Americans Familiar with Affordable Care Act are its Strongest Supporters

An Ipsos/NPR study shows that opinions vary dramatically as does the understanding of key facts

People have opinions. That’s a fact. In the democratic process, citizens express their opinions directly by voting. In a perfect democracy – the democracy many policy makers and pundits think we live in – citizens make those decisions based on the facts in a well-informed, rational way. Voters ideally should understand the issues and then vote in the way that benefits them and advances their views.

Except, of course, that’s not how it works at all. People often have an incomplete or incorrect view of the facts. Some issues make it tricky to pin down what the “facts” are. More importantly, people have opinions on issues regardless of their knowledge of them.

We partnered with NPR to ask Americans about their opinions of healthcare in the U.S. and the Affordable Care Act specifically. We also quizzed them on several key facts related to the legislation.

Perhaps surprisingly, people who identify as Democratic, Republican or Independent often had similar levels of understanding of the facts. In other words, while both sides of the aisle accuse each other of not knowing anything, it turns out that they’re more often on the same page than not.

If political ideology or affiliation were the only drivers that mattered, then whether or not respondents have the facts straight should be irrelevant. In that case, the results of the opinion questions should look like the national averages regardless of whether people get the fact-based questions correct. That’s not what we see at all, however.

Those who understand the most about the Affordable Care Act (ACA or “Obamacare”) are among the most likely to feel that it has done more good than harm and should be strengthened and expanded. Those who have less knowledge of the facts support the new administration’s desire to repeal and replace the law – or even to repeal it without replacing it. As far as this issue goes, what we see is that the people who know more about the ACA tend to be more supportive, essentially looking more like the Democratic point of view. This suggests that those who identify as Republicans or Independents shift toward supporting Obamacare when armed with certain basic facts.

Do people know about the law because they support it, or support it because they know the facts? We can’t determine causation, but the correlation itself is fascinating.

These are among the findings of an Ipsos/NPR survey of 1,012 American adults. By cross-tabulating the quiz questions and other responses, we can see how the understanding plays into the opinion. Finally, we can also see how media consumption habits and political party identification impact opinions.

In general, Americans understand a lot about the healthcare system here. Three in four correctly answered that most Americans qualify for Medicare when they turn 65, although only 35% know that living in poverty alone does not qualify you for Medicaid. Eight in ten Americans know that we pay more for healthcare than people in other countries and a majority know that the oversized financial outlay doesn’t yield the best results in the world.

Public understanding of the ACA is mixed. Six in ten know that it stopped insurers from being able to refuse coverage to sick people (with pre-existing conditions that can range from cancer to pregnancy). A similar percentage know that it required insurers to cover routine preventive care. However, less than half of Americans (49%) are aware that the number of uninsured Americans has decreased since the ACA’s passage, and fewer (23%) are aware that it has caused government spending on Medicare to decrease.

Q: Since the passage of the Affordable Care Act (Obamacare), has the number of uninsured Americans increased, decreased or stayed the same?

It’s probably not surprising that Americans are ideologically split along party lines on opinion questions like, “the ACA has done more good than harm” and whether the ACA should be “strengthened and expanded,” “left as-is,” “repealed and replaced” or “repealed and not replaced.” Democrats and Independents have a more favorable view of the ACA than Republicans do. Independents support or reject the ACA in percentages that are right in line with the U.S. average. (See Q7)

Q: Which of the following is closest to your opinion?

As mentioned, people who identified with our political parties had a pretty even level of understanding and yet, at a party level, they arrived at different conclusions. This survey approach allows us to see that the knowledge of the issues also appears to be correlated to opinions about the ACA.

For instance, if you were among the 51% of Americans who knew that the ACA lead to more people having insurance, you were nearly twice as likely to think the ACA had done more good than harm. That 51% is much closer to the 58% of democrats who support the ACA.

Those who answered that question correctly were nearly two-to-one in favor of expanding vs. replacing the ACA. They were nearly twice as likely as those who didn’t know this fact to think the ACA should be strengthened. Those who were incorrect were more likely to think it should be repealed and replaced. They were twice as likely as those who got the question right to say it should be repealed and not replaced.

Q: The ACA lead to a decrease in the number of uninsured Americans

When asked if the ACA stopped insurers from being able to refuse coverage of sick people, those who got the question correct (it did) were most likely to say that it should be strengthened or expanded. People who got it wrong were most likely to say it should be repealed and replaced.

Q: The ACA stopped insurers from being able to refuse coverage of sick people

Similar patterns can be seen in the cross-tabs of other fact and opinion questions, too. We consistently observed that the people who know the most about the legislation are more likely to be supporters of the act.

So where are people turning to for their information and how does that impact their opinions? Media certainly plays a role in the dissemination of facts. Radio listeners were more likely to get the question correct (65%) than those who got their information from other sources, but overall the type of media wasn’t particularly relevant. As for specific outlets, viewers of MSNBC and NBC were more likely to know the facts of the ACA than viewers of other outlets but overall there was a fairly consistent level of knowledge across the major TV news networks.

In terms of opinions, however, there was a huge difference.

Fox News viewers were the most likely to say it should be repealed and replaced (48%) followed by NBC (34%) and ABC (30%) – compared to 31% of all Americans. MSNBC were the least likely to say this with just one in seven agreeing. Fox News viewers were four times as likely to say it should be repealed and replaced as they were to say it should be strengthened or expanded which mirrors the Democrat/Republican split. Similar or even more pronounced shifts on the opposite end of the spectrum were shown by MSNBC and CNN viewers. ABC viewers were the most evenly split and representative of the nation as a whole with 37% favoring expansion and 30% favoring replacement.

As NPR reported, this seems like a messaging failure more than a policy failure. “That was a failure of communication on the part of the Obama administration,” says Bill Pierce, a senior director at APCO Worldwide, who advises health care companies on strategic communications.

“They needed to use the President more,” Pierce told NPR’s Alison Kodjak. “If this was his number one achievement, and something he was proud of doing, it was the kind of thing that he needed to be out there and talking about all the time.”

This study shows that in an era where trust is eroding in our institutions and our media facts still matter and facts still influence opinion. It will be incumbent on our government, our leaders and the fourth estate to keep pressing the truth. Otherwise, whichever “truth” seen as the most believable will have considerable sway over the electorate.

Matt Carmichael contributed to this report.