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Most Americans Don't Understand the Most Basic Things About Obamacare

...especially the ones most likely to be effected by it, according to a new survey.
September 30, 2013, 1:30pm
Image: Michael Gil/Creative Commons

“Most basic thing” is open to interpretation, but it’s at least one of these two pieces of the Affordable Care Act: 1) everyone must have health insurance by law, and 2) there are special new government websites on which to buy it. At the next tier of crucialness, we find such info as the law including provisions for subsidies intended to make insurance more affordable at lower incomes, a tax penalty for not having insurance, and a Medicaid expansion to all individuals below the poverty line.

Since last summer’s Supreme Court ruling approving most of the law, that last thing has been made optional for states (collectively) to adopt. If you live in a state with a right-wing governor and live below the poverty line, there’s a chance you’re right now getting one of the greatest intentional fuckings by a government to its people in recent American history. Sorry, Kansas.


But, on the plus side, there’s a good chance that “you” won’t even know you’ve been screwed. A study out this morning shows that just four in 10 Americans are even aware of the ACA online marketplace and that it includes premium subsidies. Meanwhile, three in four are aware of the individual mandate. So, a huge portion of the country is right now only aware of the potentially burdensome aspect of the law. The "bad" part. Interestingly, surveys seem to indicate that some portion of those survey respondents still favor the law, thinking it’s basically just a requirement that everyone buys insurance. That’s very noble, I guess.

Anyhow, these stats come courtesy of the Commonwealth Fund Health Insurance Marketplace Survey, which was done between July and September of this year and is part of a larger effort undertaken by the foundation to track implementation of the law. You can safety assume the numbers have gotten a bit more favorable by today, at the very least because tomorrow’s potential government shutdown hinges on ACA funding and the ACA's marketplaces are set to open Tuesday at

It’s not just that a whole lot of people don’t understand a law that effects absolutely everyone in the country directly, but the people that will be effected the most are more likely to not understand it. A quick summary of the findings:

·  Only 32 percent of people without health coverage during the past year are aware of the marketplaces, compared to 43 percent of people with coverage all year.


·  Thirty-one percent of people without coverage during the year are aware of the subsidies that are available, compared to 43 percent of those insured all year.

·  Just under one-third (32 percent) of adults with incomes under 250 percent of the federal poverty level ($28,725 for an individual and $58,875 for a family) are aware of the subsidies, compared to 47 percent of those with higher incomes.

When Scotus ruled that states couldn't be forced to take federal money for Medicaid expansion, it sort of threw that aspect into a seperate and even more complicated bin. Unlike the other aspects of the ACA, Medicaid expansion is not a done deal in many places. Thirteen states have yet to decide on Medicaid expansion, while six have outright said no, refusing federal dollars to cover their uninsured residents. The survey found:

·  Seventy-eight percent of people without insurance for a time during the past year, and 82 percent of people earning less than $32,499 a year for a family of four, support expanding Medicaid to more people in their state.

·  Ninety-one percent of uninsured Democrats, 78 percent of uninsured Independents, and 73 percent of uninsured Republicans strongly or somewhat favor their state making Medicaid available to more residents.

·  Ninety percent of Democrats, 79 percent of Independents, and 75 percent of Republicans making less than $32,499 a year for a family of four are in favor of making Medicaid available to more people.

"The strong support for expanding Medicaid is consistent with past studies showing that Americans generally like the individual components of the Affordable Care Act when they understand them," said Commonwealth Fund president David Blumenthal, M.D. "This study also shows that there is a great deal of work to be done to ensure that Americans have a clear, accurate view of the law and what it offers the American people."