Tuesday, October 22, 2013

Washington Post-ABC Poll Latest to Show Increasing Popularity of Obamacare

Continuing a trend that I began discussing here, the latest Washington Post-ABC News poll shows an uptick in support for the Affordable Care Act (aka Obamacare). Three times in 2013 has the Post-ABC asked the question, "Overall, do you support or oppose the federal law making changes to the health care system?" Here are the results...


According to this Post article accompanying the poll, "Support has rebounded since July among moderate and conservative Democrats, while Republican opposition has also softened."

The improvement may only seem like a few percentage points. However, the fact that two other recent polls -- NBC/Wall Street Journal and Democracy Corps -- have also shown an uptick in support for the ACA suggests the change is likely authentic (for now, at least).

The rise in support seems surprising in the context of difficulties with the federal website for people to sign up. However, some of the state websites (where such are available) seem to be working well.

The larger driver of public opinion toward Obamacare may be the unpopularity of the Republicans' actions during the recent federal-government shutdown. Paradoxically, in seeking to register their staunch opposition to the ACA, the GOP may actually have made it more popular! It is perhaps for this reason that former Florida Gov. Jeb Bush, a Republican, was calling on his party to exercise more "self-restraint."

Monday, October 21, 2013

Demographic Differences in Pew Poll

The Pew Research Center is out with a new poll (in the field October 9-13), gauging public reactions to the second week of the roll-out of the online Obamacare marketplaces. The overall sample views the roll-out unfavorably. To the question "How well are online health insurance exchanges working?," 46% answered not too well or not at all well, whereas only 29% said very or fairly well (the rest said "don't know"). Young adults (18-29), who are getting a lot of media attention on the health-care issue, are split at 37-37 between the relatively favorable and unfavorable responses.

Uninsured people with incomes too high to qualify for Medicaid need to consult the exchanges in order to fulfill the individual mandate to have health insurance. Some people with insurance may be interested in whether the exchanges offer a better deal that what they currently pay. The survey found that nearly two-thirds of the uninsured either have visited (22%) or plan to visit (42%) the exchanges; however, with the subsample of uninsured people numbering only 181, the margin of error is around +/- 7, a wider-than-usual interval. Among those with insurance, around one-third either have visited (12%) or plan to visit (19%). An interesting, even paradoxical finding is that:

Among those who have visited an exchange website, more say the exchanges overall are not working well by a 56%-37% margin. Yet when asked about their own experience on an exchange website, a 56% majority say they personally found the site to be very or fairly easy to use, while 40% say it was difficult to use.

Wednesday, October 16, 2013

Democracy Corps Poll Shows Good News for ACA Supporters

Democracy Corps, a polling/advising group headed by Democratic Party stalwarts Stan Greenberg and James Carville, has released a new health care survey in conjunction with the organization Women's Voices, Women's Vote (hat tip to Political Wire). Although clearly party-aligned, Democracy Corps has a good record for accuracy, nailing President Obama's four percentage-point victory margin last year over Mitt Romney. The newly released health care poll was in the field October 6-8, coinciding with the early stages of both the roll-out of the Obamacare online exchanges and the government shutdown. To see the full set of poll results, go here first. You'll then be able to click on links for results in the form of memos, the questionnaire, and graphs.

The report is entitled "38 Percent," referring to the estimated proportion of American voters who "clearly oppose the Affordable Care Act." Democracy Corps presents results for both its total sample (which appears to be comprised of registered voters) and a likely-voter sample. The results are very similar for the two samples, so I'll just cite figures for the total sample.

On the initial item assessing attitudes toward "the health care reform law that passed in 2010," support and opposition each drew 45% of respondents. However, subtracting respondents who answered on a subsequent question that they opposed the ACA because it "doesn't go far enough," one ends up with the aforementioned figure of 38% assumed to dislike Obamacare for conservative reasons.

Several other findings are worth noting:
  • Despite the tendency of some to jump to quick conclusions, the American public seems in large part to hold a wait-and-see attitude toward the ACA. Among four possible answer choices on current perceptions of the law, 46% of respondents said it was "too early to tell" how things would turn out, 20% saw it as making things "harder for me," 17% said they could not yet see any ways in which the law was helping, and 14% were "beginning to see benefits."

  • Positive shifts in attitude toward the ACA were seen in several subgroups from 2010 to the latest poll. For example, White voters without a college education, who have been generally hostile to Obama, have gone from hating the law in 2010 (opponents outnumbering supporters by 31 percentage points) to merely being in sizable opposition (opponents being more numerous by 18 percentage points). White older women have gone from -23 to only -4. And groups that were moderately supportive have become wildly supportive, such as unmarried women, who shifted from +9 to +29.

  • Good will toward the ACA appears premised to a large extent on the idea that the law can and will be refined and improved over time. That is how I read the results of a mini-experiment embedded within the Democracy Corps survey, at least. Some respondents were asked to choose between "We should implement and fix the health care reform law" and "We should repeal and replace the health care reform law." The clear winner was the "implement and fix" alternative, 58-38 percent. However, when the choice (given to a different set of respondents) was between "We should implement the health care reform law" (without reference to fixing the law) and "We should repeal the health care reform law," repeal was preferred 51-46.

This new Democracy Corps/Women's Voices, Women's Vote poll follows two other recent ones seemingly showing an upturn for the ACA: a late September survey by The Morning Consult/Survey Sampling International; and an NBC/Wall Street Journal poll showing that the amount by which the ACA was "underwater" (percentage saying it was a "bad idea" exceeding the percentage saying it was a "good idea") had shrunk from 13 percentage points in September to only 5 percentage points in October.

Whether people really are becoming more favorable toward the ACA/Obamacare is questionable, especially with the prolonged difficulties people are having using the websites to sign up. Another possibility is that the disrepute into which the Republicans have fallen over the government shutdown has transferred over into disdain for positions held by the GOP (such as opposition to Obamacare).

Friday, October 11, 2013

First Polling Results on Roll-Out of Exchanges

Based on news reports since the October 1 opening of the online health-insurance exchanges, two dominant -- and likely inter-related -- themes have been the high volume of response and the technical glitches plaguing the federal exchange site, healthcare.gov. Where governors opted to have their respective states create their own exchanges rather than having their citizens use the federal site as a fallback, there seems to be variation in how smoothly the websites are working (compare, for example, New York to Maryland).

Here at the Health Care Polls blog, we're interested in public opinion toward, and reaction to, the Affordable Care Act and its component parts, such as the exchanges (also known as marketplaces). And we now have what is, to my knowledge, the first major survey on the topic, from AP-GfK. The poll was conducted from October 3-7, thus gauging immediate reaction to the unveiling of the exchanges. A Huffington Post article on the poll is available here, whereas the AP-GfK technical report is here.

AP-GfK surveyed 1,227 adults, for which the margin of error (MoE) is said to be 3.4 percentage points for the 95% confidence level. According to the Huffington Post article:

Overall, the poll found, 40 percent of Americans said the launch of the insurance markets hasn't gone well, 20 percent said it's gone somewhat well and 30 percent didn't know what to say. Just 7 percent said the launch had gone "very well" or "[extremely] well."

(The article had a typo about the final 7 percent, which I corrected based on the technical report.)

Seventy-six individuals from the original 1,227 respondents, or 7%, reported that they or someone in their household had "tried to sign up for health insurance coverage through this market." With the stated 3.4% MoE around the 7% estimate, we could say (assuming accurate responses) that between 3.6 and 10.4 percent of the U.S. public as a whole had tried the exchanges.

However, the MoE varies slightly depending on whether the sample is relatively evenly divided on an issue (e.g., 50/50, 55/45) or relatively unanimous (e.g., 90/10), with the margin being smaller (more precise) the closer to unanimity. My impression is that pollsters usually report the MoE assuming a 50/50 breakdown on the survey items, so if AP-GfK did so, then the MoE around the 7% who claimed to have used the exchanges would be tighter than 3.6 to 10.4 percent.*

Those 76 exchange users were asked a variety of questions. Quoting from the above-linked Huffington Post article, "Among those who've actually tested out the system, three-quarters of those polled said they've experienced problems trying to sign up. Only about 1 in 10 succeeded in buying health insurance." As the same article notes, however, the MoE for responses of just these 76 people is a whopping +/- 13.5%. Now that AP-GfK has provided an initial estimate of the proportion of Americans using the exchanges, they and other pollsters might consider obtaining oversamples of exchange users in future surveys, so that estimates from this group can have greater precision.

One area in which the AP-GfK poll appears to be somewhat out-of-whack is the 37% job-approval rating for President Obama, compared to other polls from around the same time that peg the President's approval between 40-51%. Assuming that attitudes toward the Affordable Care Act and the exchanges are correlated with support for Obama, then evaluations of the ACA and exchanges may be biased somewhat in a negative direction by the AP-GfK poll.

*The margin of error with 95% confidence is calculated from:

+/- 1.96 X square root (pq/n)

where p = the percentage of respondents who answered in one way (e.g., "yes" on a yes/no question), q = the percentage who answered with the other choice, and n = sample size. (Readers with some statistical training may recognize +/- 1.96 as the values that cut off the upper and lower 2.5% of the "bell curve" distribution, thus leaving 95% of the distribution.)

Using the AP-GfK's reported sample size of 1,227, a 50/50 division on a question (i.e., p and q each equal .50), would yield a margin of error of:

1.96 X square root (.25/1,227) = .028 or 2.8%

(I do not know why there is the slight discrepancy between AP-GfK's reported MoE of 3.4% and my calculation of 2.8%; if AP-GfK has a cluster-sampling component to its work, that would raise the MoE.)

Anyway, using the conventional MoE formula with a breakdown of .07 and .93 for usage vs. non-usage of the health-insurance exchanges, the calculation is...

1.96 X square root (.065/1,227) = .014 or 1.4%

An online margin-of-error calculator, which corrects for population size, is available here. You might enter 200,000,000 for the population size, which is roughly how many adults there are in the U.S. With any large population, the middle term in the larger equation tends toward 1, so has no effect when used to multiply the other elements of the equation.

Wednesday, October 2, 2013