Health Reform Polls Are Inconsistent and Confusing. Should We Still Pay Attention?

by Anthony Wilson, California Healthline Contributing Editor

TOPIC ALERT:

Which one of the below scenarios is most true?

    A.) The Affordable Care Act is an increasingly unpopular law among U.S. residents.

    B.) The ACA is a wildly popular law, with many provisions garnering overwhelming approval.

    C.) U.S. residents know very little about the ACA.

"A" is a good answer, given that a Gallup poll released late last month found that 52% of respondents disapprove of the law, while 44% support it. A similar poll by Gallup last year found that 45% of respondents disapproved of the law and 48% approved.

"B" is also a good option. Polls from the last three years have consistently shown that while many U.S. residents dislike the ACA itself, they overwhelmingly favor most of its provisions.

Most recently, the Kaiser Family Foundation's March 2013 tracking poll found that respondents favored all but one of the law's major provisions and more than half of those garnered support greater than 70%. And no surprise, the individual mandate was the least popular provision. Meanwhile, a Reuters/Ipsos poll conducted in the days before the Supreme Court upheld the ACA last summer found that "strong majorities" favored most of the provisions in the law. Even more surprising, the poll found that most provisions were popular even among respondents who identified as Republicans.

There's also a convincing argument for choosing "C." Another Gallup poll released just a few weeks ago found that more than four in 10 uninsured U.S. residents are not aware that they will be required to purchase health insurance beginning Jan. 1 under the ACA's individual mandate.

Given those arguments, the answer might very well be: "D.) All of the above." The seemingly ambiguous and incongruous results from polls measuring reaction to the ACA brings up a valid question: Why should we pay attention to them?

No Reason To 'Throw Away' Polls

Ambiguity is no reason to "throw away the polls," Julie Phelan, senior research analyst at Langer Research Associates, tells California Healthline. In fact, Phelan says the results might not be as "logically inconsistent" as they seem at first glance. Phelan's firm conducts research for ABC and Bloomberg News, among other clients.

"If you look at the provisions that people support overwhelmingly, they're things ... with no cost," Phelan says, adding, "If you ask, 'Do you support allowing children to stay on their parent's insurance plans until they're 26,' people will say, 'Of course -- How's that going to hurt me?'"

Cost comes into play with the individual mandate. "That's why you see the disconnect between what people say about the law overall -- they think of the ACA as the individual mandate," she says.

Phelan also discounts the notion that U.S. residents know little about the law. She notes that many people learn about the law in "brief snippets" from the news or a pundit. As a result, the way many U.S. residents "think or know about the Affordable Care Act is different than ... policy wonks think and know about the ACA."

Despite Confusion, Wisdom in the Results

Polling experts say that despite the confusion, there is wisdom in the results.

Mollyann Brodie -- senior vice president for executive operations and director of public opinion and survey research for the Kaiser Family Foundation, which produces a series of tracking polls on the ACA -- notes that public opinion on the law has been "unbelievably stable" since it was enacted. "If you look at the data from the beginning, Democrats have liked this law from the beginning, they still do. Republicans have not liked it from the beginning, they still don't," she says.

Although there has been a slight uptick in the law's unpopularity, Brodie notes much of that change has been because many independents are shifting from a favorable view of the law to what she calls a "don't know position," where perhaps the lack of clarity surrounding the ACA has caused them to view the law less favorably.

Brodie says that consistency shows the public is still viewing the law through a political context, as opposed to from a policy perspective. She adds, "If you didn't have all this public polling data, we wouldn't even understand the extent to which this law, at least in its most nebulous, big-term way, is being viewed only through a partisan lens."

Clarity Might Be Wait-and-See

Will polling on the ACA ever become clearer?

Brodie predicts that public opinion on the law might become more definitive once U.S. residents start viewing the law through a consumer lens. She says there are plenty of "legitimate questions" surrounding the law that have not yet been answered -- such as whether the law makes health care more affordable, if people are gaining access to coverage, and whether emergency department visits are being prevented, among other things -- both because partisanship has clouded people's views of the law and many of the law's provisions have not yet taken effect.

How will we know if those things are happening?

Brodie says there is only one way: "We'll have to keep tracking people's opinions."

Weekly Roundup

Here's a look at what else is making news in the world of health reform.

Hospitals drop out of pilot program: In her "Health Reform Watch" column in the Washington Post's "Wonkblog," Sarah Kliff examines why some hospitals are dropping out of the ACA's Pioneer Accountable Care Organization. Kliff features Austin-based Seton Health Alliance, which "invested millions moving to a value-based system," only to abruptly quit the program and switch to another federal program with "a bit more flexibility."

Amid delays, an acceleration: In a Kaiser Health News/Washington Post collaboration, Jordan Rau examines the acceleration of an Affordable Care Act program that ties a portion of physicians' Medicare reimbursements to the quality of their care.

Laughing toward enrollment: In Reuters, Roberta Rampton reports on a White House effort to recruit the comedy website "Funny or Die" to help promote the ACA. Senior administration officials think the site can help encourage young, healthy individuals to enroll in the ACA's health insurance exchanges, which experts say is key to the success of the law.

Hrant Kouyoumdjian
A fundamental premise of any researched finding, poll, or survey to be credible is the transparent disclosure of underlying methodologies, hence whether comparisons with other “findings” are conforming. Sadly most non-scientifically footed media outlets keep “reporting” new studies/polls at nausea without referenced benchmarks for adequately explaining assumptions inherent in often policy driven/funded findings. Phelan and Brodie are right wrt poll internals. Context and phrasing are key variables as is sampling methodology in polls. Poll question (A) is negatively biased toward ACA with its “increasingly unpopular” adjective. (B) Is positively biased with “wildly popular” and is inconsistent with the 3 years of polling showing dislike; unless different poll designs/questions are being compared/rationalized for the inconsistency. (C) Is negatively biased with “know very little;” a more neutral question is: “Do US citizens know about the ACA?” With open follow up: “What do you know ..?”
Patrick Hagan
When you have a product, Covered California, that consumers feel that they don't need, don't want, or don't understand, then you spend $300 million to convince them that they do need it. When you have a product that consumers want, like the final Harry Potter book, "Harry Potter and the Deathly Hallows", then they pre-order 2 million books through the Amazon website in just in 6 months. Global Marketing firms Weber Shandwick and Ogilvy Public Relations should understand such a simple concept.

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