Most people know little about the Affordable Care Act’s provisions, US study finds

BMJ 2014; 348 doi: (Published 24 February 2014) Cite this as: BMJ 2014;348:g1727
  1. Michael McCarthy
  1. 1Seattle

Although almost all US residents have an opinion about the Affordable Care Act, few know very much about what the law does, a new study has shown.1

The study was an analysis of data from a survey conducted in September, just before the opening of the health insurance exchanges. It found that 82% of people surveyed had an opinion about the healthcare reform law (34% favorable and 48% unfavorable) but that under a third said that they had heard “some” or “a lot” of information about its provisions.

The study was conducted by Sharon K Long and Dana Goin of the Urban Institute, a non-partisan policy think tank based in Washington, DC.

Many respondents said that they had heard “nothing at all” about key provisions of the law. For example:

  • 46% had heard “nothing at all” about the provision that allows lower paid people to obtain insurance through Medicaid

  • 45.1% had heard “nothing at all” about provisions that prevent insurers from placing caps on what they will pay for care that is covered as an essential benefit

  • 45.7% had heard “nothing at all” about the provisions that eliminate out-of-pocket copayments or deductible costs for preventive services such as immunizations and cancer screening.

The survey also found that despite a fierce debate over Medicaid expansion—triggered by a 2012 US Supreme Court decision2 that allowed states to opt out of the expansion program—only 11.8% of respondents could accurately report whether or not their state had decided to participate in the program. To date only 25 states and the District of Columbia have chosen to expand their programs.

Awareness of the act’s provisions was particularly low among low income and uninsured people, who stand to gain the most from the law: as many as a half of respondents reported having heard “nothing at all” about the Medicaid expansion, the health insurance exchanges, or the subsidies available to help low income enrollees pay their premiums.

“The low level of awareness of many of the provisions specifically designed to improve access to health insurance and its new benefits doubtless contributes to the stronger negative rather than positive perceptions of the law among the American public at the end of 2013,” the researchers wrote.


Cite this as: BMJ 2014;348:g1727


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