BIRMINGHAM, Ala. – Despite the Affordable Care Act’s making regular headlines since 2010, health policy experts at the University of Alabama at Birmingham say a study suggests there was not enough focus on implications for Alabama residents until the Health Insurance Marketplace opened Oct. 1, 2013 — potentially affecting their knowledge, attitudes and behaviors.
Michael Morrisey, Ph.D., director of the UAB Lister Hill Center for Health Policy, and colleagues recently completed a survey of 601 Alabama residents on issues of the ACA, the health insurance exchanges and Medicaid expansion.
Using random digit dialing, the researchers obtained a diverse sample among Alabamians ages 19-64 years old from Oct. 1-31, 2013. Compared to the 2010 U.S. Census, the respondents were generally representative of Alabama residents within the ages of those affected by the Health Insurance Marketplaces.
“We wanted to measure and assess the knowledge so that policymakers and the public will be better informed,” Morrisey explained. “We did find that Alabamians do not feel well-informed about their health insurance options; only 16 percent of Alabamians believed they ‘knew a lot’ about the ACA, and 12 percent ‘knew a lot’ about the exchanges.”
Findings of the survey include:
• In Alabama, 15 percent of residents ages 19-64 do not have health insurance.
• Half of Alabamians say they know little or nothing about the ACA or health insurance exchanges.
• There is general support for Medicaid expansion, which would affect 11 percent of the population or about 331,000 people.
• Nearly one-third of Alabamians, or about 819,000 people, would be eligible for a health insurance subsidy — 201,000 of these are currently uninsured.
• Approximately one-half of Alabamians do not support the ACA in general; however, they do support some of its provisions.
• Affordability of health insurance seems to be the key to the law’s success, but Alabamians are generally rather gloomy about its overall effect on insurance options and premiums.
“We were surprised at the extent of support for an expansion of the Medicaid program, even given the unpopular view of the ACA overall,” Morrisey said of the findings.
Morrisey says the results can be used to better understand Alabamians’ views of specific health care reform elements and of reform generally. Also, Morrisey says the data allows the researchers to explore the likely effects of the law on coverage.
“For example, while 54 percent of Alabamians indicated that they had a ‘pre-existing’ health condition, only 7 percent indicated that they had been denied health insurance coverage as a result of a pre-existing condition,” Morrisey explained. “This may suggest that eliminating these provisions in health insurance is not as big an issue with the public as might be assumed.”
The researchers intend to resurvey Alabamians later in 2014 to see their experiences with the law and to see if their attitudes change.
