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Policy Points A decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support. A 2020 poll that probed both support for one public option approach (Medicare "buy-in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts. Although the COVID-19 pandemic viscerally highlighted the need for a more coherent health care system-including universal coverage-other recent evolutions in the broader US political context could undermine reform., (© 2023 Milbank Memorial Fund.)

Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency-and the sitting president-have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences. Using a 2019 nationally representative telephone survey, this article considers how variations in political values, attitudes toward government, and experiences with the health care system relate to competing health reform preferences. Differences between those who favor Medicare for All over building on the ACA largely reflect different levels of satisfaction with the status quo and views of private health insurance. By contrast, differences between ACA supporters and those who would favor replacing it with a state-based alternative reflect sharply different political values and attitudes. Key differences remain significant after controlling for demographic, health, and political characteristics. Overwhelming public support still eludes the ACA, and reaching consensus on future directions for health reform will remain challenging given differences in underlying beliefs., (Copyright © 2020 by Duke University Press.)

Changes in insurance coverage over time, or "churning," may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months-a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts., (Project HOPE—The People-to-People Health Foundation, Inc.)

An individual mandate is an important feature of many recent plans to achieve universal health insurance coverage in the United States, without radically changing the way most Americans get health care and coverage. Using national public opinion data, we find that on its own, an individual mandate does not have broad support across partisan and sociodemographic groups. Policymakers who choose to pursue an individual mandate for policy reasons may expand the base of supporters by incorporating it into a "shared-responsibility" plan that includes requirements for employers, government, and insurers.

This study examines public opinion about the new health reform law in Massachusetts at four stages, from the beginning of the debate in September 2003 through June 2008, two years into implementation. We find that the favorable political environment in Massachusetts likely encouraged leaders to act and also contributed to the shape of the legislation as a "shared responsibility" compromise plan. Despite perceptions by some that the law is not helping the uninsured, support for it remains high-even for the individual mandate, the law's most controversial feature. There is little interest in repealing this legislation.

The article discusses the different varied version regarding health care reform in the U.S. that the 2008 presidential nominees Sen. Barack Obama and Sen. John McCain have. A large majority of voters favor a change in the existing health care system and want to support those who can bring about that change.

The article focuses on the public opinion related to the debate on the proposed replacement of the health care reform Affordable Care Act (ACA) in the U.S. under the administration of President Donald Trump. Topics include the concern on the impact of the repeal of the law, the public values supporting the debate on the role of the government in providing universal health care among Americans, and the various components of the proposed repeal-and-replace bill.

This analysis of national opinion polls shows that a majority of Americans support increased spending on public health in general and that they see public health interventions as saving money in the long term. At the same time, many do not favor increased federal spending in a number of areas that public health officials deem important. In addition, polls show striking partisan differences, with Republicans much less supportive than Democrats of additional spending on public health. This split may have political implications for the public health component of the new health reform law if there is a change in party control of one or more houses of Congress after the November 2010 elections. As a result, in order to sustain public support for increased spending, it will be critically important to give examples of cost savings from public health programs and to highlight how they have reduced mortality from major chronic illnesses, such as cancer, heart disease, and HIV/AIDS. [ABSTRACT FROM AUTHOR]

Looks at public responses to reforms in medical care and medical economics in Australia, Canada, New Zealand, Great Britain and the United States. Access to health care; Financial burden; Quality ratings; Worries about the future; Public satisfaction or dissatisfaction.

Reports the opinion of United States voters on issues related to health care, including health care as an election issue and Medicare. Data and methods; Results; Conclusions.

The article focuses on the public opinion regarding the national debate in the U.S. Congress over the health care reform in the U.S. It states that the public sent at least three distinct messages to the Congress including the approach of middle class Americans to the cost and security of their health care insurance coverage, achievement of the Congress for comprehensive reform, and specific proposals to overhaul the health care system. It says that the increasing worries of middle class Americans has driven the latest health care reform debate. It mentions that the Americans were divided over the primary choices for reform such as to contain increasing health care costs and ways to achieve universal coverage.

Focuses on the reasons for the decline in public support for United States President Bill Clinton's health care reform proposal. Key beliefs underlying public attitudes about reform; Strategic and substantive choices faced by President Clinton.

Offers a study concentrating on health care reform in the United States. The absence of the topic in the 1996 presidential election; The documentation of decreased health care services; Data and methods; Results; Conclusions.

Over the past twenty-five years, Health Affairs has become a visibly important source of information for policymakers. In addition, academic readers of Health Affairs have learned that the real world of policy making is complex; rarely involves decisions based on the thinking of a single discipline; and includes political, historical, and administrative factors in its outcome. Health Affairs has also made members of the academic community more appreciative of interdisciplinary work and more aware of other factors, such as health politics, that need to be addressed if their research is to be meaningful to decision- makers. [ABSTRACT FROM AUTHOR]

Editorial. Discusses strategies for health care and health insurance reform to improve medical care access among uninsured people in the U.S. Results of a public opinion poll regarding health care access in the country; Implementation of a compulsory private insurance provided by employers; Use of tax credits for purchase of private health insurance.

Alternative approaches in Medicaid are proliferating under the Trump administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and Medicaid expansion. Our sample consisted of 2,739 low-income nonelderly adults in three Midwestern states: Ohio, which expanded eligibility for traditional Medicaid; Indiana, which expanded Medicaid using health savings accounts called POWER accounts; and Kansas, which has not expanded Medicaid. We found that coverage rates in 2017 were significantly higher in the two expansion states than in Kansas. However, cost-related barriers were more common in Indiana than in Ohio. Among Medicaid beneficiaries eligible for Indiana's waiver program, 39 percent had not heard of POWER accounts, and only 36 percent were making required payments, which means that nearly two-thirds were potentially subject to loss of benefits or coverage. In Kansas, 77 percent of respondents supported expanding Medicaid. With regard to work requirements, 49 percent of potential Medicaid enrollees in Kansas were already employed, 34 percent were disabled, and only 11 percent were not working but would be more likely to look for a job if required by Medicaid. These findings suggest that current Medicaid innovations may lead to unintended consequences for coverage and access. [ABSTRACT FROM AUTHOR]

We examined income gaps in the period 2011-13 in self-assessments of personal health and health care across thirty-two middle- and high-income countries. While high-income respondents were generally more positive about their health and health care in most countries, the gap between them and low-income respondents was much bigger in some than in others. The United States has among the largest income-related differences in each of the measures we studied, which assessed both respondents' past experiences and their confidence about accessing needed health care in the future. Relatively low levels of moral discomfort over income-based health care disparities despite broad awareness of unmet need indicate more public tolerance for health care inequalities in the United States than elsewhere. Nonetheless, over half of Americans felt that income-based health care inequalities are unfair, and these respondents were significantly more likely than their compatriots to support major health system reform--differences that reflect the country's political divisions. Given the many provisions in the Affordable Care Act that seek to reduce disparities, any replacement would also require attention to disparities or risk taking a step backward in an area where the United States is in sore need of improvement. [ABSTRACT FROM AUTHOR]