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  • The DOL has issued a final rule that will expand FMLA leave rights for same-sex spouses, regardless of where same-sex couples reside.
  • The DOL’s new guidance for same-sex spouses takes effect on March 27, 2015.
  • The final rule adopts a “place of celebration” rule, instead of the “state of residence” rule, for recognizing same-sex marriages.
  • The final rule also redefines “spouse” under the FMLA to expressly reference same-sex marriages. 

 


Under the final rule, eligible employees in legal same-sex marriages will be able to take FMLA leave in order to care for their spouses or family members, regardless of where they live


On Feb. 25, 2015, the Department of Labor (DOL) issued a final rule that expands protections under the federal Family and Medical Leave Act (FMLA) for same-sex spouses. This final rule revises the definition of “spouse” under the FMLA to:

·      Adopt a “place of celebration” rule (which is based on where the marriage was entered into), instead of the “state of residence” rule that applied under prior DOL guidance; and

·      Expressly include same-sex marriages in addition to common law marriages, and encompass same-sex marriages entered into abroad that could have been entered into in at least one state.

Under the final rule, eligible employees in legal same-sex marriages will be able to take FMLA leave to care for their spouses or family members, regardless of where they live. The DOL’s guidance becomes effective on March 27, 2015. 

This final rule replaces guidance regarding FMLA protections for same-sex spouses that was issued following the U.S. Supreme Court’s decision in United States v. Windsor. The Windsor decision, issued on June 26, 2013, invalidated Section 3 of the federal Defense of Marriage Act (DOMA), which barred same-sex couples from being treated as married under federal law.

In connection with the final rule, the DOL also issued a set of frequently asked questions (FAQs) to help employers and employees understand the changes to the FMLA’s definition of “spouse.”

To comply with the final rule, employers should review and update their FMLA policies and procedures (as necessary). Employers should also train employees who are involved in the leave management process on the expanded eligibility rules for same-sex spouses under the FMLA.

Background

The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons. The FMLA also includes certain military family leave provisions.

Following the U.S. Supreme Court’s ruling on DOMA, the DOL issued Fact Sheet #28F to clarify the scope of an employer’s obligation to 

make FMLA available to same-sex spouses. This fact sheet provided that, under the FMLA, the term “spouse” includes a same-sex spouse if the marriage is recognized under the laws of the state in which the employee resides.

As a result, employers in states that allow same-sex marriages are currently required to treat employees’ same-sex and opposite-sex spouses equally for purposes of federal employee benefit laws. However, these protections apply only to same-sex marriages that are valid under state law. They do not apply to same-sex couples in civil unions or domestic partnerships, or same-sex couples living in states that do not recognize same-sex marriage.

Overview of the Final Rule

The final rule changes the definition of “spouse” under the FMLA to look to the law of the jurisdiction in which the marriage was entered into (including for common law marriages), as opposed to the law of the state in which the employee resides. The final rule’s definition also:

·      Expressly references the inclusion of same-sex marriages in addition to common law marriages; and

·      Includes same-sex marriages entered into abroad.

Under the final rule, eligible employees in legal same-sex marriages will be able to take FMLA leave to care for their spouses or family members, regardless of where they live. However, these protections still do not apply to same-sex couples that are not legally married (for example, same-sex couples in civil unions or domestic partnerships).

New Definition of “Spouse”

The final rule defines the term “spouse” under the FMLA as follows:

Spouse, as defined in the statute, means a husband or wife. For purposes of this definition, husband or wife refers to the other person with whom an individual entered into marriage:

·      As defined or recognized under state law for purposes of marriage in the state in which the marriage was entered into; or

·      In the case of a marriage entered into outside of any state, if the marriage is valid in the place where entered into and could have been entered into in at least one state.

This definition includes an individual in a same-sex or common law marriage that either:

1.    Was entered into in a state that recognizes such marriages; or

2.    If entered into outside of any state, is valid in the place where entered into and could have been entered into in at least one state.

The revised definition makes clear that the terms “husband” and “wife” include all individuals in lawfully recognized marriages. According to the DOL, this definition is intended to cover all spouses in legal marriages as defined in the regulation, regardless of whether they use the terms “husband” or “wife.”

“Place of Celebration” Rule

The final rule moves from a “state of residence” rule to a rule based on the jurisdiction where the marriage was entered into (place of celebration). This rule is intended to ensure that all legally married couples, whether opposite-sex or same-sex, will have consistent FMLA rights, regardless of where they live.

As of Feb. 25, 2015, same-sex marriage has been legalized in 37 states and the District of Columbia (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia

Washington, West Virginia, Wisconsin and Wyoming).

Additionally, 18 countries extend the right to marry to same-sex couples (Argentina, Belgium, Brazil, Canada, Denmark, England/Wales/Scotland, Finland, France, Iceland, Luxembourg, The Netherlands, New Zealand, Norway, Portugal, Spain, South Africa, Sweden and Uruguay).

The DOL believes that a “place of celebration” rule will:

·      Provide consistent federal family leave rights for all legally married couples, whether opposite-sex or same-sex, regardless of where they live;

·      Reduce barriers to the mobility of employees in same-sex marriages in the labor market; and

·      Reduce the administrative burden on employers that operate in more than one state or have employees who move between states with different marriage recognition rules.

Impact on FMLA Leave

The definitional change means that eligible employees, regardless of where they live, will be able to:

·      Take FMLA leave to care for their same-sex spouse with a serious health condition;

·      Take qualifying exigency leave due to their same-sex spouse’s covered military service; or

·      Take military caregiver leave for their same-sex spouse.

Additionally, in Fact Sheet #28B, the DOL recognized the eligibility of same-sex partners, whether married or not, to take leave to care for a partner’s child, provided that they meet the in loco parentis requirement of providing day-to-day care or financial support for the child. The final rule expands the basis for an employee to take leave to care for a child of a same-sex spouse. Under the final rule, eligible employees are entitled to take FMLA leave to care for their stepchild (the child of the employee’s same-sex spouse) even if the in loco parentis requirement of providing day-to-day care or financial support for the child is not met.

The final rule also entitles an eligible employee to take FMLA leave to care for a stepparent who is the same-sex spouse of the employee’s parent, regardless of whether the stepparent ever stood in loco parentis to the employee.

The final rule does not change the DOL’s current guidance that permits employers to require employees who take leave to care for a family member to provide reasonable documentation of the required family relationship. An employee may satisfy this requirement either by providing documentation (such as a marriage license or a court document) or by providing a simple statement asserting that the necessary family relationship exists. According to the DOL, it is the employee’s choice whether to provide a simple statement or another type of document. Employers may not use a request for confirmation of a family relationship in a manner that interferes with an employee’s FMLA rights.

Legal Debate on Same-sex Marriage

On Jan. 16, 2015, the U.S. Supreme Court agreed to hear appeals in same-sex marriage cases from Ohio, Tennessee, Michigan and Kentucky. The Supreme Court will take on the issue of whether same-sex couples have a constitutional right to marry or whether states are permitted to ban same-sex marriage.

The Supreme Court’s opinion has the potential to impact the legality of same-sex marriages throughout the United States, either by legalizing gay marriage or by overturning court decisions that have invalidated state bans on same-sex marriage. 

The Supreme Court’s ruling is expected to be issued in the summer, most likely in late June 2015.   

More Information

For more information on the FMLA, please visit the DOL’s FMLA webpage.

In a front-page story, the New York Times (1/6, A1, Pear, Subscription Publication) reports that members of Harvard University’s Faculty of Arts and Sciences “are in an uproar” over health plan changes that will require them to share more of their health care costs. The university said in its enrollment guide for this year that it “must respond to the national trend of rising health care costs, including some driven by...the Affordable Care Act,” which many of the faculty “championed,” continues the piece. It notes that Harvard’s plan is still quite generous, and the changes will introduce “standard features of most employer-sponsored health plans.”

        Referring to the New York Times piece, the Washington Post  (1/5, Millman) “Wonkblog” notes the “health-care irony” in the situation: Professors are angry that the policies they’ve recommended for years are now being applied to them. It says Harvard’s plan still “pays about 91 percent of medical costs, on par with the richest platinum plans available on the ACA exchanges.”

        The Washington Post (1/5, Adler) “Volokh Conspiracy” blog reports similarly.

        In a Bloomberg View (1/5) op-ed, Megan McArdle looks at the “whining” professors, saying that “The deepest irony is, of course, that Harvard professors helped to design Obamacare. And Obamacare is the reason that these changes are probably necessary.” She states that “this is what cost-control actually looks like” and recommends that Americans shed the delusion that there are no trade-offs.

        The Daily Caller (1/5, Ross) reported that, while the faculty voted in November against the health plan changes, the vote “was too late to stop cost increases from taking effect this month, leading to an uproar among some faculty.” The DC notes that the complaints are “curious given Harvard faculty’s general support for Obama and his policies.” 


Health Insurance Explained – The YouToons Have It Covered is a light-hearted treatment of a difficult and important topic, breaking down insurance concepts, such as premiums, deductibles and provider networks. It explains how individuals pay for coverage and obtain medical care and prescription drugs when enrolled in various types of health insurance, including HMOs and PPOs.

Written and produced by the Kaiser Family Foundation. Narrated by Former U.S. Senate Majority Leader Bill Frist, a nationally-recognized surgeon and Foundation trustee. Creative production and animation by Free Range Studios.  The video is also available in Spanish.

If you would like to share the video with audiences offline, you may request to download the video by filling out the form below.  Permission from KFF to show the video during presentations, events or meetings is not required.  To share the video on websites, please embed the video directly from YouTube (click the “Share” link.)  We ask that you follow the citation language on our reprint information page — see the citation section for “Other Website Features.”

If you are unable to view the video on YouTube or within the player box above, try viewing it in an alternative player.

The 2013 animated video, “The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act” is also available in Spanish. The YouToons first appeared in the 2010 animated short, “Health Reform Hits Main Street,” which explained how the health reform law would work. A Spanish-language version is available here.


Basics of ERISA Welfare Benefit Plans


A group health plan is an employee welfare benefit plan established or maintained by an employer or an employee organization, or both, that provides medical care for employees and/or their dependents directly through insurance or reimbursement. The Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code are the two key laws governing these welfare benefit plans.

General ERISA responsibilities:

ERISA sets minimum standards for most voluntarily established pension and health plans in the private industry to provide protection for individuals in these plans. ERISA applies to employee benefit plans, including welfare benefit plans, with some exceptions.

ERISA requires plans to provide participants with plan information including important information about plan features and funding, provides fiduciary responsibilities for those who manage and control plan assets, requires plans to establish a grievance and appeals process for participants to get benefits from their plans and gives participants the right to sue for benefits and breaches of fiduciary duty.

Welfare benefit plans must meet ERISA rules on:

  • Reporting and disclosure to participants and the Department of Labor
  • Benefit claims procedures and denials
  • Fiduciary responsibility
  • Prohibited transactions

Plans subject to ERISA:

  • Medical, surgical or hospital care
  • Benefits for accident, disability, sickness or death
  • Unemployment benefits
  • Vacation benefits
  • Apprenticeship or other training programs
  • Day care centers
  • Scholarship funds
  • Prepaid legal services
  • Holiday and severance pay plans

In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees or plans which are maintained solely to comply with applicable workers’ compensation, unemployment or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident citizens or unfunded excess benefit plans.

Determining exactly which plans are ERISA welfare benefit plans is complicated. Employers looking to provide benefits to employees without originally creating an ERISA-qualified plan should use extreme caution and should consult with their legal counsel as they may inadvertently create an ERISA plan, subjecting it to ERISA’s rules.

 

DOL Audits

The Department of Labor (DOL)’s Employee Benefits Security Administration (EBSA) has the authority to conduct audits on benefit plans that are governed by the Employee Retirement Income Security Act (ERISA). DOL audits often focus on violations of ERISA’s fiduciary obligations and reporting and disclosure requirements.

The DOL may also investigate whether an employee benefit plan complies with ERISA’s protections for plan participants, such as the special enrollment rules or mental health parity requirements. Recently, the DOL has been using its investigative authority to enforce compliance with the Affordable Care Act (ACA).

Penalties for noncompliance and other errors found during an audit can be steep. For example, during the 2013 fiscal year, more than 70 percent of audits resulted in monetary fines or other corrective action. There are several factors that increase or indicate your likelihood of being audited, including the common triggers listed below.

DOL Audit Triggers
A DOL audit can be triggered for a variety of reasons. Some audits can be avoided through careful administrative efforts; other audits are initiated through no fault of your own.

Common triggers for a DOL audit include these preventable causes:

Participant complaints. If any of your plans’ participants complain to the DOL about potential ERISA violations, your plan will likely be subjected to an audit. For example, according to a DOL audit summary, 775 new investigations in 2013 resulted from participant complaints.

Incomplete or inconsistent information. The DOL is more likely to investigate a plan that has incomplete answers on the plan’s Form 5500, or if information you report is inconsistent from year to year.

Another reason your plan might be selected for a DOL audit is due to the DOL’s national enforcement priorities or projects, which focus investigative resources on certain issues. According to the DOL, the following are areas of heightened importance for audits:

Major case enforcement. EBSA is focusing on major cases in order to best protect areas that have the greatest impact on plan assets and participants’ benefits.

Employee contributions initiative. EBSA is focusing on delinquent employee contributions in order to help protect employee contributions to their 401(k), health care and other plans.

In addition to these priorities, the DOL also has several national enforcement projects that receive investigative emphasis:

•Contributory Plans Criminal Project

•Fiduciary Service Provider Compensation Project

•Health Benefits Security Project

•Rapid ERISA Action Team

•Employee Stock Ownership Plans

•Voluntary Fiduciary Correction Program

DOL audits can be triggered by negligence or mistakes on your part, or because your plan falls within one of the areas in which the DOL is focusing its investigative efforts.

Regardless of why you are selected for an audit, you need to be prepared. Contact Trinicore today for the information you need to avoid DOL triggers, as well as tools to help you prepare for and navigate an audit.

If you’ve never visited the Kaiser Family Foundation’s website, it’s worth your time.  Not only do they cover a wide range of topics (inclduing healthcare), but their materials, insights, and polls are all publically available.  This article was originally published Dec 18, 2014 | Bianca DiJulio, Jamie Firth, and Mollyann Brodie


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


With many of the Affordable Care Act’s (ACA) major provisions taking effect this past year, such as the individual mandate and coverage expansions through Medicaid and the health insurance marketplaces, the December Kaiser Health Tracking Poll finds that many Americans are aware of the main parts of the law and, with the exception of the individual mandate, at least 6 in 10 feel favorably towards them. However, as the employer requirement takes effect in January for firms with 100 or more workers, Americans’ initial opinions of the provision are malleable, particularly if they hear it may cause some employers to move workers from full time to part time. Similarly, opinions on the individual mandate can change when more information is provided.

Despite the individual provisions receiving high marks, opinion of the law overall remains stable with 46 percent reporting an unfavorable view and 41 percent reporting a favorable view. The public is fractured over what Congress should do next with the law with 3 in 10 preferring repeal, about 1 in 10 saying they would like Congress to scale back the law, a fifth saying they want implementation to continue, and a quarter favoring expanding the law. Americans give a wide variety of answers when asked to say in their own words what the law does, but about 4 in 10 say that it expands access to health care and health insurance. And, about one month into the ACA’s second open enrollment period, the poll finds the vast majority of the uninsured don’t know the deadline to enroll, most expect to get health insurance in the next few months, and nearly two-thirds say they don’t think they’ll have to pay a fine, or don’t know if they will, for not having coverage this year.

Employer And Individual Requirements

The Public’s Views On The Eve Of The Employer Requirement

In January, the employer requirement to offer coverage or pay a penalty goes into effect for employers with 100 or more workers. The public generally has a favorable view of the employer requirement with 60 percent favoring the provision and 38 percent with an unfavorable view.

But, opinion on the employer mandate is not fixed and there is some room for movement. After providing those in favor of the employer mandate with the statement that “some employers are moving some workers from full time to part time to avoid paying the fine,” the share with an unfavorable opinion rises from 38 percent to 68 percent.

In contrast, when those with unfavorable views of the employer mandate are provided with the statement that “most employers with 100 or more workers already offer health insurance and won’t have to pay the fine,” the share with a favorable view of the employer requirement rises from 60 percent to 76 percent.

8675 Figure 1

Figure 1

A Focus On The Individual Mandate

This year marks the first year the individual mandate was in effect, requiring nearly all Americans to have health insurance or else pay a fine.  The public generally holds an unfavorable view of this provision (64 percent), but some report a favorable view of it (35 percent). However, like in the case of the employer mandate, opinion on the individual mandate is somewhat malleable. The most persuasive message of those tested to move opponents to supporters is the reminder that “most Americans still get coverage through their employers or a public insurance program and so automatically satisfy the requirement without having to buy any new insurance.”  Upon hearing this, about 6 in 10 (62 percent) have a favorable view of the requirement to have coverage. Other statements also move opinion more favorably on the individual mandate and over the 50 percent mark, including mention of the hardship exemptions (59 percent), the fact that without the mandate people may wait to buy insurance until they’re sick resulting in higher costs for others (54 percent), and that without such a requirement insurers may deny coverage to those who are sick (51 percent). Being told the actual amount of the fine is not as influential in terms of changing people’s views and leaves about four in 10 (41 percent) with a favorable view of the provision.

Figure 2

Figure 2

Alternatively, some who originally hold favorable views of the provision can also be moved to view the requirement unfavorably. The share with an unfavorable view of the mandate goes up from 64 percent to three-quarters or more after hearing that “requiring all Americans to have health insurance could mean that some people would be required to buy health insurance that they find too expensive or didn’t want” or after hearing the amount of the fine.

Figure 3

Figure 3

Views Of The ACA One Year Into Coverage Expansions

The ACA In Their Own Words

When asked to say in their own words the main thing the law does, 4 in 10 (41 percent) say it expands access to health care and health insurance, with some naming specific groups such as those with lower incomes (7 percent) and the uninsured (5 percent) that stand to benefit from increased access. Many fewer say the law increases costs or makes insurance too expensive (8 percent), requires people to purchase insurance (7 percent), helps them personally or people generally (7 percent), or that it makes health care more affordable (5 percent).

FIGURE 4: In Their Own Words
Can you tell me, in your own words, what do you think the main thing the health care law does?
Category Percent Mentioning Quotes
Expands Access 41% “Gets everyone insured.”“Makes insurance more available for everyone.”“Provides healthcare.”  
Increases Costs/ Too Expensive 8 “Raised cost of healthcare.”“Raises the premium.”“It costs us money.” 
Requires people to buy coverage 7 “Forced to buy healthcare.”“Requires everybody to get insurance.”“Requires people to be insured.”  
Helps me/ people 7 “I think it helps people that need help.”“Helps me to pay my monthly insurance bill.”“Helps people who are less fortunate.” 
Made insurance more affordable 5 “It creates a way for people to afford health care.”“It allows more affordable health care.”“It helps people afford their own insurance.” 

These responses vary by overall opinion of the law. About 6 in 10 of those with a favorable view of the law (62 percent) say the law expands access, compared to a quarter of those with an unfavorable view (24 percent) who also say the law increases costs (16 percent) or requires people to purchase health coverage (12 percent).

Opinion On The ACA Remains Stable

Nearly 5 years after passage and a year after the coverage expansions under the ACA took effect, overall opinion on the law remains stable with 46 percent of the public reporting an unfavorable view of the law and 41 percent a favorable view. Party identification has long been the factor dividing opinion on the law and the results from this month’s tracking are no different. Eight in 10 Republicans (79 percent) say they have an unfavorable view compared to 7 in 10 Democrats (69 percent) who say they have a favorable view. Independents are more divided with 46 percent favorable and 40 percent unfavorable.

Figure 5

Figure 5

The Public Is Divided On What Next

As a Republican-led Congress prepares to get down to work in January, Americans remain split on what Congress should do next with the law. About 3 in 10 (31 percent) say the law should be repealed entirely, 12 percent say they would like Congress to scale back what the law does, 2 in 10 (21 percent) say the law should be implemented as is, and a quarter say the law should be expanded (24 percent). But like opinion of the law overall, opinion is divided by party.  About 6 in 10 Republicans (62 percent) share the view that the law should be repealed entirely, while Democrats feel the law should be expanded (38 percent) or continued as is (36 percent).  Opinion among independents is more scattered. For example, 25 percent of independents say they want the law expanded and 27 percent say they would prefer the law repealed.

Figure 6

Figure 6

A Closer Look At Awareness And Views Of Specific ACA Provisions

While opinion on the law overall remains negative, large shares of Americans report feeling favorably toward a number of the law’s specific provisions, including the creation of the marketplaces where people can shop for and purchase coverage (78 percent), the financial assistance available to low- and moderate-income people (76 percent), the option for states to expand their Medicaid programs (75 percent), and, as noted earlier, the requirement that employers with 100 or more full time workers offer coverage or pay a penalty (60 percent).  And, while Republicans are relatively unified in their dislike of the law overall, at least half say they have favorable opinions of the provisions that create marketplaces (66 percent), provide financial assistance (55 percent), and allow for the expansion of Medicaid (52 percent).  Support drops off considerably among Republicans for the employer mandate (34 percent), compared to majorities of Democrats (78 percent) and independents (61 percent).

A clear exception to the favorable views of several of the law’s provisions is in views of the requirement that nearly all Americans have insurance or else pay a fine.  Nearly two-thirds (64 percent) say they have an unfavorableopinion of this provision, including 45 percent who say they feel “very unfavorable.”

FIGURE 7: Many Elements Of ACA Continue To Be Popular Across Parties
Percent who say they have a FAVORABLE opinion of each provision of the law Total Public Democrat Independent Republican
Create exchanges/marketplaces 78% 91% 79% 66%
Subsidy assistance to individuals 76% 90% 78% 55%
Medicaid expansion 75% 90% 78% 52%
Employer mandate/penalty for large employers 60% 78% 61% 34%
Individual mandate/penalty 35% 53% 31% 17%
Note: Question wording abbreviated. For full question wording, see survey topline.

In addition to viewing most of these provisions favorably, many people also recognize that these elements are included in the law. The most widely recognized provision is the individual mandate (77 percent), but still roughly two-thirds are aware that the law requires employers with 100 or more employees to offer coverage or else pay a fine (69 percent), creates marketplaces (67 percent), provides financial assistance to low- and moderate-income individuals (67 percent), and gives states the option to expand the Medicaid program (62 percent).

Figure 8

Figure 8

While the public recognizes many of the law’s main provisions, they are less familiar with the law’s practical implications, such as the fine for not having health insurance. Over 7 in 10 (72 percent) say they do not know what the fine will be for people who do not get insurance in 2015, and another 19 percent say some amount other than the 2014 or 2015 actual amounts. Six percent reported the 2014 amount ($95 per person or 1% of household income), and just 3 percent responded with an amount similar to the 2015 fine of $325 per person or 2% of household income.

Figure 9

Figure 9

Americans also continue to hold misperceptions about some aspects of the law.  For example, about 4 in 10 say the law allows undocumented immigrants to receive financial help from the government to buy health insurance or that it establishes a government panel to make decisions about end-of-life care for people on Medicare, and another 2 in 10 say they are unsure if the law does these things.

FIGURE 10: Misperceptions About ACA Continue
To the best of your knowledge, would you say the health reform law does or does not do each of the following? CORRECT INCORRECT
No Yes Don’t Know/Refused
Allow undocumented immigrants to receive financial help from the government to buy health insurance 38% 43% 19%
Establish a government panel to make decisions about end-of-life care for people on Medicare 41% 41% 19%

A Look At The Uninsured

About a month into the ACA’s second open enrollment period, very few of the uninsured (5 percent) are aware that the deadline to enroll is February 15 and 13 percent believe the deadline is the end of 2014. A majority of the uninsured explicitly say they don’t know when the deadline is (57 percent), give a date outside of this year’s open enrollment period (12 percent), or say the deadline already passed or that there is no deadline (12 percent). The vast majority of the uninsured are also unaware of what the fine for not having health insurance will be in 2015. Just 3 percent respond with an amount similar to the 2015 fine, while the rest provide an amount similar to the 2014 fine (7 percent), some other amount (17 percent), or say they don’t know (74 percent).

Figure 11

Figure 11

While many uninsured don’t know the fine amount, a little over a third of the uninsured (37 percent) expect to have to pay a fine for not having coverage this year, while over 4 in 10 say they will not (44 percent) and 19 percent say they don’t know. In fact, many uninsured may be exempt from paying a fine due to financial hardship or other exemptions under the law.

Figure 12

Figure 12


 

Dramatic changes in the insurance marketplace make the professional insurance advisor's role increasingly important to individuals, small businesses and large corporations in finding cost-saving measures and coverage options.  A licenced and experienced insurance agent provides and services insurance products while educating and advising you on how to manage risk and make informed insurance choices. However, there are individuals that are more than just “agents...”, and we at Trinicore take the business of being not just a “insurance” guy, but being your trusted and expert insurance and benefit advisor, sersiouly.  This is why we continue to expand our education, and have completed a sequence of college level courses leading to a professional designation including Registered Health Underwriter (RHU), Certified Employee Benefits Specialist (CEBS), and Chartered Life Underwriter (CLU) designations. Advisors like the ones at Trinicore are highly trained insurance professionals who will guide you through the complex task of choosing appropriate coverage at an affordable cost and are dedicated to serving the long-term interests of consumers.

 

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