Americans might like the Affordable Care Act (ACA) a little better if they – well, understood it.
That's the indication of a new survey, which found that people tend not to understand the health care reform legislation very well – but when they do, they start to warm up to it.
Researchers from GfK, Stanford, the University of Michigan, Princeton and the Associated Press quizzed 2,605 people on 18 "provisions" – 12 of which were actually in the law. Respondents had to identify whether the provisions surveyors were asking them about were actually part of the ACA, and then rate how certain they were of their answer.
Finally, they were asked 1) whether they favored or opposed those provisions and 2) whether they favored changing the law.
Like other recent surveys, support (or lack of) for the ACA ran along party lines, with 32 percent favoring and 36 percent opposing the legislation overall.
When researchers asked people whether a given provision was in the bill, accuracy rates for some provisions were "strikingly high," said the report's authors. But when they took the respondent's certainty into account – that is, certainty that a provision was or wasn't in the ACA – then those accuracy rates dropped.
So low, in fact, that when respondents' certainty was factored in, "only one provision was correctly identified with high certainty as being part of the ACA by a majority." That provision was the one that allows people to stay on their parents' health insurance plan until they turn 26 – 52.2 percent were rightly confident that was in the law.
On each of the remaining 11 legitimate ACA provisions surveyors asked about, less than 40 percent of respondents were confident enough in their knowledge of the law to answer their questions with a high degree of certainty. A sampling:
– Only 38.7 percent were confident that large companies have to provide health insurance to its employees.
– Only 36.3 percent believed citizens without health insurance have to pay a fine (unless they have specific reasons).
– Just 32.6 percent believe insurance companies have to sell health coverage to folks with preexisting conditions.
– Only one in five respondents were confident that seniors with high drug costs get discounts.
– 16.8 percent believe the law will subsidize the cost of health insurance for low-income citizens.
What's more, on each of the fake ACA provisions surveyors threw into the fray, at least 70 percent of respondents at least had a suspicion they were actually true. Again, each of the following provisions is based on actual misconceptions, but are not in the actual ACA:
– 74.6 percent believed job applicants have to disclose previous illnesses to employers.
– 76.8 percent believed restaurants with unhealthy food have to pay the government a fee.
– 83.2 percent believed death panels are real.
– 85.9 percent believed smokers have to pay an additional $1,000 every year.
– 86.7 percent believed a health care ID card would be required to get treated at a hospital.
– 89.5 percent – almost nine in 10 people – believed that the ACA requires that unauthorized immigrants get free treatment.
As the authors wrote: "Not a single respondent answered every quiz question correctly with high certainty" – and 22.1 percent of respondents got every question wrong after the certainty of their answers was factored in. Just 0.1 percent of respondents were able to correctly answer 16 out of the quiz's 18 questions with a high degree of certainty.
Which has big implications considering that "the more accurate a person's beliefs were about the 18 elements [surveyors] asked about, the more he or she liked the ACA," wrote the report's authors. If everyone in the nation understood all the ACA's provisions and could answer questions about them accurately with high confidence, they projected that 88 percent of Democrats, 74 percent of independents and 40 percent of Republicans would favor the law.
The report also noted that Democrats's answers were significantly more accurate than independents, and independents' answers were significantly more accurate than Republicans.
Southside health providers and advocates lauded the Supreme Court's decision in June to uphold the constitutionality of the ACA, in part because of its benefits for those without insurance, who have a large presence in South L.A. But the legislation's future is hazy, and may hinge on November's presidential election, as Republican nominee Mitt Romney has promised to repeal at least parts of the law if he's elected.