National Cost Drives Opinion on Health Care Public divided on how changes to ACA would affect pocketbook

West Long Branch, NJ – A national Monmouth University Poll conducted right before Congressional Republicans unveiled their health care plan this week found that 1-in-3 Americans believe any such reform would drive up their costs compared with 1-in-5 who anticipate their costs going down. Most Americans prefer to keep the Affordable Care Act in place with improvements, while still retaining the ACA’s individual mandate. The bottom line for most Americans will be how any changes to the ACA will impact their own health care costs.

Before House Republicans revealed their new health care legislation, most Americans (51%) said they would prefer to keep the Affordable Care Act and work to improve it, with another 7% saying they want to keep the ACA entirely intact. Just 4-in-10 want to see the ACA repealed, either with a replacement put in place (31%) or repealed entirely without a replacement (8%). The poll finds majority support for retaining the ACA regardless of how individuals get health care coverage – such as through an employer (57% prefer to keep the law), a privately purchased plan (55%), or publicly funded coverage (63%).

There may be a pitched battle over the Republican plan since it is not clear how similar or different it may be from the ACA. Two-thirds (66%) of those who want to repeal Barack Obama’s signature policy say it is very important to them that Congress follow through on this GOP promise. On the other hand, a similar 60% of those who want to keep the law say it is very important to them that the ACA remains basically intact.

“People on opposite sides of this issue are strongly attached to their position on the ACA. Early reviews of the Republican draft plan suggest that it might not do enough to either retain or repeal it, which may leave all sides disappointed,” said Patrick Murray, director of the independent Monmouth University Polling Institute in West Long Branch, New Jersey.

Before details of the GOP plan emerged, one-third (33%) of the public suspected that a repeal and replace effort would cause their own health care costs to go up, 20% expected their costs would go down, and 38% expected no change to their costs. Those with private insurance (32%) or with no coverage at all (31%) are slightly more likely than those with employer-provided plans (18%) and public coverage (13%) to anticipate cost savings from any repeal and replace effort.

The poll also found that the vast majority of Americans (84%) support offering tax credits to help low and moderate income families purchase private insurance, while the Republican proposal seems to have shifted to an age-based rather than an income-based credit. Additionally, a majority (53%) also support a mandate requiring that every person carries health insurance, which is an ACA provision that the new legislation eliminates.

“It looks like the new Republican bill is a mixed bag in terms of the public’s expectations for what worked with the ACA. Ultimately, most Americans will judge this plan in terms of its anticipated impact on their own household budgets,” said Murray.

Just over half (52%) of Americans report that their health care costs have gone up in the past two years – including 28% who say they have gone up a lot and 24% who say they have gone up somewhat. Another 41% say their costs have not changed and just 4% report their health care costs have gone down. More than two-thirds (69%) of those with private insurance report their costs have gone up in the past two years. This compares with 58% of those with employer-provided plans and 35% of those with publicly funded coverage, such as Medicare, Medicaid or military plans, who say the same.

One-third (36%) of Americans blame the Affordable Care Act for contributing to the rise in their families’ health care costs. Another 13% say that the ACA actually helped lower their own costs and 48% say the ACA did not have an impact on their own health care costs either way. Among those who purchase insurance in the private market – including through ACA exchanges – 48% say their health care costs have gone up because of the ACA, 25% say they have gone down and 27% say their costs have remained the same.

A January Monmouth University Poll found that health care costs had jumped to the top spot among day-to-day issues that concern American families – which in turn spurred this deeper dive into the topic. Nearly half of Americans (46%) say it is difficult for them to pay health care deductibles and other out-of-pocket expenses compared with 43% who say this is easy for them. The public is divided on the ease of paying health insurance premiums – 42% say this is difficult for them and 42% say it is easy.

Paying for health care is a lot more problematic for American families than paying for other household expenses such as grocery bills (33% say this is difficult and 62% say this is easy) and mortgage or rent payments (33% difficult and 45% easy). Paying for health care is even more difficult than paying tax bills (41% say paying taxes is difficult and 48% say this is easy for them).

Among those who get insurance through an employer – representing about half of the country – about 4-in-10 say meeting their health care costs is difficult (38% for premiums and 42% for out-of-pocket expenses). Among those who purchase private insurance – about one-tenth of Americans – the majority say they have difficulty meeting those costs (62% for premiums and 60% for out-of-pocket expenses).

“Monmouth is committed to looking beyond the political headlines to examine how these policies affect people where they live,” said Murray, adding, “Satisfaction levels can prove to be more predictive than typical political metrics like presidential job ratings and favorability. If people are struggling, they will look for change.”

One-in-five (20%) Americans report that there has been a time in the past two years when they had to choose between paying for health care or other household expenses like rent or mortgage, including 32% with private insurance plans, 15% with employer plans, 18% with public plans, and nearly half (48%) of those with no insurance coverage at all. Furthermore, 3-in-10 (31%) Americans report that someone in their household did not go for needed care in the past two years because of the expense involved – including 40% of those with private plans, 25% with employer plans, 26% with public plans, and fully 63% of those without insurance.

“Earlier this year, we found that paying for health care is the top issue of families across the country, surpassing jobs and other expenses as the concern most likely to keep Americans up at night. Whether the public feel that their own costs are under control will be a much more telling metric than whether they support or oppose any particular provision in the new health care bill,” said Murray.

The Monmouth University Poll was conducted by telephone from March 2 to 5, 2017 with 801 adults in the United States. The results in this release have a margin of error of +/- 3.5 percent. The poll was conducted by the Monmouth University Polling Institute in West Long Branch, NJ.

QUESTIONS AND RESULTS

(* Some columns may not add to 100% due to rounding.)

[Q1-15 previously released.]

[Q16-23 held for future release.]

Now I’d like to ask you about some concerns closer to home.

24-28.

I’m going to read you some typical household expenses. For each, please tell me if it is very easy, somewhat easy, somewhat difficult, or very difficult for you to pay for it? If you do not have this expense, just let me know. [QUESTIONS 24 – 28 WERE ROTATED] Mortgage or rent payment March

2017 Very easy 17% Somewhat easy 28% Somewhat difficult 22% Very difficult 11% Do not have this expense 20% (VOL) Don’t know 2% (n) (801) Grocery bills March

2017 Very easy 28% Somewhat easy 34% Somewhat difficult 26% Very difficult 7% Do not have this expense 4% (VOL) Don’t know 1% (n) (801) Health insurance premiums March

2017 Very easy 19% Somewhat easy 23% Somewhat difficult 20% Very difficult 22% Do not have this expense 13% (VOL) Don’t know 2% (n) (801) Health care deductibles and out of pocket expenses March

2017 Very easy 17% Somewhat easy 26% Somewhat difficult 25% Very difficult 21% Do not have this expense 9% (VOL) Don’t know 3% (n) (801) Paying taxes March

2017 Very easy 20% Somewhat easy 28% Somewhat difficult 27% Very difficult 14% Do not have this expense 9% (VOL) Don’t know 2% (n) (801)

29. Have your health care costs gone up, gone down, or stayed about the same over the past two years? [If GONE UP: Have they gone up by a lot or somewhat?] March

2017 Gone up a lot 28% Gone up somewhat 24% Gone down 4% Stayed about the same 41% (VOL) Don’t know 4% (n) (801)

30. Has there been a time over the past two years that you had to choose between paying for health insurance or medical care and paying for things like rent or mortgage, or has this not happened? March

2017 Yes, has happened 20% No has not happened 79% (VOL) Don’t know 0% (n) (801)

31. In the past two years, have you or anyone in your household not gone for needed health care because you felt you could not afford it, or has this not happened? March

2017 Yes, has happened 31% No has not happened 68% (VOL) Don’t know 1% (n) (801)

32. Do you feel the Affordable Care Act of 2010, which is sometimes called Obamacare, has had an impact on your family’s health care costs, or has it not really had an impact? [If YES: Has it made your own costs go up or go down?] March

2017 Yes, made costs go up 36% Yes, made costs go down 13% Not really had an impact 48% (VOL) Don’t know 3% (n) (801)

33. What would you like to see Congress do when it comes to the Affordable Care Act – They should keep the law as it is. They should keep the law in place and work to improve it. They should repeal the law and replace it with an alternative. They should repeal the law and not replace it? [CHOICES WERE ROTATED] March

2017 Keep law as it is 7% Keep law and work to improve it 51% Repeal law and replace it 31% Repeal law and NOT replace 8% (VOL) Don’t know 3% (n) (801)

34. [BASED ON RESPONSE TO Q33:] How important is it to you that the current health care law [is/is not] repealed – very important, somewhat important, or not too important? March

2017 Very important 60% Somewhat important 19% Not too important 16% (VOL) Don’t know 2% (VOL) No opinion on ACA 3% (n) (801)

35. If the Affordable Care Act was repealed and replaced by Congress, do you think your own health care costs would go up, go down, or stay about the same? March

2017 Go up 33% Go down 20% Stay the same 38% (VOL) Depends 2% (VOL) Don’t know 7% (n) (801)

36. If the Affordable Care Act was repealed and replaced by Congress, do you think you would have more choice, less choice, or about the same amount of choice in deciding how you get health care? March

2017 More choice 27% Less choice 23% About the same amount of choice 43% (VOL) Depends 3% (VOL) Don’t know 5% (n) (801)

37. Do you support or oppose requiring everyone to carry health insurance? March

2017 Support 53% Oppose 43% (VOL) Don’t know 4% (n) (801)

38. Do you support or oppose providing tax credits to help low and moderate income families purchase health insurance if they cannot get coverage through their jobs? March

2017 Support 84% Oppose 14% (VOL) Don’t know 3% (n) (801)

[Q39-53 held for future release.]

METHODOLOGY

The Monmouth University Poll was sponsored and conducted by the Monmouth University Polling Institute from March 2 to 5, 2017 with a national random sample of 801 adults age 18 and older, in English. This includes 401 contacted by a live interviewer on a landline telephone and 400 contacted by a live interviewer on a cell phone. Telephone numbers were selected through random digit dialing and landline respondents were selected with a modified Troldahl-Carter youngest adult household screen. Monmouth is responsible for all aspects of the survey design, data weighting and analysis. Final sample is weighted for region, age, education, gender and race based on US Census information. Data collection support provided by Braun Research (field) and SSI (RDD sample). For results based on this sample, one can say with 95% confidence that the error attributable to sampling has a maximum margin of plus or minus 3.5 percentage points (unadjusted for sample design). Sampling error can be larger for sub-groups (see table below). In addition to sampling error, one should bear in mind that question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of opinion polls.

DEMOGRAPHICS (weighted) Self-Reported 26% Republican 43% Independent 31% Democrat 49% Male 51% Female 32% 18-34 36% 35-54 32% 55+ 66% White 12% Black 15% Hispanic 7% Asian/Other Health Insurance 49% Through employer 10% Private plan 25% Public coverage 6% Through parents, other 10% No insurance

Click on pdf file link below for full methodology and results by key demographic groups.

Download this Poll Report with crosstabs