Health Insurance Marketplace In The Us: Exploring Affordable Care Act Coverage Options
Health Insurance Marketplace In The Us: Exploring Affordable Care Act Coverage Options - This report draws on the Public Agenda/USA Today/Ipsos Hidden Commons nationally representative survey of U.S. adults and four focus groups to explore the U.S. public’s perceptions and values of health care, including people’s beliefs about the health care system. How much change in perception needs, their changing goals and priorities, and their views on various proposals.
Americans of nearly all political stripes want changes to the health care system, study finds. Even people who currently have what they consider to be satisfactory health insurance believe the system needs major changes. Americans across the aisle are also largely aligned on the goals of the health care system -- starting with making it more affordable and making sure people aren't penalized for pre-existing conditions.
Health Insurance Marketplace In The Us: Exploring Affordable Care Act Coverage Options
Republicans and Democrats differ somewhat in how they approach these goals, and independents and people without political backgrounds are often somewhere in between. These differences rarely involve large or unbridgeable gaps. In addition, for the four approaches to health care reform that the survey asked people to consider (see Finding 3), about a quarter of Americans said they did not have enough information to express their opinion, suggesting that the public has plenty of leeway. Opinions evolve as people learn more.
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Given the public's desire for significant change in health care, the findings of this survey suggest that leaders should focus pragmatically on a number of goals that would attract strong consensus across party lines. While partisanship plays an important role in shaping perceptions of how to achieve these goals, the findings of this study provide outlines for actionable public conversations about improving health care in the United States. We hope this report, and the other Hidden Commons events that accompany it, will help focus, frame, stimulate and facilitate this conversation.
This report summarizes the results of a nationally representative survey of 1,020 adult Americans ages 18 and older. The survey was conducted by Ipsos from 19-26 December 2019 using the probability-based Web Knowledge Panel®. Respondents completed the survey in either English or Spanish. The survey is weighted to match census data to ensure adequate representation of the American people.
The study also drew on four population-diverse focus groups conducted by Public Agenda in October 2019 in Baltimore, Maryland; Dallas, Texas; Earth City, Missouri; and New Rochelle, New York.
Click here to see the full survey methodology, top line with full question wording, and cross-tabulation by political affiliation.
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Finding 1: Americans of all political stripes are calling for major reforms to the health care system, including those who are satisfied with their current insurance.
Clearly, a majority of Americans want to see major changes to the U.S. healthcare system: 40 percent want major changes, and another 22 percent want it to be completely redesigned. Only 7% of Americans think the system should remain as it is; see Figure 1.
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This desire for change is shared across the political spectrum. Roughly six in 10 among Republicans, Democrats, independents and apoliticals say the system needs major changes or a complete redesign. However, retirees and those over 55 are much less likely to seek a complete redesign.
In focus groups conducted for the study, participants expressed anger and frustration with the healthcare system and articulated their strong desire for change. [2]
“It’s a pressing problem, and it’s getting worse.” – Earth City, Missouri; 70s; White; Republican “There are so many parts of this system that are broken.” – Texas Dallas, Texas; 30s; white; Republicans: "Why don't we knock it down and start over?" – Dallas, Texas; 30s; black; independent "If you make tiny Change, and you'll only get tiny improvements. I think, as Americans, we just have to embrace the idea that we might have to break the system to see improvements." – Dallas, Texas; 30s; Asia People; Independent Even people who are happy with their current insurance want changes in the health care system.
People's satisfaction with their own insurance coverage overshadows perceptions of the nation's healthcare system as a whole. Nearly half of Americans describe their current health insurance as excellent or very good, but just over half (54%) think the health care system needs major changes or a complete redesign. That includes nearly equal shares of Republicans, Democrats, independents and apoliticals who describe their insurance as excellent or very good but still think the system needs major changes.
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Focus group participants often expressed their insecurities about the healthcare system, especially the financial toll it took on them and their families.
"The system works to a certain extent. But the system chooses who it works for. I thought at one point I had good health care. But the rug is pulled from under you and then you struggle. ” – Baltimore, MD; 60s; White; Republican “The opportunities and good fortune that some of us have had is not available to everyone. Not everyone has insurance through their jobs.” – New Rochelle, NY; Over 50s; White; Republican "People are tied to jobs they can't leave. They can't divorce. If someone is diagnosed with a disease, pre-existing conditions will Prevent them from getting coverage in the future. I think some level of basic health care should be provided to everyone, regardless of employment status. Because you can easily lose your job.” – Baltimore, MD; 40s; Asian; Democrat “Some People have access to health care, but they don’t have the means to pay for it.” – Earth City, Missouri; 30s; Asian; Independent “I have young children. My deductible is like $6,000 or $7,000 $. The few clinics popping up are good, but if they can't do x-rays, then you're paying for the place, you have to go here and pay for the place, I mean the costs are adding up. If you can't really get out of it benefit, why should they have these things?” – Earth City, MO; 30s; Latino; Republican
Finding 2: Americans across the political spectrum share many of the same goals in health care, starting with making health care more affordable for the average person—perhaps because half of Americans experience severe financial hardship as a result of health care , or know someone who has been through this. Other important mutual goals include coverage for pre-existing conditions and coverage for long-term care.
Of the nine goals for improving health care tested in the survey, 85 percent or more of Americans said each was very or somewhat important to them. In fact, more than 90 percent of Americans consider five goals to be very or somewhat important: making health care more affordable for the average American, lowering the cost of prescription drugs, ensuring affordable health insurance for people with pre-existing conditions, Cover long-term care for the elderly and people with disabilities, and ensure that all communities have access to enough doctors and hospitals; see Figure 2.
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While those goals are widely shared by the American public, Democrats have expressed a particularly strong focus on affordability, improving access and getting everyone covered.
Far more Democrats than Republicans say all goals are very important, although majorities of all political stripes say each goal is at least somewhat important. Independents and apoliticals fall between the two major parties, leaning slightly toward Democratic views.
For example, 89 percent of Democrats say making health care more affordable for ordinary Americans is very important, while 65 percent of Republicans say that goal is very important. Likewise, 84 percent of Democrats say it is very important to ensure that low-income people receive the same quality of basic health care as high-income people, but fewer than half (48 percent) of Republicans say that goal is very important.
Even more starkly, 84% of Democrats think it's very important to ensure all Americans have health insurance, but only 35% of Republicans think that goal is very important.
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In addition to differences brought about by political affiliation, certain goals were also considered particularly important by other demographic groups. For example, African-Americans and Hispanics are more likely than white Americans to say they want to improve the quality of care, ensure that all Americans have insurance that covers treatment for mental health and addiction services, and ensure that low-income Americans receive the same quality care is very important. People who had significant or partial exposure to the health care system were more likely to say that making health care more affordable is important, both for the average American and for people with pre-existing conditions.
The survey asked respondents to prioritize two goals from those they considered very important.
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