As outreach efforts for enrollment in the health insurance marketplaces created by the Affordable Care Act (ACA) increase over the summer, the August Kaiser Health Tracking Poll finds that the public’s most trusted sources of information on the law are not necessarily the ones people are most likely to be hearing from. The public is most likely to say they trust health care professionals like doctors, nurses, and pharmacists, as well as federal and state health agencies when it comes to information about the law. Young adults, a key target of outreach efforts, are particularly likely to say they trust official sources of information like state and federal agencies. By contrast, the most common places where people say they’ve actually heard about the law are from the news media, family and friends. A third of the public now says they’ve heard “a lot” or “some” about the health insurance marketplace in their state, up from 22 percent in June. Despite saying they’ve heard about the law from various sources, confusion remains, with more than four in ten saying the law has been repealed or overturned, or being unsure whether it remains the law of the land. And about half say they don’t understand how the law will impact their own families. While negative views on the law continue to outpace positive ones this month, a majority of the public says they disapprove of cutting off funding as a way to stop the law’s implementation. The most commonly chosen reason for opposition to defunding the ACA is that “using the budget process to stop a law is not the way our government should work,” followed by a belief that “without funding the law will be crippled and won’t work as planned,” and feeling that the law will be “a good thing for the country.”

Doctors And Nurses, Federal And State Agencies Are Most Trusted Sources Of Information On ACA

As the October 1st opening of the ACA’s health insurance marketplaces approaches and outreach efforts ramp up, this month’s Kaiser Health Tracking Poll seeks to understand where the public is turning for information about the law, and which sources of information they trust most. Rising to the top of the list of trusted sources are doctors and nurses (44 percent say they would trust them “a lot” for information about the law), federal agencies (34 percent), state agencies (33 percent) and pharmacists (30 percent). About one in five say they would put a lot of trust in information from employers (21 percent), churches (21 percent), non-profit and community organizations (20 percent), and family and friends (18 percent), while fewer feel this way about health insurance companies (15 percent) and the news media (8 percent). At the bottom of the list, just 3 percent say they would trust information about the ACA from social networking sites “a lot.”

Young Adults, Democrats More Likely To Say They Trust Official Sources

Young adults, who have been a key target of outreach efforts and whose participation in the ACA’s health insurance exchanges is seen by many as important to the law’s success, are even more likely than their older counterparts to have confidence in official sources of information about the law. Nearly half of 18-25 year-olds and almost four in ten 26-35 year-olds say they would put “a lot” of trust in information about the ACA from federal and state agencies.

Trust in official sources also divides along partisan lines, with Democrats more than twice as likely as Republicans to say they would trust federal agencies “a lot” (47 percent versus 21 percent). The partisan gap in trust of state agencies is somewhat narrower, but still substantial (41 percent versus 24 percent).

FIGURE 2: Young Adults, Democrats More Likely To Say They Trust Official Sources Of Information On ACA Percent who say they would trust information about the health care law from each of the following “a lot” BY AGE BY PARTY ID TOTAL 18-25 26-35 36-64 65+ Dem Ind Rep Federal agencies such as the Department of Health and Human Services 34% 49% 38% 32% 23% 47% 31% 21% State agencies such as your state Medicaid office or health insurance marketplace 33 45 37 29 26 41 30 24

Most Trusted Sources Are Not Necessarily Where People Are Most Likely To Get Information About The Law

While health professionals and state and federal agencies top the list of trusted information sources on the ACA, the top places where people report actually getting information about the law are the news media (81 percent say they’ve heard about the law from this source in the past month) and family and friends (49 percent), both of which rank lower in terms of the public’s trust.

Behind the news media and family and friends, roughly two in ten say they’ve heard about the law from social networking sites like Facebook or Twitter (23 percent), a doctor or other health professional (22 percent), letters or brochures in the mail (20 percent), an employer (19 percent), and TV shows like “The Daily Show with Jon Stewart” (19 percent). Fewer, but still more than one in ten, say they’ve gotten information from federal agencies (16 percent), email subscriptions (16 percent), health insurance companies (15 percent), posters or billboards (15 percent), state agencies (14 percent), and non-profit groups (12 percent). Less common sources include online videos, mobile apps, and door-to-door visits.

FIGURE 3: News Media, Family And Friends Top Sources For Hearing About ACA Percent who say they have heard about the ACA in past 30 days from each of the following Any news media 81% National or local TV news 61 Radio news or talk radio 53 Cable TV news 52 Mainly Fox News 16 Mainly CNN 12 MSNBC 6 Mainly Other/DK 18 A newspaper or magazine 45 An online news source 37 Friends and family 49 Social networking sites like Facebook or Twitter 23 Your doctor or another health care professional 22 Letters or brochures you’ve received in the mail 20 An employer 19 Shows like ‘The Daily Show with Jon Stewart’ or ‘The Colbert Report’ 19 Federal agencies such as the Department of Health and Human Services 16 An email from an organization whose listserv you are subscribed to 16 A health insurance company 15 Posters or billboards 15 State agencies such as your state Medicaid office 14 A non-profit or community organization 12 A YouTube video or any other online video 9 A mobile app on your smartphone or tablet 7 Someone who came door to door in your neighborhood, or approached you at a supermarket or mall 2

Many Young People Report Getting ACA Information From Social Networking Sites, But Trust In This Information Is Low Across All Age Groups

Nearly a quarter of the public (23 percent) say they have heard something about the ACA from social networking sites like Facebook or Twitter in the past month. Not surprisingly, younger adults are much more likely than their older counterparts to say they have gotten information this way. Still, even among those ages 35 and under, higher shares report getting information from news media and friends and family than from social networking sites. While young adults are more likely to say they have gotten information from these sites, trust in them as a source of information is low across all age groups, with fewer than 5 percent in any age group saying they trust them “a lot.”

FIGURE 4: Young Adults More Likely To Hear About ACA From Social Media, But Not More Likely To Trust BY AGE TOTAL 18-25 26-35 36-64 65+ Percent who say they’ve heard about the health care law in past 30 days from each of the following News media (including cable, national, and local TV, radio, newspaper, and online news) 81% 75% 81% 84% 80% Friends and family 49 49 52 51 42 Social networking sites like Facebook or Twitter 23 40 36 19 6 How much would you trust information about the health care law from each of the following? A lot 3% 0% 4% 4% <1% Some 16 17 20 16 12 Only a little 28 35 31 26 23 Not at all 49 47 45 50 50 Don’t know/Refused 5 0 1 4 14

Over A Third Report Actively Seeking Out Information On The ACA

Beyond the information they happen to come across, just over a third (36 percent) of the public say they have tried to get more information about the law, including a similar share of the uninsured (33 percent). Those who have sought out information are most likely to say they turned to a general internet search (55 percent) or the news media (23 percent). Far fewer say they sought information from a health insurance company (8 percent), a government website (7 percent), a health care provider (6 percent) or another government source (6 percent).

One in ten Americans (10 percent) say they have been personally contacted by someone about the health care law through a phone call, email, text message, or door-to-door visit. The share who report being contacted is similar among some key target groups, including the uninsured and those with lower incomes.

FIGURE 6: One In Ten Report Being Personally Contacted About ACA Percent who say they’ve been personally contacted about the health care law through a phone call, email, text message, or door-to-door visit Total 10% Uninsured, under age 65 12 Annual household income under $40,000 10 Age 18-25 6 Age 26-35 9

About a quarter (27 percent) of those who reported being personally contacted say the person wanted to give them general information about the law, and about one in ten say they were contacted by someone making arguments against the law (11 percent) or by someone making arguments in favor of it (9 percent).

Confusion About Law Remains

Roughly half the public (51 percent) continues to say they don’t have enough information about the ACA to understand how it will impact them and their family, a share that has been fairly steady since 2010. The share who feel they don’t have enough information is particularly high among Hispanics (64 percent), the uninsured (62 percent), young adults (62 percent of those ages 18-25), and those with lower incomes (60 percent of those with family incomes less than $40,000 a year).

Further, a large share remains confused about the law’s status, with 44 percent either thinking the law has been repealed (8 percent), overturned by the Supreme Court (5 percent), or unsure whether it remains the law or not (31 percent).

Opinion On ACA Continues To Tilt Negative, But Majority Disapproves Of Defunding

Public opinion on the ACA as a whole continues to tilt negative this month, with 37 percent saying they have a favorable view of the law and 42 percent expressing an unfavorable view, shares that have held relatively steady since February of this year.

Still, a majority of Americans (57 percent) say they disapprove of the idea of cutting off funding as a way to stop the law from being implemented, a finding that has been consistent in Kaiser Health Tracking Polls since January 2011. Republicans and those with an unfavorable view of the law overall are more likely to approve of attempts to defund the ACA, but even among these groups, about a third (34 percent and 33 percent, respectively) say they disapprove.

FIGURE 9: Majority disapproves of cutting off funding for ACA Whether or not you like the health care law, would you say you approve or disapprove of cutting off funding as a way to stop some or all of the law from being put into place? BY PARTY ID BY FAVORABILITY OF ACA TOTAL Dem Ind Rep Favorable Unfavorable DK/Ref. Approve 36% 15% 39% 60% 14% 60% 24% Disapprove 57 81 53 34 83 33 58 Don’t know/Refused 8 4 7 6 3 6 18

The most commonly chosen reason for opposition to defunding the ACA is that “using the budget process to stop a law is not the way our government should work,” (named as a major reason by 69 percent in this group), followed by a belief that “without funding the law will be crippled and won’t work as planned,” (56 percent) and feeling that the law will be “a good thing for the country” (49 percent). Fewer (35 percent) say their main reason for opposing defunding efforts is that they’ve “heard enough about the health care law and it’s time to move on to something else.”

More Hearing About Exchanges

With the opening of the ACA’s health insurance marketplaces less than two months away, there has been a recent uptick in the share who say they’ve heard about this particular aspect of the law. This month, a third (33 percent) say they’ve heard “a lot” or “some” about the marketplace in their state, up from 22 percent in June. Among the uninsured and those with lower incomes, two key target groups for the marketplaces, roughly three in ten say they’ve heard more than a little about the health insurance marketplaces so far. A similar share of 26-35 year-olds reports hearing about the marketplaces, though the share is closer to two in ten (21 percent) among those under age 26.

FIGURE 11: More Report Hearing About Insurance Exchanges JUNE 2013 AUGUST 2013 How much, if anything, have you heard about this new health insurance marketplace, [also known as (STATE EXCHANGE NAME)] in your state? TOTAL TOTAL Uninsured, under age 65 Annual household income under $40,000 Age 18-25 Age 26-35 A lot 8% 12% 12% 10% 3% 10% Some 14 21 17 19 18 19 Only a little 34 34 28 32 35 29 Nothing at all 45 33 43 38 43 41

This month’s survey also sought to shed light on previous experiences that might be relevant for navigating the ACA’s health insurance exchanges. Overall, about half the public reports having ever compared across health insurance policies to choose a plan, a share that is somewhat lower among the uninsured, those with lower incomes, blacks and Hispanics, and those ages 18-25. Furthermore, a quarter of the public overall either buys their own insurance now or has tried to do so in the past three years, and this experience is actually more common among the uninsured and those with lower incomes.

Most of the public (72 percent) says they have purchased a product online at some point, and over a third (35 percent) say they do this “often.” About six in ten (61 percent) say they’ve used the internet to access health information, including a quarter who report doing so “often.” The uninsured, Hispanics, and those with lower incomes are somewhat less likely to report experience with online purchases and accessing health information, while young adults are more likely to say they often buy products online.

FIGURE 12: Reported Experiences That May Be Relevant For Navigating Health Insurance Exchanges TOTAL Uninsured, under age 65 Annual household income under $40,000 Blacks Hispanics Age 18-25 Age 26-35 Percent who say they have ever had to compare health insurance policies and decide which one to choose 53% 39% 44% 44% 36% 22% 53% Percent who currently buy insurance on their own or have tried to in past 3 years 25 37 30 28 24 19 26 Percent who say they have used the internet to buy a product online… Ever 72% 63% 56% 66% 54% 89% 79% Often 35 19 19 31 20 44 45 Percent who say they have used the internet to access health information… Ever 61% 50% 49% 56% 43% 66% 69% Often 24 16 17 16 11 26 28

Public Divided On Health Insurance Industry As A Whole, But Favorable About Their Own Insurance Company

The public’s views on health insurance companies as a whole generally tilt negative, with about half (49 percent) of Americans having an unfavorable view and 43 percent having a favorable one. Those who say they have tried to purchase insurance on their own in the past three years have a slightly more negative assessment of health insurance companies (59 percent have an unfavorable opinion). When it comes to their own insurance company, insured Americans are much more positive: 74 percent say they have a have a favorable view of their own insurance company, while just 23 percent are unfavorable.

Figure 13: Views Of “Your Own” Insurance Company More Positive Than Industry As A Whole Do you have a favorable or unfavorable opinion of… BY EXPERIENCE PURCHASING INSURANCE TOTAL Currently purchase own insurance or tried to in past 3 years Have not tried to purchase own insurance in past 3 years …health insurance companies Favorable 43% 35% 46% Unfavorable 49 59 45 …your own health insurance company (among the insured) Favorable 74% – – Unfavorable 23 – –

Asked how they think the ACA will impact insurance companies, a third (33 percent) think the law will leave them worse off, while about three in ten each say these companies will be better off under the law (28 percent) or see no difference (28 percent).

Ability To See One’s Own Doctor And Wide Range Of Covered Services Most Valued Features In A Health Plan

This month’s tracking poll asked what people value most in a health plan. Between a third and four in ten rated all factors we asked about – including having a comprehensive, affordable plan with good customer service, minimal paperwork, and low cost-sharing – as “extremely important”. But when forced to choose which aspect is most important, the ability to see one’s own doctor (17 percent) and having a plan that covers a wide range of services (12 percent) rise slightly higher than other factors.

Cost Both Most Liked And Least Liked Aspect Of Americans’ Health Insurance Policies

Asked specifically what they like best about their policy, a third of the insured (34 percent) mentioned cost-related factors like low out of pocket expenses or low premiums and a quarter (26 percent) named comprehensive benefits and prescription drug coverage.

FIGURE 15: In Their Own Words: What do you like BEST about your current health insurance policy? Cost-related (low out of pocket expenses/not too expensive, affordable/someone else pays for it/low premiums/other) – 34% “The co-pay is really low and the premiums are low.” “That it doesn’t cost me anything and it’s 100% provided by my employer.” “I have an out of pocket max.” Coverage-related (good benefits and coverage, provider choice, covers prescription drugs) – 26% “I have access to a selection of doctors without referrals.” “It covers almost all of the costs of my prescriptions.” “They cover a lot more than you think they are going to cover.” Factors related to insurance company (satisfied with insurance company, little paperwork) – 14% “Don’t have to fill out a whole lot of paperwork.” “I like the statement of benefits they send me and my medical flexible spending and the co-pay statement. I like that they give me that information and I do not have to hunt it down.” Glad I have coverage/Meets needs – 11% “I’m just happy to have coverage.” Access to health care – 3% “Having easy access to a doctor.”

While many seem to enjoy low costs as the best feature of their plan, a similar share name high costs as the worst feature. A third of the insured (33 percent) say that high cost sharing or rising premiums are the things they like least about their policy, a figure that rises to two-thirds (63 percent) among those who purchase their own insurance.