UNBIASED AND UNFILTERED: THE REAL IMPACT OF THE AFFORDABLE CARE ACT ON INSURANCE COVERAGE, ATTITUDES AND OPINIONS

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1 UNBIASED AND UNFILTERED: THE REAL IMPACT OF THE AFFORDABLE CARE ACT ON INSURANCE COVERAGE, ATTITUDES AND OPINIONS JULY 10, 2014 Dan Witters Research Director, Gallup-Healthways Well-Being Index

2 TODAY S AGENDA About the Gallup-Healthways Well-Being Index Public Opinion and the Affordable Care Act Uninsured Rates Trended Medicaid Expansion and the Exchanges The Individual Mandate: Stress Testing the Fine Questions 2

3 THE GALLUP-HEALTHWAYS WELL-BEING INDEX: 2 MILLION COMPLETED INTERVIEWS AND COUNTING Launched January 2, days of data collection per year 55 measures of well-being, including health insurance status: "Do you have health insurance coverage?" Outbound Phone, RDD, 50% Landline/50% Cell English/Spanish 95%+ Coverage of U.S. Adult Population Data weighted to U.S. Census Bureau Statistics 3

4 THE GALLUP-HEALTHWAYS WELL-BEING INDEX: 2 MILLION COMPLETED INTERVIEWS AND COUNTING (GHWBI): About 353,000 completed interviews per year About 88,300 completed interviews per quarter (+/- 0.3%) About 29,400 completed interviews per month (+/- 0.5%) 2013 to Present (GHWBI and Gallup Daily Tracker): About 178,000 completed interviews per year About 44,500 completed interviews per quarter (+/- 0.4%) About 14,800 completed interviews per month (+/- 0.7%) 4

5 THE POLITICAL IMPLICATIONS: AMERICANS PERCEPTIONS OF THE ACA AND ITS IMPACT 5

6 FAMILIARITY WITH AFFORDABLE CARE ACT UNCHANGED OVER LAST 10 MONTHS Still thinking about the 2010 Affordable Care Act, how familiar are you with the healthcare law: very familiar, somewhat familiar, not too familiar, or not at all familiar? 6

7 DESPITE ENROLLMENT SUCCESS, HEALTHCARE LAW STILL UNPOPULAR Do you generally approve or disapprove of the 2010 Affordable Care Act, signed into law by President Obama, that restructured the U.S. healthcare system? 7

8 PARTY AFFILIATION CLOSELY ALIGNED WITH APPROVAL OF AFFORDABLE CARE ACT (AUGUST 2013-MARCH 2014) % of Those Who Approve % of Those Who Disapprove REPUBLICAN/REPUBLICAN LEAN INDEPENDENT/INDEPENDENT LEAN 9 14 DEMOCRAT/DEMOCRAT LEAN

9 FEW AMERICANS SAY AFFORDABLE CARE ACT HAS HELPED THEM (MAY 21-25, 2014) As you may know, a number of provisions of the healthcare law have already gone into effect. So far, has the new law [rotated:] helped you and your family, not had an effect, or hurt you and your family? 9

10 PERCENTAGE OF AMERICANS WHO THINK LONG-TERM IMPACT WILL MAKE NO DIFFERENCE GROWS In the long run, how do you think the healthcare law will affect your family s healthcare situation? Will it [rotated:] make things better, not make much of a difference, or make things worse? 10

11 REPUBLICANS SHOW DECLINE IN BELIEF THAT HEALTHCARE LAW WILL MAKE THINGS WORSE % Make Worse % Make Better % Not Make Much Difference REPUBLICANS April 7 8, Feb. 28 Mar. 1, DEMOCRATS April 7 8, Feb. 28 Mar. 1, INDEPENDENTS April 7 8, Feb. 28 Mar. 1,

12 THE INSURANCE IMPLICATIONS: HOW INSURANCE RATES ARE CHANGING, AND FOR WHOM 12

13 THE UNINSURED CLIMBED SLOWLY BUT STEADILY FROM 2008 THROUGH THE THIRD QUARTER OF 2013 (FINAL QUARTER BEFORE OPENING OF EXCHANGES) 20.0% % 15.0% 16.4% 16.1% 16.1% 15.4% 17.4% 17.5% 16.6% 17.3% 17.3% 16.3% 16.1% 16.9% 17.1% 16.8% 16.3% 18.0% 14.6% 14.4% 10.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Jan Feb Mar Apr May Jun 13

14 APRIL THROUGH JUNE 2014 LOWEST MONTHLY UNINSURED RATES IN 78 MONTHS OF SUCCESSIVE MEASUREMENT; BEST ESTIMATE OF 11.1 MILLION NET REDUCTION SINCE Q % % 15.0% 16.4% 16.1% 16.1% 15.4% 17.4% 17.5% 16.6% 17.3% 17.3% 16.3% 16.1% 18.0% 16.9% 17.1% 17.1% 16.8% 16.2% 16.3% 15.6% 15.0% 14.6% 14.4% 13.4% 13.5% 10.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Jan Feb Mar Apr May Jun 14

15 ESTIMATED NET REDUCTION IN UNINSURED AS OF QUARTER 2, 2014 COMPARED TO QUARTER 3, 2013 IS 11.1 MILLION Net Reduction in Uninsured as of Q2-14 Compared to Q3-13 (Best Estimate): Net Reduction in Uninsured as of Q2-14 Compared to Q3-13 (High-End Estimate): Net Reduction in Uninsured as of Q2-14 Compared to Q3-13 (Low-End Estimate): 11.1 Million 13.1 Million 9.2 Million 15

16 ALL MAJOR RACIAL AND ETHNIC GROUPS HAVE DECLINED BY Q2-14 COMPARED TO Q3-13 LEVELS 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% White (About n=33,000 per quarter) Black (About n=4,100 per quarter) Asian (About n=900 per quarter) Hispanic (About n=4,000 per quarter) 41.4% 32.6% 20.9% 14.0% 15.5% 10.4% 12.5% 8.9% Q3-13 Q2-14 Point Percent Reduction Reduction % % % % 16

17 THE EXCHANGES AND MEDICAID EXPANSION: THE ROLE OF THE STATES AND HOW THE NEWLY INSURED ARE GAINING THEIR INSURANCE 17

18 IN 2013, MASSACHUSETTS HAS LOWEST AND TEXAS HAS HIGHEST UNINSURED RATE FOR THE SIXTH STRAIGHT YEAR Rank % of Residents Without Health Insurance State 1 Massachusetts Hawaii Vermont Minnesota Iowa Delaware Pennsylvania Wisconsin Connecticut Michigan Kansas New York Maryland 12.9 % of Residents Without Health Insurance Rank State 37 Nevada New Mexico Kentucky Arizona North Carolina Montana Georgia Oklahoma California Louisiana Florida Mississippi Arkansas Texas

19 21 STATES (AND DISTRICT OF COLUMBIA) HAVE EXPANDED MEDICAID AND SET UP A LOCALLY MANAGED MARKETPLACE EXCHANGE Arkansas California Colorado Connecticut Delaware Hawaii Illinois Iowa Kentucky Maryland Massachusetts Michigan Minnesota Nevada New Mexico New York Oregon Rhode Island Vermont Washington West Virginia 19

20 STATES THAT HAVE IMPLEMENTED MEDICAID EXPANSION AND STATE-BASED EXCHANGES HAVE REDUCED THEIR RATE OF UNINSURED BY 3-FOLD OVER THOSE THAT HAVE NOT States (Plus D.C.) That Have Expanded Medicaid and Implemented Own Exchange States That Have Not Expanded Medicaid and/or Implemented Own Exchanges 2013 Uninsured Rate 16.1% 18.7% Q1-14 Uninsured Rate 13.6% 17.9% Point Change

21 MORE IN U.S. HAVE SELF-FUNDED HEALTH COVERAGE, MEDICAID (AMONG YEAR-OLDS) Is your insurance coverage through a current or former employer, a union, Medicare, Medicaid, military or veteran s coverage, or a plan fully paid by you or a family member? (Primary and Secondary combined; Year-Olds) 21

22 OVER HALF (56%) OF NEWLY INSURED GAINED INSURANCE THROUGH EXCHANGES Is your health insurance a new policy that just took effect this year; that is, in 2014, or a policy you had before the beginning of this year? Did you get your new policy from a state or federal exchange, or not? Newly Insured in 2014: 5.0% of Adults Newly Insured Through Exchanges: 2.8% Newly Insured But Not Through Exchanges: 2.2% Based on interviews April 15-June 17, 2014 (n=31,438) 22

23 NEWLY INSURED THROUGH THE EXCHANGES SKEW YOUNGER Is your health insurance a new policy that just took effect this year; that is, in 2014, or a policy you had before the beginning of this year? Did you get your new policy from a state or federal exchange, or not? Newly Insured in 2014, Used Exchange National Adults % 21% Based on interviews April 15-June 17, 2014 (n=31,438) 23

24 NEWLY INSURED ADULTS THROUGH THE EXCHANGES REPORT WORSE HEALTH THAN AVERAGE U.S. ADULTS Would you say your own health, in general, is excellent, very good, good, fair, or poor? Newly Insured in 2014, Used Exchange National Adults Excellent 16% 21% Very Good Good Fair Poor 8 5 Based on interviews April 15-June 17, 2014 (n=31,438) 24

25 AMONG NEWLY EMPLOYED, ADULTS WHO ARE UNEMPLOYED, INVOLUNTARILY PART TIME, AND NOT IN WORKFORCE ALL MORE LIKELY TO USE EXCHANGES New in 2014, New in 2014, Used Exchange Did Not Use Exchange Employed Full Time (Employer) 34% 59% Employed Full Time (Self) 9% 8% Employed Part Time, Do Not Want Full Time 5% 6% Unemployed 11% 7% Employed Part Time, Want Full Time 15% 5% Not in Work Force 28% 15% Based on interviews April 15-June 17, 2014 (n=31,438) 25

26 THE INDIVIDUAL MANDATE: TESTING THE IMPACT OF THREE FINE LEVELS: $95, $500, AND $1,000 26

27 $500 FINE MORE IMPACTFUL THAN $95 FINE, BUT NO GAIN FROM MOVING TO $1,000 If you know the annual fine for not having insurance was [rotate:] $95, $500, or $1,000, would you be more likely to get health insurance or more likely to pay the fine? 70% 60% 50% 47% Get Insurance or Pay Fine, At Three Fine Levels 46% 60% 62% 40% 30% 20% 10% 32% 28% 0% $95 Fine $500 Fine $1000 Fine Get Insurance Pay Fine 27

28 To stay up to date on our well-being discoveries, visit: and Dan Witters Research Director, Gallup-Healthways Well-Being Index Gallup Omaha, NE USA