Eight Key Findings on Americans' Experiences With the Healthcare Law

Despite Americans continuing to view the Affordable Care Act (ACA) more negatively than positively and a federal health exchange website rife with technological glitches, the U.S. uninsured rate has fallen in so far in 2014.

The majority of uninsured Americans reported in February that they do plan to get insurance, making it possible that the uninsured rate will continue to decline in the coming weeks and months. The deadline for obtaining health coverage is March 31, but the Obama administration this week announced an extension for Americans who have logged into the healthcare exchange website but have not purchased a health plan.

Gallup will continue to monitor Americans' opinions of and experiences with the healthcare law as the March 31 deadline approaches and throughout the extension period. In the meantime, here are eight key findings about the healthcare situation in the U.S. as the deadline to get health coverage approaches:

1. Two-thirds of Americans report the healthcare system works for them. However, Americans with health insurance are more than twice as likely as those without health insurance to be satisfied with the healthcare system -- 72% vs. 33%, respectively. With the majority of uninsured Americans dissatisfied with the way the healthcare system is working for them, the ACA has the potential to improve the healthcare situation for this group.

2. Americans' attitudes toward the healthcare law continue to be more negative than positive, with 40% approving and 55% disapproving of the law in March. Additionally, by 40% to 21%, Americans say the law is more likely to make their families' healthcare situations worse rather than better. These evaluations are highly related to party identification, and thus may have more to do with Americans' political leanings than a more objective assessment of the law and how it is actually working.

3. Just under a quarter of Americans say the healthcare law has already hurt them or their families, while 10% say it has helped them so far. The majority of Americans (63%) feel the law has had no effect on them or their families. As more people sign up for insurance or get new plans to comply with the law, the percentage of Americans who say they have been unaffected will presumably go down. Party affiliation tends to color the responses, with Republicans being the most likely to report a negative impact from the law.

4. As states determine how to implement the Affordable Care Act, a pattern has emerged showing that states with the highest rates of uninsured residents are among the least likely to expand Medicaid and to establish state-based exchanges.

5. The percentage of uninsured Americans has drifted down in early 2014, from 17.1% in the fourth quarter of 2013 to 15.9% as of the end of February 2014. The uninsured rate has fallen within almost every major demographic group -- though most dramatically among lower-income and black Americans. Hispanics are still the most likely demographic to lack health insurance among key subgroups and have seen one of the smallest decreases in their percentage uninsured -- 0.8 percentage points. This suggests that, while the healthcare law is increasing access to insurance, some of the key target populations continue to opt out.

6. More Americans (18.1%) now report that their primary health insurance coverage is through a plan fully paid for by themselves or a family member compared with the end of 2013 (17.2%). This increase coincides with a fall of nearly two points in the percentage of Americans who get insurance through a current or former employer (43.4%). This increase may suggest that Americans are using the federal and state health exchanges to find competitively priced coverage, rather than depending on insurance plans issued through an employer. Alternatively, it could also be that employers are no longer offering coverage.

7. More than half of those without insurance in the U.S., 55%, reported in February that they planned to buy insurance rather than pay a fine, which is down from 63% last fall. One reason for the decline may be that many of those who were uninsured last fall may have already signed up for insurance. More than half of the remaining uninsured who plan to obtain insurance say they plan to get it from an exchange. These findings are generally positive for supporters of the ACA, as the majority of uninsured Americans plan to get insurance, and many will use the federal and state exchanges. However, in many instances, a verbal intention to buy insurance may not be manifested in subsequent behavior. Additionally, a sizable portion of uninsured Americans plan to remain that way.

8. Uninsured Americans who have visited an exchange site remain about twice as likely to rate their experience negatively as positively. These negative experiences could be due to general dissatisfaction with plan offerings because of cost or a lack of coverage options. Alternatively, despite the Obama administration's intensive efforts to fix problems plaguing the website, issues with the site may continue to discourage or prevent Americans from signing up for health plans. The Obama administration announced this week that Americans who report having technical difficulties with the exchanges are eligible for an extension to sign up for a health plan.

For those interested in a more in-depth review of the data, Gallup is pleased to invite you to An Inside Look at Gallup's Healthcare and ACA Data, an event that will provide an unprecedented look into Americans' experiences with and perspectives on topics related to the Affordable Care Act and healthcare. Gallup experts will present data collected from 1,000 Americans per day -- from 2008 through the present -- via the Gallup-Healthways Well-Being Index and Gallup Daily tracking surveys. The event will take place April 16, 2014, in Washington, D.C.