Kaiser Health Tracking Poll - June 2017: ACA,

Replacement Plan, and Medicaid

Jun 23, 2017 | Ashley Kirzinger, Bianca DiJulio, Liz Hamel, Bryan Wu, and Mollyann Brodie
Follow @Mollybrodie on Twitter

KEY FINDINGS:

As the Senate prepares to hold a vote on a plan to repeal and replace the Affordable Care
Act (ACA), a majority of Americans say they have an unfavorable view of the plan (55
percent) while three in ten have a favorable view. In the past month, support for the
replacement plan has decreased among Republicans (from 67 percent in May to 56
percent currently) and among supporters of President Trump (from 69 percent to 55
percent).
Over the past year, Kaiser Health Tracking Polls have found a modest increase in support
for the ACA and this months poll finds about half of the public (51 percent) expressing
favorable views of the ACA while 41 percent hold an unfavorable view. This is the first
month that favorability has tipped over the 50 percent mark since Kaiser Family
Foundation began tracking attitudes on the law in 2010 and continues the trend found last
month with the public more favorable towards the ACA than the replacement plan (51
percent vs. 30 percent).
Large shares of the public overall, and majorities across parties, support the federal
governments role in prohibiting health insurance companies from charging individuals
with pre-existing conditions more for their coverage and requiring health plans to cover a
certain set of benefits, while fewer would want to turn these decisions over to the states.
Few Americans, regardless of party identification, say repealing and replacing the 2010
Affordable Care Act should be the most important priority for President Trump and
Republicans in Congress (7 percent of Democrats, 9 percent of independents, and 8
percent of Republicans). Another two in ten (22 percent) say it is very important but not
the most important priority. Republicans are much more likely to see repealing the ACA
as a very important or top priority (50 percent) than Democrats (18 percent) or
independents (28 percent).
The majority of the public regardless of partisanship hold favorable views of
Medicaid, the government health insurance and long-term care program for low-income
adults and children. Three-fourths (74 percent) of the public say they have a favorable
view of the program, including four in ten (37 percent) who have a very favorable
view. In addition, six in ten say the program is working well for most low-income people
nationally (61 percent) and seven in ten say the program is working well for most low-
income people in their state (67 percent).
 When asked about proposed changes to the Medicaid program, a majority of the public
support allowing states to impose work requirements on non-disabled adults (70 percent)
or drug testing as a condition of enrollment (64 percent). However, fewer support
changes that would cut funding or alter the funding structure. For example, about one-
third support reducing funding for Medicaid expansion or limiting how much money each
state gets from the federal government each year.
The public is more likely to blame health insurance companies rather than the actions of
the current or previous administration for insurers deciding not to sell insurance in certain
ACA marketplaces. About four in ten (42 percent) say the problems are mainly due to
profit-driven decisions by health insurance companies while fewer say the problems are
due to either the way the law was designed by the Obama administration and Democrats
in Congress (28 percent) or uncertainty brought on by the actions of President Trump and
Republicans in Congress (22 percent).

Affordable Care Act vs. Replacement Plan

With the U.S. Senate currently discussing a plan to repeal and replace the Affordable Care Act
(ACA), the most recent Kaiser Health Tracking Poll examines the publics attitudes towards this
proposed legislation as well as the 2010 Affordable Care Act it seeks to replace.

Most of The Public Views The ACA Replacement Plan Unfavorably

The June Kaiser Health Tracking Poll finds a majority of Americans (55 percent) continue to
hold unfavorable views of the replacement plan, while three in ten say they have a favorable
view. Similar to last month, an enthusiasm gap persists with a larger share saying that they have
a very unfavorable view (38 percent) than saying they have a very favorable view (11
percent). Democrats overwhelmingly say they have an unfavorable view of the replacement plan
(85 percent) and more independents say they have an unfavorable view than a favorable view (52
percent vs. 30 percent). On the other hand, more Republicans say they have a favorable view
than an unfavorable view (56 percent vs. 25 percent).
Figure 1: Majority of the Public Holds Unfavorable View of the ACA Replacement Plan

A Decrease in Support for the ACA Replacement Plan Among Republicans

Last months survey found that the ACA replacement plan had solid support among the
Republican base with two-thirds of Republicans saying they had a favorable view of the plan.
This months survey finds an 11 percentage point decrease in support among Republicans, with
56 percent of Republicans now saying they have a favorable view of the Republican
replacement plan. There is also a decrease in support among those who say they approve of
President Trump (from 69 percent to 55 percent). The share of Democrats and independents who
view the replacement plan favorably has remain unchanged (8 percent and 30 percent,
respectively).
Figure 2: Amid Senate Discussions, Fewer Republicans and Trump Supporters Now Hold
Favorable Views of the Replacement Plan

ACA is Viewed More Favorably than the Replacement Plan

In addition, the public is more likely to express a favorable view of the ACA than of the plan to
repeal and replace the ACA. Half (51 percent) of the public view the ACA favorably compared
to three in ten who view the replacement plan favorably.
Figure 3: More View the ACA Favorably than View the Replacement Plan Favorably

While attitudes towards both the ACA and the Republican replacement plan are driven by
partisanship, there is a partisan intensity gap. About half of Democrats (53 percent) have a very
favorable view of the ACA, while far fewer Republicans about one-fifth (21 percent) have a
very favorable view of the Republican replacement plan.
Figure 4: While Attitudes Toward ACA and Replacement Plan Are Driven by Partisanship,
There Is a Partisan Intensity Gap

Views of the ACA Over Time

Over the past year, Kaiser Health Tracking Polls have found a modest increase in support for the
ACA. This months poll finds about half of the public (51 percent) expressing favorable views of
the ACA this is the first month that favorability has tipped over the 50 percent mark since
Kaiser Family Foundation began tracking attitudes on the law in 2010 and an increase of nine
percentage points since June 2016.
Figure 5: More of the Public Have Favorable Views than Unfavorable Views of ACA

More Americans Think They will be Better Off if Obamacare remains the Law of the Land

A larger share of the public (50 percent) think they and their family will be better off if the ACA
remains the law of the land than think they will be better off if the ACA is repealed and replaced
with the Republican plan (36 percent). There are distinct party differences with three-fourths (74
percent) of Republicans saying they will be better off with the Republican alternative while eight
in ten Democrats say they will be better off under the ACA. Independents remain in the middle,
but still a larger share say they and their families will be better off under the ACA (50 percent)
than under a Republican alternative (35 percent).
Figure 6: Partisans Differ on Whether Their Families Will Be Better off if ACA Is Repealed or if
It Remains Law

Few Support Proposed State Waivers

Majority of the Public Opposes Two Fundamental Changes to Health Insurance System

While the Senate continues working on their version of plan to repeal and replace the ACA, this
months Kaiser Health Tracking Poll examines attitudes towards possible changes to the health
insurance system that would allow states to apply for waivers to federal requirements that
prohibit insurance companies from charging people with pre-existing conditions more than
others for their health insurance and that require health insurance plans to cover a specific set of
benefits.

Majority of the Public Opposes State Waivers To Allow Insurers to Charge More for Those with Pre-Existing
Conditions

The pre-existing condition waiver would allow states to permit insurers to charge people with
pre-existing health conditions a higher rate if they dont maintain continuous coverage. Seven in
ten say the federal government should continue to prohibit health insurance companies from
charging individuals with pre-existing health conditions more for their coverage while one-fourth
(26 percent) say that states should be able to decide whether insurers can charge people with pre-
existing conditions more. A majority of Democrats (84 percent), independents (68 percent), and
Republicans (59 percent) want continued protection for people with pre-existing conditions from
the federal government.

Figure 7: Majorities Across Partisans Want Continued Protection for People with Pre-Existing
Conditions
Individuals Living in Households Without Pre-Existing Conditions

One of the purposes of allowing insurers to charge individuals with pre-existing conditions more
if they have not had continuous coverage is to reduce health insurance costs for individuals
without pre-existing conditions. Yet, the Kaiser Health Tracking Poll finds that even among
those who are living in households without an individual with a pre-existing condition, a
majority support continued federal protections.
Figure 8: Majority of Those in Households Without Pre-Existing Conditions Want Continued
Federal Protection

Majority of the Public Opposes State Waivers To Allow Insurers to Waive Essential Health Benefits

Another type of waiver that was included in the House-passed version of the ACA replacement
plan would allow states to modify the essential health benefits provision of the ACA, meaning
health insurance companies could sell plans that cover fewer benefits than are currently required
by federal law. The poll finds support for the status quo with two-thirds of the public saying they
want the federal government to continue to require health insurance companies to cover a certain
set of benefits while about three in ten (31 percent) say states should be able to decide whether
insurers can sell plans that cover fewer benefits than currently required. There are party
differences with a large majority of Democrats supporting the status quo (81 percent) compared
to fewer, but still a majority, of independents (65 percent) and Republicans (52 percent).
Figure 9: More Support Status Quo for Essential Benefit Coverage than Support Allowing States
to Decide

The Politics of Health Policy

Few Think Repealing and Replacing the ACA Should Be the Top Priority for President
Trump and Republicans in Congress

The most recent Tracking Poll finds few Americans, regardless of party identification, say
repealing and replacing the 2010 Affordable Care Act should be President Trump and
Republicans in Congress most important priority (7 percent of Democrats, 9 percent of
independents, and 8 percent of Republicans). Another two in ten (22 percent) say it is very
important but not the most important priority. Among Republicans, half say it is either the
most important priority or a very important priority but not most important. Six in ten
Democrats (58 percent) say repealing and replacing the ACA should not be a priority while a
four in ten independents (42 percent) say it should be one of many priorities for Trump and
Republicans in Congress.
Figure 10: Few Americans, Regardless of Party Identification, Say Repealing and Replacing
ACA Should be the Most Important Priority

Politics of Voting for or Against the Republican Replacement Plan

While the future of the Republican replacement plan for the ACA is unclear, it is evident that
there may be political consequences for Senators and Representatives voting on the plan. When
asked how their own representatives vote on the Republican replacement plan could affect their
support for that individual, nearly one in three say their representatives vote (either for or
against) would have no effect on their likelihood of supporting them. Yet, about half of
Democrats say they would be more likely to support a representative who voted against the
Republican replacement plan (51 percent) while six in ten (61 percent) Republicans saying they
would be more likely to support a representative who voted for the Republican plan to repeal
and replace the ACA. Independents are more divided on how their representatives vote could
impact their support. About one-third of independents saying they are more likely to support a
representative who voted against the Republican replacement plan (35 percent) which is similar
to the share (30 percent) who say they are less likely to support them if they voted against it.
Figure 11: Support for Representatives Vote on Republican Replacement Plan Largely Driven
by Partisans; Independents Are Divided

While a majority of Republicans say will be more likely to support a representative who votes
for the Republican replacement plan, it is less clear how a vote against the plan would affect
support. Half of Republicans say that if their elected representative votes against the replacement
plan, they would either be more likely (16 percent) to support them or it would have no effect
on their support (35 percent), compared to 46 percent who say they would be less likely to
support.
Figure 12: Half of Republicans Say If Their Rep. Votes Against the Republican Plan, They
Wouldnt Be Less Likely to Support Them

Possible Next Steps for Health Care Reform

If the most recent repeal efforts do not pass Congress, the public is divided on what they want
President Trump and Republicans to do next, with similar shares saying they want lawmakers to
keep working on a plan to repeal and replace the ACA (49 percent) as say they want them to stop
working on health care and move on to other priorities (45 percent).
Figure 13: Republicans Want to Keep Working on Replacement Plan; Democrats Want to Move
on and Independents Are Split

While Republicans are not overwhelmingly in favor of the ACA replacement plan, a large
majority of them (80 percent) want President Trump and Republicans in Congress to keep
working on a plan to repeal and replace the 2010 health care law if the replacement plan does not
pass. This is compared to two-thirds of Democrats (67 percent) who want them to stop working
on health care and move on to other priorities. Independents are divided with similar shares
wanting them to keep working on replacement plan (49 percent) as want them to stop working on
health care and move on to other priorities (45 percent).

Medicaid

As part of the ongoing discussions about repealing and replacing the ACA, Republicans have
proposed significant cuts and changes to the current Medicaid program.

Large Majority of Americans Have Favorable View of Medicaid

Unlike attitudes towards the ACA or the Republican replacement plan, the public is less divided
in their attitudes towards Medicaid, the government health insurance and long-term care program
for low-income adults and children. Three-fourths (74 percent) of the public say they have a
favorable view of the program, including four in ten (37 percent) who have a very favorable
view. About one-fifth (19 percent) of the public reports an unfavorable view of Medicaid,
including a larger share of Republicans (31 percent) than Democrats (11 percent).

Figure 14: Majorities Across Partisans View Medicaid Favorably

In addition, six in ten of the public say the program is working well for most low-income people
in the nation, overall (61 percent) and two-thirds say the program is working well for most low-
income people in their state (67 percent). Majorities of Democrats, independents, and
Republicans say Medicaid is working well both in the nation, overall (68 percent, 62 percent, and
52 percent, respectively) and in their state (72 percent, 68 percent, and 59 percent, respectively).
Figure 15: Majorities Across Partisans Say Medicaid Is Working Well for Most Low-Income
People Covered by the Program

Four in Ten Are Aware House-Passed Replacement Plan Makes Major Reductions to Medicaid Spending

With the reduction in Medicaid spending largely not in the focus of discussions surrounding the
ACA replacement plan, the survey finds about four in ten (38 percent) are aware that the House-
passed replacement plan makes major reductions to federal funding for Medicaid over the next
ten years. An additional one-fourth (27 percent) say the health care plan makes minor
reductions to Medicaid, while 13 percent say it makes no reductions. A considerable share
(20 percent) say they dont know if the replacement plan makes any reductions to federal
funding for Medicaid or not.
Figure 16: Four in Ten Are Aware the House-Passed Replacement Plan Makes Major Reductions
to Medicaid

Attitudes Towards Proposed Changes to Medicaid

Currently Congress and the Trump administration are discussing changes to Medicaid and may
allow more state flexibility around how the program is operated and who is eligible. The June
Kaiser Health Tracking Poll finds a majority of the public support allowing states to impose
work requirements for non-disabled adults (70 percent) or drug testing as a condition of
enrollment (64 percent). However, fewer support changes that would cut funding or alter the
funding structure, such as imposing limits on the length of time people can be enrolled in the
program (36 percent), reducing funding for Medicaid expansion (36 percent), changing the
funding structure to limit how much money each state gets from the federal government each
year (35 percent), or stopping federal Medicaid payments to Planned Parenthood for one year (30
percent). Even fewer (21 percent) support limiting federal funding for Medicaid coverage of
long-term care for seniors and people with disabilities.
Figure 17: Large Support for Work Requirements and Drug Tests, Fewer Support Other
Proposed Changes to Medicaid

Republican Support for Most Proposed Changes to Medicaid

The majority of Republicans support most of the proposed changes to the Medicaid program
including large majorities who support allowing states to impose work requirements (82 percent)
and drug test requirements (82 percent). Fewer but still a majority of Republicans support
changing the funding to a per capita cap system to limit federal spending (62 percent), allowing
states to impose length-of-time restrictions (59 percent), and stopping federal payments to
Planned Parenthood for one year (54 percent). A majority of Democrats (56 percent) and
independents (77 percent) support allowing states to impose work requirements and a majority of
independents also support allowing states to impose drug test requirements (65 percent). Few
regardless of party identification support limiting federal funding for Medicaid coverage of
long-term care for seniors and people with disabilities.

Table 1: Republicans More Likely to Support Proposed Changes to Medicaid

Percent who support the following specific
changes to Medicaid currently being Democrats Independents Republicans
considered by Congress and the
Administration:
Allowing states to require adults without
disabilities to work or be looking for work
56% 77% 82%
in order to get health insurance through
Medicaid
Allowing states to require individuals to get
a drug test before they are able to get and 47 65 82
keep health insurance through Medicaid
Allowing states to impose limits on the
length of time people can get health 19 34 59
insurance through Medicaid
Reducing the federal funding that was
included in the 2010 health care law for 25 35 51
states that expanded Medicaid
Changing the funding for Medicaid to limit
how much money each state gets from the 17 32 62
federal government each year
Stopping federal payments to Planned
Parenthood clinics for one year for health
14 29 54
care services provided to people on
Medicaid
Limiting federal funding for Medicaid
coverage of long-term care for seniors and 14 20 28
people with disabilities

Support for Medicaid Regardless of Whether Their State Expanded Medicaid

As noted in previous Kaiser Health Tracking Polls1, Medicaid is popular among individuals
living in states that have expanded their Medicaid program as well as those that have not. For
example, as seen in the interactive below, 73 percent of individuals living in states without
Medicaid expansion have a favorable view of the Medicaid program, 64 percent say Medicaid is
working well in their state, and 61 percent say the program is working well in the nation overall.
In addition, about one-third (35 percent) are aware that the House-passed Republican
replacement plan makes major reductions to Medicaid spending.
Large Majorities View Medicaid Favorably, Say it is Working Well
Health Insurance Marketplaces

Over the past several weeks, there has been considerable attention given to decisions by health
insurers to no longer sell insurance in some ACA marketplaces. Based on current insurer rate
filings and news reports, its estimated that 48 counties (35,894 enrollees) are currently expected
to have no insurer on the ACA marketplaces in 2018.2

Despite this impact being limited to a select number of counties and not affecting those with
employer sponsored insurance, four in ten (43 percent) of the public believe that health insurance
companies choosing to not sell insurance plans in certain marketplaces will have a negative
impact on them and their families, while about half say they dont think it will have any impact
on them.

Figure 18: Half Think Health Insurance Companies Leaving the ACA Marketplaces Will Have
No Impact on Them and Their Families

Americans are divided on how well they think the health insurance marketplaces are working
with more than half (54 percent) saying the health insurance marketplaces are working well in
their state and nearly half (46 percent) saying they are working well in the nation, overall. These
findings are relatively unchanged from the April 2017 Kaiser Health Tracking Poll.3
Most Democrats say the marketplaces are working well in their own state (67 percent) and
nationally (61 percent). More Republicans say the marketplaces in their own state are working
well (35 percent) than nationally (26 percent). Independents are divided with 56 percent saying
they are working well in their own state and about half (47 percent) saying they are working well
in the nation overall.

Figure 19: Democrats Are More Positive in Views of How Marketplaces Are Working

Public is Most Likely to Blame Insurers for ACA Marketplace Problems

When asked who is to blame for the current problems affecting the ACA marketplaces, about
four in ten (42 percent) say the problems are mainly due to decisions by health insurance
companies driven by profits while fewer say the problems are due to either the way the law was
designed by the Obama administration and Democrats in Congress (28 percent) or uncertainty
brought on by the actions of President Trump and Republicans in Congress (22 percent).
Republicans are more likely to place blame on the Obama administration and Democrats in
Congress (57 percent), while about half of Democrats (51 percent) blame the problems on profit-
driven decisions by insurance companies.
Figure 20: Democrats, Independents More Likely to Say Problems with ACA Marketplaces Are
Due to Decisions by Insurance Companies

This article courtesy of the Kaiser Family Foundation