities across racial and ethnic groups aren’t sure whether people are able to get medication to prevent getting HIV, with 65% of White adults who say so, 63% of Black adults, and 60% of Hispanic adults.