Survey: Most Alabamians don’t understand or like Obamacare—but support Medicaid expansion, Mike Oliver, Jan. 8, 2014

A majority of Alabamians oppose the Affordable Care Act but nearly two-thirds believe the state should expand Medicaid, according to a new survey that also revealed a distinct lack of knowledge about the federal health reform law.

The support of Medicaid expansion in the wake of negative Obamacare feelings "surprised me," said Michael Morrisey, director of the University of Alabama at Birmingham Lister Hill Center for Health Policy, which today released the survey of 601 Alabamians. "While there are obviously overall negative feelings about the ACA, the majority of Alabamians want to expand Medicaid."

But in Alabama and 22 other states, Medicaid expansion is one of the key parts of so-called Obamacare that these states have declined to incorporate.

While 54 percent of respondents said they had not heard one way or another whether Alabama has decided to expand Medicaid, 63 percent agreed or strongly agreed that they should expand.

An earlier study conducted by Morrisey and UAB economist David Becker found that Medicaid expansion in Alabama, which is offered through the ACA provisions, would generate about $1 billion in state tax revenue after expenses from 2014 to 2020. Some 331,000 people would be affected by such an expansion, Morrisey said.

Morrisey said the survey results are useful to better understand public views of the reform, both overall and separated out from its many facets. For example, while 53 percent say they don't support the ACA, 65 percent support elimination of pre-€existing condition clauses in policies.

The results will also help researchers to study how the law affects coverage.

In general Alabamians don't feel well-informed about the federal health reform law, with only 16 percent reporting they "knew a lot" about ACA, according to the survey. Although amid a media blitz in October, 77 percent said they knew when open enrollment began.

Half of those surveyed said they know little or nothing about ACA or health insurance exchanges.

About 15 percent lacked health insurance on the day they were surveyed -- 41 percent of those had been without coverage for two years.

When Alabamians were asked what would be the biggest measure of success for the ACA, the biggest group of respondents -- 31 percent -- said its success should be judged by the affordability of premiums. Only 8 percent said by the percentage of the uninsured. Those answers, Morrisey said, may not bode well for the success of the reform whose goals envisioned by policymakers may be at odds with people's expectations.

"When you look at the Affordable Care Act, it's intent came down to reducing the uninsured population, but here people are looking at it in terms of affordability," Morrisey said.

The survey was conducted during the month of October through random digit dialing, stratified by the state's 11 public health areas. It has a 4 percent margin of error.

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