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This month’s Kaiser Health Tracking Poll finds public opinion of the Affordable Care Act (ACA) continues to be almost evenly split, with 43 percent reporting a favorable view and 42 percent reporting an unfavorable view. The share with a favorable view exceeds the share with an unfavorable view for the first time since November 2012, albeit by one percentage point, and the difference is within the survey’s margin of sampling error and is not statistically significant.  When asked about health care priorities for the President and Congress, the change that comes out on top for Democrats, Republicans and independents alike is making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them, with three-quarters of the public (76 percent) saying this should be a top priority.  Sixty percent say that government action to lower prescription drug prices should be a top priority and majorities say things like provider network protections and increased transparency related to the prices and quality of health care should be top priorities. Other than high-cost prescription drugs, Democrats, Republicans and independents have different ideas of their top priorities in health care. In terms of the availability of price and quality information, fewer than 1 in 5 say they have seen any information comparing the quality or prices for hospitals, doctors, or health insurers in the past 12 months, and fewer than 1 in 10 report using these types of information.

The Public’s Views Of The ACA

Closely Divided On The Health Care Law

This month’s Kaiser Health Tracking Poll finds American’s opinion of the health care law closely divided, 43 percent say they have a favorable view of the law and 42 percent say they have an unfavorable view. Last month, opinion narrowed to the closest margin in over two years (41 percent favorable and 43 percent unfavorable), and now appears to be holding steady. This month, the share with a favorable view exceeds the share with an unfavorable view for the first time since November 2012, albeit by one percentage point, and the difference is within the survey’s margin of sampling error and is not statistically significant.

Figure 1

Figure 1

The public continues to view the law through a partisan lens, a dynamic that has persisted since the passage of the law in 2010. Most Democrats (70 percent) express a favorable view of the law, while most Republicans (75 percent) express an unfavorable view, and independents fall in between (42 percent favorable, 46 percent unfavorable).

Figure 2

Figure 2

The ACA’s Price Tag

Before the health care law went into effect, the independent Congressional Budget Office (CBO) projected how much it would cost the government to implement. In March, the CBO revised their original estimate and now expects the federal government will spend significantly less on the health care law than had been projected.1 This news went largely unnoticed by the public. Only 8 percent correctly answered that the law is now costing the government less than originally estimated, while half think that it is now costing more, 2 in 10 (18 percent) believe it is costing about the same as originally estimated, and a nearly quarter (23 percent) say that they don’t know.

Those with an unfavorable view of the health care law are more likely than those with a favorable view to say it is costing the government more than expected (71 percent versus 35 percent). Similar variation in opinion exists along party lines, with Republicans more likely to say the law is costing the government more than expected and Democrats more likely to say the law is costing the government less or about the same as expected.

Figure 3

Figure 3

Personal Impact Of The ACA

More than a year after the implementation of the health care law, a majority of Americans (56 percent) report that the law has had no direct impact on their families. Of those who do report being impacted, similar shares say the law has helped them (19 percent) as say it has hurt them (22 percent). Until last month, the Kaiser Health Tracking Poll consistently found that more of the public felt hurt by the law than helped.

Again, political party identification factors into the public’s perception of the law’s personal impact. Republicans are more likely to say the law has hurt them rather than helped them (38 percent vs. 5 percent), and Democrats are more likely to say the law has helped them rather than hurt them (32 percent vs. 8 percent).  Roughly 2 in 10 independents (18 percent) say the law has helped them and a quarter (25 percent) say it has hurt them.

Figure 4

Figure 4

What Should Congress Do Next About The ACA?

The public continues to be divided about what they would like to see Congress do next with the law. Just under half want Congress to either expand what the law does (24 percent) or continue implementing it as is (22 percent), while about 4 in 10 want to see Congress either scale back the law (12 percent) or repeal it entirely (29 percent). These shares have remained constant for nearly six months.

Figure 5

Figure 5

Health Care Priorities For The President and Congress

Now that the ACA is 5 years old and through its second open enrollment period, the April Kaiser Health Tracking Poll looked at what some of the public’s health care priorities are for the President and Congress going forward. When asked about many different aspects of health care delivery and the health care system, the issue that comes out on top for Democrats, Republicans and independents alike is making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them, with three-quarters of the public (76 percent) saying this is a top priority.  Sixty percent say that government action to lower prescription drug prices should be a top priority and majorities say things like provider network protections and increased transparency related to the prices and quality of health care should be top priorities.

Figure 6: “Top Health Care Priorities” for the President and Congress Total Democrats Independents Republicans
Making sure that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them 76 87 72 66
Government action to lower prescription drug prices 60 68 57 51
Protecting people from being charged high prices when they visit hospitals covered by their health plan but are seen by a doctor not covered by their plan 56 63 62 44
Making sure health plans have sufficient provider networks 55 64 58 43
Making information about the price of doctors’ visits, procedures, and tests, such as hip replacements and MRIs more available to patients 55 62 58 43
Making information about what doctors and hospitals are covered under different health insurance plans more available 54 60 55 46
Making information comparing the quality of health care provided by doctors and hospitals more available to patients 54 64 53 47
Changing current eligibility rules so that financial help under the health care law to purchase health insurance is available to more people 50 72 44 31
Requiring all states to expand their Medicaid program to cover more low-income, uninsured adults 50 74 43 28
Making the notes doctors take about patients routinely available to patients 45 53 40 39
Helping people with moderate incomes pay high out-of-pocket costs for medical care 44 52 45 33
Repealing the requirement that employers with 100 or more workers pay a fine if they don’t offer health insurance 39 40 36 37
Repealing the requirement that nearly all Americans have health insurance or else pay a fine 37 27 37 52
Repealing the entire health care law 36 16 37 60
Reducing the number of people that are able to get financial help from the government to purchase health insurance under the health care law to save the government money 28 27 26 34
Eliminating a tax on the most expensive employer-sponsored health plans, also called Cadillac plans, that helps pay for the health care law 26 25 27 27
Note: Items asked of half samples.

Beyond agreeing that high-cost prescriptions should be affordable to those who need them, Republicans, Democrats, and independents have different ideas of their top health care priorities for the President and Congress. The issues that rank second and third for Democrats build on the ACA – namely requiring all states to expand their Medicaid programs (74 percent of Democrats say this is a top priority) and changing the eligibility rules so that more people are able to get financial help to purchase health insurance under the health care law (72 percent of Democrats say this is a top priority). The second and third ranked top health care priorities for Republicans are also ACA related but include repealing the entire law (60 percent) and repealing the individual mandate (52 percent).  For independents, changes like provider network protections and price transparency rank second and third.

Figure 7

Figure 7

Personal Health Care Experiences And Perceptions

Few Report Comparing Plans, Hospitals, Or Doctors On Quality & Prices

Overall, 31 percent report seeing information comparing doctors, hospitals, and health insurance plans in the past 12 months. However, when asked more specifically if they have seen information comparing prices or quality across plans and providers, fewer than 1 in 5 say they have seen these types of information. Even fewer report actually using this information in making decisions about doctors, hospitals or health insurance plans.

Figure 8

Figure 8

Many Say Finding Cost Information Is Difficult

Not only do few say they have seen information comparing prices, many say it is difficult to find out how much medical treatments and procedures provided by different doctors or hospitals would cost. Nearly two-thirds (64 percent) say this is difficult, while a third say it is at least somewhat easy to find out how much medical treatments would cost. Three-quarters of the uninsured (76 percent) say it is difficult to find out this information.

Figure 9

Figure 9

Confidence And The Ability To Pay For Unexpected Health Care

Over half the public says they are at least somewhat confident that they have enough money or health insurance to pay for usual medical costs (68 percent) or for a major illness requiring hospitalization (55 percent), but still 3 in 10 (30 percent) say they are not confident they have enough to pay for usual medical costs and over 4 in 10 (44 percent) say they are not confident they could pay for care for a major illness or injury that required hospitalization.  The nonelderly uninsured are much more likely to say they are not confident they could pay than those under age 65 with insurance.

Figure 10

Figure 10

Given a hypothetical situation in which an unexpected medical bill cost $500, 45 percent of the public says they would be able to pay it in full, 20 percent says they would pay the bill by putting it on a credit card and paying it off over time, 7 percent say they would have to borrow money from a bank, friends, or family, and 20 percent say they would not be able to pay the bill at all. The nonelderly uninsured are more likely than the nonelderly insured to say they would not be able to pay the bill at all (32 percent vs. 18 percent) or that they would have to borrow money to pay the bill (14 percent vs. 7 percent).  When the cost of the unexpected medical bill is increased to $1,500, fewer people say they could pay it in full (26 percent) and more say they would have to pay it off over time (27 percent), borrow money (10 percent), or not be able to pay it at all (26 percent). Four in ten of the uninsured under age 65 (41 percent) say they would not be able to pay an unexpected medical bill of $1,500.

Figure 11

Figure 11

Some Insured Find Affording Premiums And Cost Sharing Difficult

Most nonelderly insured say it is easy to afford their deductible (57 percent), the cost of insurance (64 percent), and other cost sharing (71 percent). A third of those under age 65 with insurance (36 percent) say it is difficult to afford their deductible, 28 percent say it is difficult to afford the cost of health insurance each month, and 24 percent say it is difficult to pay for copays for doctor visits and prescription drugs.

Figure 12

Figure 12

Perception Remains That Personal Health Care Costs Are Increasing

Among nonelderly Americans with health insurance, about a quarter (24 percent) report that their health insurance premiums have been going up a lot lately and 22 percent say they have going up a little, while about 4 in 10 (39 percent) say they have been holding steady. In terms of deductibles and copayments, nearly a quarter (23 percent) say that these costs have been rising a lot and 16 percent say they have going up a little, while just over half (53 percent) say the cost of their deductibles and copayments has been holding steady.

Figure 13

Figure 13

Kaiser Health Tracking Poll: April 2015 Methodology

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.