ACA Exchanges Debut Oct. 1 Amid Uncertainty

September 24, 2013

In This Article

Nearly Half of Americans Are Not Sure the ACA Remains in Effect

With the debut of the exchanges only a week away, the ACA continues to battle headwinds as daunting as those that blew during the Tea Party townhall meetings of 2009 and the court battles that culminated in a narrow Supreme Court victory in June 2012.

For one thing, public opposition to the law is both strong and confusing. According to the Kaiser Family Foundation (KFF), more Americans had an unfavorable view (47%) of the ACA than a favorable view (37%) as of August, a pattern that has generally held true in the organization's monthly tracking poll since the law was passed. However, 57% of Americans disapprove of efforts to defund the law. Likewise, a poll this month by the Pew Research Center and USA Today found that although 53% of Americans are against the ACA, half of these opponents believe that lawmakers should try to make the law work as well as possible.

On top of those sentiments, misinformation and ignorance about the law abound.

  • About half of Americans said last month that they don't understand the ACA well enough to know how it will affect them, "a share that has been fairly steady since 2010," according to KFF.

  • Four in 10 Americans are not sure whether the ACA even remains the law of the land, with some thinking that either the Supreme Court overturned it or that Congress repealed it, said KFF. Given that the GOP-controlled House has voted to kill the law more than 40 times, "some people might wonder," said the Urban Institute's Ian Hill.

  • About the same percentage of uninsured Americans don't realize that the ACA requires them to obtain health coverage in 2014, the Pew Research Center and USA Today reported.

  • And the exchanges? Just 51% of Americans told the Pew Research Center and USA Today that an exchange will operate in their state. Residents of states that are operating their own exchanges with or without federal collaboration are far more in the know (59%) than residents of states that turned the job over to the federal government (44%).

Some of the same states that wanted no part of the exchanges have placed obstacles in the way of federal efforts to implement the law. Missouri has prohibited state and local government officials from cooperating with the federal exchange in their state while county health departments in Florida are under orders to keep ACA enrollment workers called navigators off their premises. HHS has complained to Texas Governor Rick Perry that his state's attempts to regulate navigators represent a "blatant attempt" to render them ineffective.


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