The Affordable Care Act brought the rate of uninsured Americans to a record low 9 percent in 2015. It's the major achievement of the controversial health care law and one the Obama administration likes to tout whenever it can.
Health and Human Services Secretary Sylvia Burwell did just that in an interview with NPR on Tuesday.
"We have the lowest uninsured rate in the nation's history," Burwell said. "Twenty million Americans have insurance that didn't have insurance before the Affordable Care Act. For many people, they consider it just a basic part of their health care."
But many of those surveyed in a new NPR/Ipsos poll got it wrong. About half believed that the number of people without insurance had increased or stayed the same, or said they didn't know what the law's effect has been on insurance coverage.
That was a failure of communication on the part of the Obama administration, says Bill Pierce, a senior director at APCO Worldwide, who advises health care companies on strategic communications.
"They needed to use the president more," said Pierce. "If this was his No. 1 achievement, and something he was proud of doing, it was the kind of thing that he needed to be out there and talking about all the time."
Democrats were better informed than Republicans, with 54 percent of Democrats saying the law had reduced the number of people without insurance, compared to 41 percent of Republicans.
One problem, Pierce said, is that the law was passed in 2010 but didn't go fully into effect for years. In that time, the website that housed the insurance exchange, the most public part of the program, failed.
"By the time the insurance rate started to fall, a lot of minds were already set," he said.
NPR's poll was designed to gauge the public's knowledge of some basic aspects of the U.S. health care system. The results come as Republicans on Capitol Hill are working to repeal the law. The Senate early Thursday morning passed a measure taking the first step toward dismantling the law.
While many people in the poll were misinformed about the big picture when it comes to Obamacare, they had stronger knowledge about the details of the law.
The majority of those surveyed know that the ACA protects people with pre-existing conditions from being refused coverage and that it requires insurance companies to pay for preventive care.
However, the heated debate during the 2008 presidential race over so-called "death panels" left a mark.
About a third of those surveyed believed Obamacare places limits on end-of-life medical care and another half were not sure. Only 18 percent correctly said that no such limits exist under the law.
Beyond Obamacare, many people had a good grasp of the overall quality of the U.S. health care system.
The majority was aware that Americans generally pay more for health care than people in other countries and that even so, health care outcomes in the U.S. do not have "the best results in the world."
The poll also reiterated findings from a separate survey from the Kaiser Family Foundation last week that showed that people are about evenly split on their view of the Affordable Care Act.
Still, most people don't want lawmakers to repeal the law until they have a replacement plan in place. Only 14 percent favor repeal without a replacement plan.
That message seems to have gotten through to lawmakers. Earlier this month, Republican leaders in the House and Senate were advocating an immediate Obamacare repeal, with a slow phaseout while they consider ways to replace the law so people who have insurance can still get it.
But many lawmakers walked those plans back this week in statements and via Twitter. Some, including President-elect Donald Trump, said they did not want to see a repeal until a replacement is ready.
"We're going to be submitting, as soon as our secretary is approved, almost simultaneously — shortly thereafter — a plan. It will be repeal and replace. It will be, essentially simultaneously," Trump said in a news conference Wednesday.
The poll surveyed 1,011 adults on Jan. 4 and 5, 2017.
STEVE INSKEEP, HOST:
The Senate overnight voted to approve a budget resolution which amounts to the first step of a repeal of the Affordable Care Act, also known as Obamacare. There's a long, long, long way to go. Republicans and Democrats have yet to agree on a replacement. And this huge national debate is happening amid a cloud of misinformation. That's according to a new NPR Ipsos poll. They asked what people know about the law and found that many of us are misinformed. Joining us this morning is NPR health policy correspondent Alison Kodjak to talk about the survey's findings. Hi, Alison.
ALISON KODJAK, BYLINE: Hi, Steve.
INSKEEP: So what do we think we know that we don't know?
KODJAK: Well, you know, there's just a lot of information that people are slightly or very much misinformed about. The poll is designed to gauge what people know about basic facts. And the biggest surprise, I think, was that more - about half the people - a little bit more - don't even know that the Affordable Care Act has extended insurance to millions of people who didn't have it anymore. The insurance rate - I mean, the rate of uninsured people has gone down to 9 percent which is the lowest in the nation's history, sort of the one basic piece of information that the government probably - the Obama administration probably wants out there and half the people in the country don't know that that's happened.
INSKEEP: I've wondered if this is one of the disadvantages of this law from the beginning. I mean, if you think about Social Security or Medicare, we may be confused about some of it, but we basically get what it is. This is a complicated law, and peace - people from the very beginning didn't basically get what it was.
KODJAK: That's true. And it was, you know, brought in under a huge amount of controversy. People knew that they were going to be, quote, "forced to buy insurance." And then when the law...
INSKEEP: Which is actually true. That part is true, yeah.
KODJAK: It is true. It is true. But what was lost in a lot of the debate was the extension of Medicaid to a lot of people who get Medicaid now who weren't eligible before, so low-income people now are insured who weren't before. And what was lost was some of the ways that the government helps people get insurance. And this law really only applies to a small portion of the population, now 10 million people - but this part of the law.
So most of the people who are thinking about it and talking about it and, perhaps, voting on it, it doesn't affect them directly. Also, the effects of the law happened years after the debate happened. So all this negative info was in the air already, and that sticks with people. I talked to a lot of experts in communication. They say once you get a first impression that's bad, it's really hard to make it good again.
INSKEEP: With that said, is there something real about people's concerns here? They know what they pay for insurance. They know whether they like their insurance or they don't like their insurance, and they're basically expressing a concern. Is that true?
KODJAK: Yes. That's absolutely true. And one of the big concerns is that over time, people who bought insurance on the Affordable Care Act exchanges saw the top-line rates for the insurance go up, and that meant people who don't - aren't eligible for subsidies saw their prices shoot way up. And at the same time generally, some of the insurance benefits on the market overall also were cut back and prices went up, so that people see their insurance rates go up anywhere and they blame it on the Affordable Care Act.
INSKEEP: So the president-elect has made a big promise here along with Republicans in Congress - going to replace it with something that is better and yet cheaper. What's the status of the repeal and the talk at least of replacement?
KODJAK: Well, as you said at the beginning, they're working on the repeal. They're talking about replacement. There's been no replacement plan proposed yet. And so it's unclear what's going to come in in the place of this law.
INSKEEP: And so that's - what? - weeks of debate, months of debate, who knows how much debate?
KODJAK: It looks like it's going to be at least weeks of debate because in the last few days, the Congress has said they want to replace it at the same time as they repeal it. So they're going to have to come up with that plan.
INSKEEP: Well, we'll see what happens. That's NPR's Alison Kodjak. Thanks very much for coming by.
KODJAK: Thanks for having me, Steve. Transcript provided by NPR, Copyright NPR.