A new study finds the Americans most likely to be affected by the proposed repeal of the Affordable Care Act tend to strongly support all the ACA's provisions — with one exception.
The Health Reform Monitoring Survey (HRMS), conducted by researchers at the Urban Institute, found high levels of support for provisions such as guaranteed issue (providing coverage regardless of health status), allowing young adults to stay on parents' insurance, Medicaid expansion, and requiring coverage of essential benefits.
Looking closely at attitudes on the ACA
The study says as talk of replacing the ACA continues in Washington, D.C., many Americans still value the specific provisions written into the health reform law.
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"Most adults are aware of the potential for replacement of the ACA and prefer to keep rather than repeal key ACA provisions other than the individual mandate," the report says. "Support for these provisions is particularly high among adults with Marketplace coverage or Medicaid, who gain the most benefit from the ACA, but adults with non-Marketplace, nongroup coverage also express majority support."
Michael Karpman, co-author of the study and a research associate at the Urban Institute's Health Policy Center, says the survey is valuable because it looks specifically at populations that would be directly affected by a repeal of the ACA.
"In general, we see a lot of public opinion polls that focus on overall support or opposition to the ACA or the repeal legislation," he says. "They don't really focus on the people most affected. By zooming in on the attitudes of those individuals, we were able to get a really good idea of the level of support among those people who are going to be most affected by a repeal."
The survey, which includes more than 9,500 nonelderly Americans, finds levels of support near 80 percent or higher for many provisions of the ACA. Premium subsidies have the second-lowest level of support, but that provision is supported by nearly 70 percent of respondents overall (68.6 percent).
The survey also breaks responses down by type of insurance (people on Medicaid, those on the individual ACA marketplace, those with employer-based insurance, etc.), as well as age, income, and health status. Strong support for provisions of the ACA are found across the board — except in one area.
The individual mandate — disliked by everyone
The ACA's individual mandate, as other surveys have found, continues to be singularly unpopular with Americans. In this survey, only 28.5 percent of respondents overall support the mandate.
So, why is the individual mandate so unpopular? Karpman notes the survey found no subset of the population tallied more than 30 percent support for the provision. "There's really no group that we surveyed that expressed majority support for the individual mandate," Karpman says.
The survey shows even those with low incomes, who in theory benefit the most from requiring more people to pay into the insurance pool, are not supporters of the mandate. Less than 30 percent (27.2 percent) of those making less than 138 percent of the federal poverty level support the individual mandate.
In addition, nearly 30 percent of low-income respondents say they'd be inclined to drop their insurance plan if individual mandate didn't require them to buy one — even though their plans were subsidized to some degree.
"I think it's possible that for some of these folks the burden of paying premiums is just higher in general," Karpman says.
ACA features popular, funding mechanism problematic
The findings underline a problem health reformers have not yet solved: People want the benefits of universal health coverage, but dislike what it takes to put that coverage in place.
"Once again we see that the coverage reforms created by the ACA are supported by comfortable majorities," says Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation, which helped fund the survey. "The individual mandate remains unpopular, revealing a disconnect between the kinds of protections people want and the mechanisms needed to provide them."
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