Tracking the Affordable Care Act with the RAND Health Reform Opinion Study


Apr 22, 2014

measuring blood pressure

This commentary originally appeared on RWJF's Human Capital Blog on April 22, 2014.

Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.

One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.

The public opinion part of our survey contains three questions. First, we ask respondents to report whether their opinion of the ACA is generally favorable or unfavorable. (Click through to see related graphs.) Following an initial dip in favorable opinion in November, public opinion of the ACA has remained relatively stable, except for one week in March. Approximately 35 percent hold favorable opinions while approximately 52 percent hold unfavorable opinions. The remainder responds “don't know.” While there have been fluctuations, nearly all are within the margin of error, suggesting very stable opinions.

Second, we've been asking people about whether they think the Affordable Care Act will make them and their family better or worse off. Since the beginning of February 2014, the share saying that they expected to be better off has remained remarkably stable at around 13 percent. Among those responding “worse off” or “about the same,” there have been many more fluctuations. Between 35 and 40 percent select each of these two categories, with the remainder responding “don't know.” Third, we ask about whether the country will be better off or worse off with the reform. Similarly, when we look at this question, we again see that the percentage of those responding “better off” has been more stable (around 28 to 29 percent) than the share responding “worse off” (between 41 and 48 percent) or about the same (between 11 and 17 percent).

Across all three questions we see more stability in the response categories that are supportive of the ACA and more fluctuations in the responses opposed to the ACA. This suggests that those who are more uncertain and whose opinions are more in flux are gravitating toward negative opinions of the ACA rather than positive.

However, we observe 10 to 15 percent of respondents changing their opinions each month. Each month, we compare respondents' responses to the general opinion question to their responses in the previous month, allowing us to observe how many are changing their opinion even in a relatively stable climate. Our unique data allow us to observe that underlying churn in opinion is masked by the overall stability. This churn does include fluctuations in favorable opinions as well as unfavorable opinions. Often the flows into and out of favorable opinions cancel each other out, leading to a relative stable overall favorable opinion rate.

These provocative data not only provide a number of interesting results, but also prompt many yet to be answered questions. In the coming months, we'll be looking into these results in more depth and hopefully answering many more questions about what drives both public opinion and insurance transitions.

Katherine Grace Carman is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.