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Public opinion shifts about the ACA


A new study explores the tangible effects of the ACA and the study author weighs in on the implications for managed care.

There’s a growing appreciation of the Affordable Care Act's (ACA) effects, even as the overall approval of the law itself remains stubbornly divided, according to a new study, being released as a Web First by Health Affairs, and in the May issue of Health Affairs.

The study compared public opinion about the ACA between 2010 and 2014 and found a significant increase in appreciation for the tangible effects of the law in widening access to health insurance.

“The ACA benefits are increasingly appreciated by Americans and is contributing to stronger perceptions of its impact in widening impact,” study author Lawrence R. Jacobs, tells Managed Healthcare Executive.

To compile their study data, Jacobs and the other study author Suzanne Mettler, tracked respondents’ responses through three waves of a panel study conducted in the fall of 2010, 2012, and 2014. Fifty-five percent (660 out of 1,200 panelists) responded to all three waves.

The proportion of Americans who believed that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those who considered reform to have some or a great impact increased by 19 percentage points, according to the study.

The study also found a statistically significant softening of opposition among those who held unfavorable views in 2010. According to the authors, while the ACA’s concrete effects are increasingly recognized (even by Republicans), the toxic political environment continues to split overall evaluations of the law itself.

“The implication for MCOs is that rising enrollment is coinciding with stronger appreciation of marketplaces and Medicaid programs,” says Jacobs, a professor at the University of Minnesota.

Next: Views from the National Business Group on Health




While the majority of those surveyed (47%) held an unfavorable view of the ACA, 41% had a favorable view compared to 2014, when 45.6% held unfavorable views and 36.2% favorable toward the ACA.


“People credit the ACA with widening access, supplying subsidies, helping seniors with prescription drugs and expanding coverage of young adults,” says Managed Healthcare Executive Editor Advisor Joel Brill, MD, chief medical officer at Predictive Health LLC.

Between 2010 and 2014, 13% more Americans increasingly credited health reform with delivering tangible benefits to themselves and to their families, according to the study.

The percentage of respondents who still support repeal of the ACA remains high, but it shrank by 9 percentage points.

“The authors found no conclusive evidence that people's opinions of the ACA were affected by whether or not they lived in states that expanded eligibility for Medicaid,” Brill says.


Steve Wojcik, vice president, public policy, National Business Group on Health, believes that one shouldn't read too much into the study findings. "It is unclear what this means for healthcare executives now and in the future, particularly since many of the costs to sustain the expansion are now coming due and we continue to have high rates of growth in healthcare spending, including on the exchanges," he says.

However, he is not surprised by the findings.

"The ACA primarily focused on access and frontloaded them, including covering dependents to age 26, bringing back people who had maxed out of their plans and of course the exchanges and Medicaid expansion," he explains.  "From the perspective of survey respondents . . .what’s not to like about that, especially since many of the fees and higher taxes came later and some are still to come? Many people may not even be fully aware that they have been affected perhaps by higher fees and taxes and changes in their health coverage.

"Many of the costs to sustain the expansion were backloaded like the Medicare cuts and taxes on employer plans and others were not obvious and were hidden by design-like the provisions that made retiree coverage more expensive," Wojcik continues. "The survey report didn’t cover this. It’s focus was on how people felt about expansion. So it’s not at all surprising because I don’t think anyone opposed expanding access and trying to cover everyone, except for some who didn’t want to cover illegals. It’s not uncommon that people have a favorable view about expanding coverage or some benefit in general, but when you ask them how they feel about having to pay for it in some way, the views are likely to change. It will be interesting if they continue to survey the same people in the future, particularly if the costs grow."

Will the ACA collapse?

Not likely, according to Brill. “The law has created benefits many people have come to rely upon and has created new business models in the insurance and provider industries,” he says.

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