Digging Deeper Into Public Opinion of the Affordable Care Act


(The RAND Blog)

doctor taking pulse

by Katherine Grace Carman

January 15, 2014

Over the past month, we've been bringing you the latest data on public opinion of the Affordable Care Act (ACA) from the RAND Health Reform Opinion Study (RHROS). Our study uses a new methodology to measure public opinion of health reform, allowing us to observe true changes in opinion by surveying the same people over time.

This week, we again report our latest findings. Unfavorable opinion of the ACA has dropped to the lowest point since the opening of the exchanges. Positive opinion has remained stable for the last three weeks. The share responding “don't know” has increased.

Given the breadth and complexity of data collected in our study, we are presenting additional information on the American Life Panel website for those who desire a deeper look into public opinion of the ACA.

We now include a detailed graph illustrating changes in opinion from one month to the next. This graph presents all transitions between “favorable,” “unfavorable,” and “don't know.” These results compare responses this week to responses one month ago, the last time the same group of respondents was approached. To better see the differences between opinion categories, try clicking on the legend on the right side of the graph to hide and redisplay each of the lines.

Changes in Opinion

Have respondents changed their opinion of the ACA from positive to negative since the last time they were surveyed?

As mentioned in previous posts, we continue to see a declining trend in shifts to “unfavorable” from both the “favorable” and “don't know” categories. However this week we see more people shifting to reporting “don't know” than shifting away from “don't know.” While the share of changing opinions continues to be lower than in November, there has been a slight increase in churn since last week. This is unsurprising given the drop in unfavorable opinions—that is, those leaving the “unfavorable” category would necessarily move to either “don't know” or “favorable.” What is potentially interesting about this increase in churn is not only that people are leaving the “unfavorable” category, but also that it seems many of them of are using “don't know” as a middle position between “unfavorable” and “favorable” as they make up their minds about the law.

We're also tracking how respondents' opinions of the ACA differ between demographic groups. For example, you can look at differences in opinion by age, gender, employment status and political affiliation.

Some differences in opinion stand out. For example, relative to those between 26 and 65 years old, respondents older than 65 are more likely to indicate a favorable opinion and less likely to say “I don't know.” Comparing men and women, there are differences in weekly fluctuations, but overall trends are similar across genders. Other groups, such as those under 26 and those who are unemployed, are too small to draw meaningful conclusions about their differences with the overall population.

We've also been asking respondents two questions about their “big-picture” expectations for the ACA:

Effect on Individuals

What effect do respondents think the ACA will have on themselves and their families?

Effect on Country

What effect do respondents think the ACA will have on the country as a whole?

Our findings indicate that almost as many individuals expect the ACA to make no difference to their families as those who expect the reform to make their families worse off—both groups are fluctuating between 33 and 40 percent. The share that expects to be better off has fluctuated between 9 and 14 percent.

When it comes to the ACA's expected effect on the country as a whole, perceptions are more closely aligned with overall opinion of the law. Perceptions of negative effects of the ACA are considerably higher than perceptions of positive effects. However, the percentage reporting that the reform will have a positive effect on the country has increased since mid-November but has dropped over the past few weeks.

Check back each week for updated data from the RHROS.

Katherine Carman is an economist at the nonprofit, nonpartisan RAND Corporation and is principal investigator for the RAND Health Reform Opinion Study.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.