Americans Still Wary of, Not Too Familiar With, Health Law

Americans Still Wary of, Not Too Familiar With, Health Law

by Andrew Dugan

Young adults least likely to say they are familiar with law

WASHINGTON, D.C. -- Less than two months before the health insurance exchanges open nationwide, more Americans disapprove (49%) than approve (41%) of the Affordable Care Act. An additional 11% have no opinion. As this landmark legislation enters the next phase in its implementation process, it remains divisive. With the exception of a bounce likely caused by President Barack Obama's re-election in November 2012, Americans have been more disapproving than approving of the healthcare law.

Trend: Americans' Views of the Affordable Care Act

These results come from an Aug. 17-18, 2013, Gallup poll.

Additionally, more Americans are pessimistic than optimistic about the future impact of the law. Less than a quarter believe it will make their family's healthcare situation better, while 38% say it will make it worse. When asked about the law's impact on the healthcare situation in the U.S., 35% say it will make the situation better, while 44% say it will make it worse. Americans' views are essentially the same as they were in June.

Americans' Assessments of Future Impact of the Affordable Care Act , August 2013

Three in 10 Not Familiar With ACA

Despite a coordinated campaign on the Obama administration's part to increase awareness about the healthcare law, 15% of Americans say they are very familiar with the law. Fifty-three percent say they are somewhat familiar with the ACA, 18% are not too familiar, and 12% are not familiar at all.

Americans' Familiarity With the Affordable Care Act, August 2013

Americans Familiar With Law More Likely to Disapprove of It Than Approve

Americans who say they are very or somewhat familiar with the law are more likely to disapprove (55%) than approve of it (42%). The picture is much more muddled among those who are not too or not at all familiar with the law: 36% approve, 39% disapprove, and 21% aren't sure.

Approval of the Affordable Care Act by Familiarity With the Law, August 2013

Young Americans Least Familiar With, but Most Optimistic About, Healthcare Law

The Obama administration has stated that the participation of 18- to 34-year-olds will be critical to the success of the ACA. This is because younger Americans -- who are less likely to have health insurance at all -- are less likely to experience health problems and, thus, they bring overall health insurance premiums down.

Although targeting young Americans is a chief aim of the ACA outreach effort, younger Americans are more likely than their elders to have little familiarity with law. More than one in three young adults say they are not too or not at all familiar, compared with 28% of middle-aged Americans and 26% of those aged 55 and older.

Familiarity With Affordable Care Act, by Age, August 2013

At the same time, Americans aged 18 to 34 are far less likely than their older compatriots to disapprove of the law. However, approval levels are similar across the three age groups.

Approval of Affordable Care Act, by Age, August 2013

Likewise, younger Americans are marginally more likely than middle-aged Americans to say the healthcare law will make their family's or the nation's healthcare situation better (27% and 37%, respectively). But they are much less likely than both older age groups to say it will make their family's healthcare (25%) or the U.S. healthcare situation (33%) worse.


The Obama administration and its allies have spent much of the summer mounting a multimillion-dollar outreach campaign to educate the public about the Affordable Care Act and the coming changes to the healthcare system. In particular, new insurance markets will go into effect Oct. 1 and broader portions of the bill, including the controversial individual mandate requiring Americans to purchase health coverage, start in early 2014. While these efforts are still unfolding, it appears the administration has its work cut out for it.

Americans currently are more likely to disapprove than approve of the law and are pessimistic about its prospects of improving the healthcare situation, at the individual or national level.

The administration's outreach campaign, then, might seem like a tall task. Many Americans are unfamiliar with the law, and even among those saying they are very familiar with the ACA, attitudes are largely tilted against the landmark law. Admittedly, the administration and like-minded groups still have some time to educate the public about the law, but they have a lot of distance to cover in terms of ensuring that the country truly understands the changes coming to the healthcare system.

Key among these endeavors will be maximizing 18- to 34-year-olds' participation in the health insurance system. Their higher probability of remaining healthy for the foreseeable future will help contain healthcare costs, but many young adults are comfortable in forgoing insurance coverage, regardless of penalty fines. Currently, younger Americans know the least about this law, which may mean lower compliance with the individual mandate when that provision takes effect.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted Aug. 17-18, 2013, on the Gallup Daily tracking survey, with a random sample of 1,021 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.

For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error is ±4 percentage points.

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by region. Landline and cell telephone numbers are selected using random-digit-dial methods. Landline respondents are chosen at random within each household on the basis of which member had the most recent birthday.

Samples are weighted to correct for unequal selection probability, nonresponse, and double coverage of landline and cell users in the two sampling frames. They are also weighted to match the national demographics of gender, age, race, Hispanic ethnicity, education, region, population density, and phone status (cellphone only/landline only/both, and cellphone mostly). Demographic weighting targets are based on the March 2012 Current Population Survey figures for the aged 18 and older U.S. population. Phone status targets are based on the July-December 2011 National Health Interview Survey. Population density targets are based on the 2010 census. All reported margins of sampling error include the computed design effects for weighting.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

View methodology, full question results, and trend data.

For more details on Gallup's polling methodology, visit

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