Health Quality An Issue For Poor, 2 Years Into Obamacare, Poll Finds

A series of polls in key states by NPR and its partners finds that more than half of adults in the U.S. believe the Affordable Care Act has either helped the people of their state or has had no effect. Those sentiments are common despite all the political wrangling that continues over the law.

About a third (35 percent) of adults say the law has directly helped the people of their state, while a quarter (27 percent) say it has directly hurt people.

"The proportion of U.S. adults who believe the law helped people in their state about equals the proportion who believe it hurt them," says Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health. "On the other hand, on a personal level, most Americans do not believe the law directly affected them."

The polls conducted by NPR, the Robert Wood Johnson Foundation and the Harvard Chan School are part of an in-depth study to assess the changing health care landscape in the two years since the Affordable Care Act took effect.

In seven separate state polls, approximately 1,000 people were surveyed in Florida, Kansas, New Jersey, Ohio, Oregon, Texas and Wisconsin. A nationally representative survey of 1,002 people was also done, asking the same questions. People were contacted by telephone (cellphone and landline) from Sept. 8 to Nov. 9, 2015.

We wanted to find out more about what is going on in these states when it comes to health care — and we asked people about their personal experiences.

We sought to find out what, if anything, has changed in how people get health care and what the quality of that care currently is. How big of an impact are cost increases having? Are there more or fewer barriers to care in the wake of the ACA?

More than 7 in 10 (72 percent) in our national survey said they get good value for what they pay toward the cost of their health care. But a significant 22 percent disagree.

That may be because few see added benefits in the face of cost increases. Only 1 in 6 adults believe their benefits have increased in the past two years, and 12 percent believe they've declined. That perception exists despite changes like the ACA's elimination of pre-existing condition exclusions and the requirement that insurers cover the full cost of preventive services like mammograms, colonoscopies and contraception.

"Though the poll finds that most people are relatively satisfied with the health care they personally receive, a substantial number have problems paying their medical bills and accessing needed care," Blendon says. "And a surprising share of Americans, particularly those with low incomes, say they face problems with the quality of care they receive."

Other poll findings:

Cost Concerns For Many

Nearly half (45 percent) of those in our national survey said their insurance premiums have increased in the past two years. Rising copays and deductibles were reported by 35 percent of the insured. When we asked people to characterize the cost of health care they received during visits to five different types of health care facilities, majorities said costs were reasonable, although this varies substantially by facility.

Not Getting Needed Care

Our polls found 1 in 7 people (15 percent) said there was at least one time in the past two years when they needed health care but did not get it. Only 23 percent of these people were uninsured. About a third (35 percent) said they could not find a doctor who would take their health insurance.

Emergency Room Use Still High

One of the goals of the ACA was to make insurance available to all Americans so that they would have a regular health care provider and not use the expensive ER so often. But a third of all adults say they got care in an ER in the past two years.

Hard To Find A Doctor

Nationally, a quarter of adults say they do not have a regular doctor or health care professional who provides most of their health care when they are sick or have a health concern. The number was highest in Texas (31 percent) and Florida (30 percent).

And among the vast majority (74 percent) who do have a regular health care provider, getting care wasn't automatic. In the past two years, more than 1 in 5 (22 percent) say there has been at least one time when they could not see their regular doctor, often because appointments weren't available or they needed care at night or on the weekend when the doctor's office was not open.

More than a third of adults in Texas said they went without needed health care when they were unable to see their regular provider.

Quality Gap

A plurality of the public rates the health care they get personally as good (46 percent), but surprisingly few rate it as excellent (33 percent).

And our survey revealed a major gap in quality depending on income. Low-income people (those with annual household incomes of less than $25,000) are far more likely (34 percent) to say the care they got was fair or poor than those with other incomes (13 percent). Still, 62 percent of low-income adults say they got good or excellent care.

The significance of this finding is that low-income people are more likely to be sick than people of other incomes. Forty-one percent of low-income adults rate their health as fair or poor, versus just 18 percent of people of other incomes.

So does all this mean the ACA is failing? It's not possible to say from these data.

When asked whether national health reform has directly impacted them, most people said it has had no direct impact (56 percent) or it has helped them (15 percent). But a quarter said it has hurt them directly.

Adults in Kansas (39 percent) and Ohio (35 percent) are significantly more likely than adults across the country to say the law has hurt the people of their state. But Ohioans (21 percent) are also more likely to say the law has directly helped them as individuals, compared with the national survey.

We'll be sorting out these findings over the next three weeks in stories online and on NPR and member station news magazines and talk shows.