Women's ACA knowledge and attitudes: Implications for reproductive health care access, utilization and equity

Objective

To characterize knowledge and attitudes of the Affordable Care Act (ACA), and sociodemographic differentials in knowledge and attitudes, among women in the United States.

Methods

We conducted a population-based, cross-sectional, internet survey of women’s health care experiences and preferences among 1,078 U.S. women 18-55 years. The comprehensive survey included a series of items assessing knowledge and attitudes of the ACA. We used weighted proportions to describe ACA knowledge and attitudes and chi-square and multivariable logistic regression to examine associations between sociodemographic characteristics and ACA knowledge and attitudes.

Results

Most women had heard of the ACA (81%), though 24% expected ACA-related insurance coverage changes. “Not knowing” was a common response for specific changes for preventive health (61%), women’s health (62%), birth control (65%), breast exam (66%) and mental health (76%) coverage. Few women believed the ACA would improve their ability to get their preferred care (14%; 22% reported it would worsen their ability, 42% did not know). One third of women disagreed with the ACA overall; 23% did not know how they felt. In bivariate and multivariate models, social determinants of ACA knowledge and attitudes included age, race/ethnicity, education, income, insurance status, political party, recent health service use and prescription contraceptive use.

Conclusions

In our representative sample, many women, especially socially-disadvantaged women, lacked knowledge and had negative attitudes about the ACA. Findings have implications for whether, when, and how improved insurance access will translate to improved service utilization, outcomes and reduced disparities for women’s health in the U.S.