Health Status of ACA Enrollees by Sign-Up Month

Using their daily-tracking surveys since October 1, 2013, the operators of the Reuters/Ipsos Poll have been able to characterize trends in health status of people who have been signing up for insurance through the Affordable Care Act/Obamacare exchanges (hat tip to HuffPollster). In October, 69% of ACA enrollees who participated in the Reuters/Ipsos surveys claimed to have some significant health issue, whereas 31% reported none. The trend began shifting in November, however, with 55% of that month's enrollees claiming a health issue and 45% not. For January (which is less than half over), the numbers have reversed: 60% of this month's enrollees now report no major health issue, and 40% do. This development is important because, in order for insurance companies to cover the treatment of the sickest of its policyholders, they need a large volume of healthy subscribers to pay into the system without needing as much treatment.

Two Brief Items

The Republican-associated polling firm Public Opinion Strategies offers "Five Observations from Four Years of Polling Data on Obamacare" (via HuffPollster).  

The Washington Post's "Wonk Blog" notes that public interest in Obamacare seems to be declining, for the moment at least, as indicated by less Google activity and press coverage lately than during the fall (via Daily Kos). One possibly discussed by Wonk Blog is that enrollment under the Affordable Care Act is going relatively smoothly and good news is considered less newsworthy than bad news.

December Trends in Obamacare Opinions (2013)

After some brutal polling numbers in November for the Affordable Care Act in connection with the glitch-filled website for signing up and the controversy over President Obama's "If you like your plan..." promise, the December numbers have rebounded a bit, but are still not great. In the remainder of this post, I draw from Polling Report's summary of Health Policy polling and other sources to highlight some key findings from the latest batch of polls.

The November polls with the harshest judgments against the ACA almost certainly were those conducted by CBS News and Quinnipiac University. Below, I've plotted the approval and disapproval numbers for the ACA from the last several polls conducted by CBS News (either with or without its frequent polling partner, the New York Times), the time frame of which encompasses both the original October 1 launch of online sign-ups and the December 1 relaunch. Whereas the absolute levels of approval and disapproval might be somewhat misleading because opposition includes some people on the left who don't think the ACA has enough government involvement, the trends over time seem pretty clear.

In the first three CBS/NYT polls shown (mid-September, early-October, and mid-October), disapproval exceeded approval by roughly 10 percentage points, give or take. In the mid-November poll (Nov. 15-18), the margin had ballooned to 30 points. However, as of the December 5-8 survey, the difference between approval and disapproval is now back to around 10 points.

The November 6-11 Quinnipiac Poll asked respondents if they "believe[d] the problems with the website will be fixed by November 30, or don't you think so?" Whereas 29% of respondents said yes, they thought the website would be fixed, a whopping 61% did not think it would be fixed. The Quinnipiac respondents' pessimism regarding the website did not appear to be well founded, as the functionality of the website does appear to be improving, based upon both news reports and polling results.

Regarding the latter, the early-December CBS/NYT Poll found nearly three times as many people (36%) saying they thought the sign-up process for the Obamacare exchanges was "getting better," than saying it was "getting worse" (13%). Forty-four percent claimed it was "about the same" as before. It is not clear to me if the part of the survey about the website was administered to all respondents or only those who had tried to sign up for insurance via the ACA exchanges. Most Americans already have health insurance and would not need to use the exchanges.

There have been suggestions by some in the media that Obamacare implementation has turned the corner and taken full repeal by the Congress -- whatever its chances were in the past -- off the table now. In looking at the aforementioned Polling Report compilation on health-policy polls, the only November 2013 poll I could find with a question on repeal was that by CBS News (Nov. 15-18). In this survey, 43% endorsed the view that, "The law has so much wrong with it that it needs to be repealed entirely." That is a very high pro-repeal figure compared to the 2012 presidential exit polls and other previous polls (except for Rasmussen polls, which I think have a strange wording). It must be remembered, though, that the mid-November CBS poll was taken amidst the furor over the malfunctioning website and people losing their existing individual-market coverage.

Based on the small number of December 2013 polls I could find that included a repeal item, support for such a move is back in line with what one would have found prior to the October-November 2013 controversies. Gallup (Dec. 3-4) found 32% of respondents endorsing "repeal the health care law entirely." The NBC/Wall Street Journal Survey (Dec. 4-8) found the following percentage breakdown (original wordings of choices shown):

Is working well the way it is ............................. 4 
Needs minor modifications to improve it ......... 36 
Needs a major overhaul ................................... 31 
Should be totally eliminated ............................. 26

Focusing on the combined percentages who favored minor or major modifications to the ACA, Chris Matthews, host of the nightly MSNBC cable show "Hardball," said the following on his December 12 broadcast:

...after all this negative P.R., all the foul-ups, the screwups, the rollout, the whole thing, and still two-thirds put their heart and their mind on the need to have adequate affordable health care for their families. They don`t like the screwups, but they want the program to work and be fixed. That`s a powerful inducement for Democrats not to turn tail.

Another positive sign for the ACA comes from a recent poll (Dec. 3-8) by the Democratic Party-affiliated group Democracy Corps. The poll was conducted not of the nation as a whole, but of likely voters residing in U.S. House districts deemed "most competitive" for next year's midterm elections (50 Republican-held and 36 Democratic-held). Democracy Corps gave respondents the choice between "implement and fix" vs. "repeal and replace" the ACA. In the 86 districts combined, implement and fix prevailed 49-44 (note that the overall sample is likely GOP-leaning, given that more of the seats are held by Republicans).

Finally, as discussed on HuffPost/Pollster, two somewhat conflicting pictures emerged regarding young adults' views of the ACA. The Harvard Institute of Politics poll of 18-29 year-olds, conducted from October 30-November 11, found generally negative views toward the health care law, including sub-40% approval ratings. In stark contrast, a CNN poll conducted November 18-20 pegs 18-34 year-olds' support for the law at 48% and that doesn't include another 12% who say they oppose the law because it is not liberal enough. In other words, 60% of 18-34 year-olds either like Obamacare or wish more liberal provisions had been enacted, according to the CNN poll.

Included in what Harvard IOP describes as its "5 Key Findings" of this year's poll, "Among the 18-29-year olds currently without health insurance, less than 1/3 say they're likely to enroll in the exchange (13% say they will definitely enroll, 16% say they will probably enroll); 41% say they are 50-50 at the moment." As has been widely discussed in health-policy circles, it is important for large numbers of young, healthy people (sometimes known as the "invincibles") to sign up for health insurance, to balance the costs of treating people with pre-existing conditions who now have greater access to insurance under Obamacare.

In fact, Washington Post policy analyst Ezra Klein argues that the actuarial soundness of the ACA enrollee pool (in terms of age and healthiness distributions) is more important than the total number of people who sign up. Thus, if the Harvard IOP numbers on young people's intent to sign up turn out to be accurate, the ACA could face difficulties.

Resurgent Republic Looks at Self-Insured Voters

The conservative-leaning group Resurgent Republic examines the demographic and attitudinal characteristics of self-insured voters, that is, those who purchased their own (pre-Obamacare) coverage on the individual market, rather than getting it from an employer. Though these individuals appear to have attributes favorable to the Republicans -- well-off economically, more likely to live in suburbs than cities -- they did not support the GOP in 2012 as strongly as they might have. The piece concludes that, "If Republicans can effectively speak to the anxiety caused by Obamacare, they’ll find an attentive audience, especially in battleground 2014 states."

I have a few quibbles and comments on the Resurgent Republic analysis. First, the article notes that, "Three-fourths (77 percent) of those self-insured are either very or somewhat satisfied with their plan." The "anxiety" alluded to above thus would stem from such highly satisfied customers having their policies cancelled. I would have liked to see the breakdown into the separate choices of "very" and "somewhat" satisfied. Second, by some estimates, roughly half of people who had their individual policies cancelled will pay less for replacement policies, which provide greater benefits. Assuming the glitches with the purchasing websites are rectified sometime soon, individual-market voters may not react as negatively to having to change insurance policies as the article suggests. Finally, Resurgent Republic cites "sticker shock" estimates from the Manhattan Institute. The Washington Post's Ezra Klein argues here that the Manhattan Institute figures are flawed.

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...

Post-ABC	July	Sept	Oct
Support	42	42	46
Oppose	49	52	49
Difference	-7	-10	-3

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."

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.

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).