Insurance Exchanges Open, What Will Consumers Think?

The federal government shut down the same day that it was required to open health insurance exchanges in the 36 states that chose not to participate in implementing this key provision of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). The more vocal opponents of the law have argued that the American people oppose it and want it repealed. But who knows what Americans as a group actually think about the law? What do the people on each side of the debate believe the law requires? And how consistent are those beliefs with what the law actually provides? Quinnipiac University‘s most recent poll showed that 45 percent were in favor of PPACA generally, with 47 percent opposed. The Rasmussen organization regularly reports that opposition to the law continues to outweigh support. Most recently, it reported that 50 percent of those questioned were against the individual mandate and 36 percent in favor, and that support for the law had not risen since July 2013. But in the same report, Rasmussen found that opposition to the law declined by 6 points during the same period.

What’s In A Name?

The Atlantic and other outlets have reported that people who “oppose Obamacare” support the key provisions when asked about them individually—the bar to exclusion of individuals with preexisting conditions, continuing coverage of one’s children until age 26, requiring employers with 50 or more employees to provide health insurance. Jimmy Kimmel’s September 30 program featured interviews with people who supported the Affordable Care Act but not Obamacare.

Lack of Knowledge

There also is evidence that many people do not understand what PPACA does or how they would be affected. On September 30, 2013, the Commonwealth Fund released the results of a poll suggesting that the public’s knowledge about the law is sketchy. It found that 75 percent of those surveyed were aware of the individual mandate, but only 40 percent were aware of the health insurance exchanges, or marketplaces.Once they became aware of the marketplaces, 60 percent of those likely to be eligible for help said they were somewhat likely or very likely to look coverage there. Even fewer respondents knew whether their state had decided to expand Medicaid.

Gallup also found that most uninsured adults are only somewhat familiar or not at all familiar with the health insurance exchanges. The youngest group of adults, between 18 and 29, were the least likely to be familiar with the exchanges. Still, Gallup found, 65 percent of uninsured adults said they would buy insurance rather than pay a penalty.

The Influence of Politics

Perhaps it’s not surprising that people’s perceptions of the law often depend on their political views. On October 1, 2013, CNN and the ORC  released the results of a poll asking respondents whether they thought their families would be better off, worse off, or about the same when the Affordable Care Act became effective. The respondents, who were interviewed between September 27 and 29, 2013, were about evenly divided between “worse off” (40 percent) and “about the same” (41 percent); only 17 percent thought they would be better off,while 2 percent had no opinion. It  appears that that the surveyors did not interview anyone under age 50, as all cells in the columns for the age groups 18-34 and 35-49 read “N/A,” However, they did interview people old enough for Medicare, whose options will remain unchanged. Even so, 77 percent of people who identified themselves as Democrats said that their family or other families would be better off, and only 16 percent of them said the law would not  help anyone. Among Republicans,  only 32 percent thought that either their family or other families would be better off, and 59 percent said the law would not help anyone. When asked whether the law was likely to work eventually or a disaster waiting to happen, 79 percent of Democrats, and 83 percent of people who identified themselves as liberal,thought the law would work eventually; 85 percent of Republicans and 76 percent of conservatives said the law was a disaster waiting to happen, while 21 percent of conservatives (11 percent of Republicans) said it would work eventually.