Many US Citizens Do Not Feel Impacted by ACA Heading into Midterm Elections

Four years after the Patient Protection and Affordable Care Act (ACA) was passed and just months into the first year of healthcare exchanges, 6 in 10 Americans (60%) said they feel no direct personal impact of the law, according to a survey from the Kaiser Family Foundation. The report also found that among the individuals who said they have felt an impact, 24% reported that the law has hurt them rather than the 14% who said it has helped.

Individual response on impact of the law varies across political party lines, with Republicans more likely to say the law has hurt them, while Democrats more likely said the law has helped (See Figure below). When asked to elaborate on how the law has hurt or helped, the respondents who said the law hurt them reported an increase in their healthcare costs (14% of general public), the law has made it more difficult for them to access care (3%), or the law has caused someone in their family to lose insurance (2%). Of the individuals reporting that the law has helped, they said the law has allowed someone in their family to get or keep coverage (5% of general public), the law has made it easier for them to get the care they need (4%), or the law has lowered their healthcare costs (3%).

According to the report, favorability of the law has been relatively stable since March, with 45% of the public reporting an unfavorable view of the ACA and 38% reporting a favorable view. Two-thirds (64%) of Democrats have a favorable opinion of the ACA, while 75% of Republicans view the law unfavorably.

When asked about accessibility of coverage under the ACA, 31% of the respondents said they knew someone personally who was able to gain health insurance because of the law, while 23% of the participants said they knew someone who lost their health insurance due to the ACA.

A majority of the survey respondents (59%) said they would rather have Congress work to improve the ACA versus the 34% of respondents who would prefer Congress work to repeal the law and replace it with something else. Most of the survey participants (61%) do not think that the Republicans in Congress have an agreed-upon alternative to the ACA. Even among the respondents who favor the repeal and replace option for the law, just 20% believe Republicans have settled on a new alternative.

The survey respondents were asked ways in which they would like to see the law improved, receiving the following top answers:

            • Make healthcare/insurance more affordable (20%)

            • More help for specific groups—ie, seniors, the poor, etc (11%)

            • Expand access/availability (11%)

            • Cover more/specific services (5%)

            • Eliminate individual mandate/fines/penalties (3%)

            • Better communication/public information/simplicity (3%)

            • Improve equity/fairness (3%)

            • Change to a single-payer/universal healthcare system (3%)

Another 24% said they were unsure or did not answer the question.

With the midterm elections just months away, the ACA is a hot political topic going into the election. Fifty-one percent of the survey participants said they are tired of hearing candidates for Congress talk about healthcare and would rather see them focus on issues like jobs. Another 43% of the respondents want the debate surrounding the ACA to continue. There was a divide over the focus going into the midterm elections across the political parties—69% of Democrats want to hear candidates talk about something else, while just 35% of Republicans feel the same way.

Healthcare was regarded as the second most important issue going into the midterm elections. Thirty-four percent of the survey respondents said the economy and jobs was their top concern, 25% said healthcare, 8% said education, 8% said energy and environmental issues, 8% said the federal budget deficit, and 7% said immigration, among some of the top answers. These responses were relatively similar across political parties.

The report noted a limitation of these results, acknowledging that the midterms were still 6 months away at the time this survey took place, so many individuals are not yet paying close attention to the election campaigns.

This survey was conducted between May 13, 2014, and May 19, 2014, among a nationally representative random digit dial telephone sample of 1505 adults ≥18 years of age living in the United States. Alaska and Hawaii were included in the analysis. A total of 750 interviews were conducted via landline and 755 were conducted via mobile phone.