Perception of PPACA flatlines

July 1, 2013

Americans generally adopt the party line on PPACA assessment even three years later

AS MORE ELEMENTS of the Patient Protection and Affordable Care Act (PPACA) are set to go into effect later this year, the Kaiser Family Foundation looked at how the general public feels about the law.

While the law has been the subject of a great deal of political rhetoric, few consumers are paying attention to exchange and Medicaid expansion decisions. Fully 48% of respondents indicated that they knew nothing at all about their state’s decision to create a state-run exchange versus a federally-run one. Roughly one in five respondents indicated that they knew at least something about the exchanges, however.

When it came to the potential Medicaid expansion, a full 78% said that did not know enough to indicate where their state stood. In states where the decision had been definitively made, the numbers were nearly as large; 80% in states expanding Medicaid and 74% in states that refused to expand. While many don’t know if their state is expanding the coverage, 52% indicated that they were in favor of the expansion. The responses fell along familiar party lines and are similar to responses from KFF’s survey in July of 2012.

PPACA continues to be controversial after its third anniversary.

Twenty-three percent of the respondents did not give their opinion on the law and 40% have an unfavorable view. When the 37% of respondents with a favorable position were asked why they had a positive view, the majority, 58%, indicated that it was because the law expanded the access to care and insurance.

Those who didn’t like the law indicated that 30% were worried about the costs, 15% did not like the individual mandate, and 13% worried about the involvement of the government in healthcare.

Even three years later, the views on PPACA fall along party lines.

Some 68% of Republicans have a negative view with 53% indicating that they had a very unfavorable view of the law. Roughly half of Democrats, 58%, had positive feelings for the law with 31% indicating that they were very favorable toward the law. Meanwhile, independents skew towards having a negative view, 45%, rather than a favorable one, 31%.

While the law as a whole remains controversial, several elements have proven to be quite popular. The provision allowing young adults to remain on their parents’ health insurance until 26 was considered favorable by 76% with 54% having a highly favorable view. Closing the “doughnut hole” in Medicare has 52% responding very favorably and 81% being favorable. Tax credits for small business had a high favorability rate at 88% and 53% being very favorable. The Medicaid expansion and insurance exchanges also have high ratings at 71% and 80%. However the highly controversial individual mandate is considered 60% unfavorable by respondents.

Despite the law going into effect 3 years ago, 57% indicated that don’t have enough information about PPACA to understand how it will affect them and this knowledge gap is even high when it comes to the uninsured, 67%, and those with a household income less than $40,000, 68%. The individual mandate is the best known element of the law with 74% indicating that it was part of the law.

Many also know that employers with more than 50 employees will have to pay a fine if they don’t offer health plans. Fewer, roughly 53%, know that the law keeps companies from denying coverage because of pre-existing conditions.

Given the controversial nature of the law, it isn’t surprising that 44% believe that the law cuts Medicare benefits, 40% believe that the law creates “death panels,” and 47% believe undocumented immigrants can receive subsidies for health coverage.

A whopping 57% believe that PPACA creates a government-run health plan.

One reason for the knowledge gaps may be because most people indicate that they haven’t any personal experience with the law. 62% indicated that they hadn’t had a negative or positive experience with PPACA and this number has held steady since December of 2010. 22% said that they’d been negatively affected by the law, citing increasing costs but decreasing benefits. Positive impacts were felt by about 17%, mostly involving young adults staying on insurance until 26 and better access to care.

-Miranda Hester