Misconception of the Patient Protection and Affordable Care Act: How Does It Impact Public Opinion?

Despite a substantial reduction in the number of uninsured since the enactment of the Patient Protection and Affordable Care Act (ACA afterwards) in 2010, public opinion is still divided in terms of the law's role in reforming US health care system. Understanding factors related to public opinion will be important for the ACA to gain more legitimacy and accomplish its goals in the future. Using population-based data from the 2013 Douglas County Community Health Survey (n=480), this study seeks to identify factors related to the misconception of the ACA and to assess whether the misconception has contributed to unfavorable opinions against the ACA. Misconception of the ACA was fairly common in the sample. Out of the four questions used for testing respondents' knowledge of the ACA, 56.7% of the respondents did not answer correctly to more than one question. Only 4% answered all four questions correctly. Being a female (OR=2.98, p=0.004), having poor self-rated health (OR=1.91, p=0.003), and being a Hispanic (OR=4.49, p=0.005) were all associated with a higher likelihood of having misconception of the ACA. By contrast, being uninsured (OR=0.35, p=0.039) and being better educated (OR=0.71, p=0.018) were both associated with a lower likelihood of having misconception of the ACA. About 56% of the sample believed that ACA is a negative step in addressing issues in health care. This negative perception of ACA was highly associated with misconception of the ACA. After controlling for selected explanatory variables, answering an additional question correctly would on average reduce the odds of perceiving ACA negatively by 21 percent (p<0.001). Misconception of the ACA was closely related to the negative perception of the ACA. Increasing public support for the ACA calls for significant educational effort to alter misconception of the ACA, especially among females, Hispanics, and people with poor health.