ACA Study

THE INDEPENDENT AND NON-PARTISAN SURVEY
OF PUBLIC OPINION ESTABLISHED IN 1947 AS

THE CALIFORNIA POLL BY MERVIN FIELD

Field Research Corporati on
601 California Street
San Francisco, CA 94108-2814
(415) 392-5763 FAX: (415) 434-2541
EMAIL: fieldpoll@field.com
www.field.com/fieldpollonline
Field Research Corporation is an Equal Opportunity Employer
THE
FIELD
POLL

Release #2477 Embargoed for Print Publication: Tuesday, August 19, 2014

2014 TCWF-Field Health Policy Poll - Part 1
Increase in California Voter Support for Affordable Care Act
Most Say the State's Implementation of the Law Has Been Successful
Growing Proportions Satisfied with the Way California's Health Care System Is Working
By Mark DiCamillo and Mervin Field
Following its first year of full implementation in California, the Affordable Care Act (ACA) is now
receiving greater support from this state's voters than at any time since its introduction in 2010. At
present, 56% of registered voters say they support the law, while 35% are opposed. This twenty-one
point margin in support is up from 15 points last year.
By a two-to-one margin (60% to 30%) voters think the state of California has been successful in
implementing the ACA. This contrasts with their much more divided assessment of the way the
federal government has implemented the law (49% successful vs. 46% not successful).
Many more voters say the state has been successful than feel it has been unsuccessful in achieving
six of seven goals that California set out to achieve when it began implementing the law. This
includes encouraging uninsured residents to get coverage, expanding Medi-Cal, providing
consumers with more insurance choices, obtaining the federal funds needed to implement the law,
providing better consumer protections, and establishing a one-stop place where consumers can go to
shop for health insurance online.
The one area where more voters think the state has not been successful in its implementation of the
law relates to limiting the rate increases that insurance companies charge to their customers.
Statewide, 46% feel California has been unsuccessful in meeting this goal, while 37% think it has
been successful. Another 17% aren't sure. Related to this is the finding that 46% of voters say they
have difficulty paying the costs of their health care, including 17% who say it's very difficult.
However, the proportion reporting that their health care costs are very difficult to afford declined
four points from 21% who said this last year.
These generally positive evaluations of the ACA and its implementation in California appear to be
impacting voters' overall views of the way the state's health care system is performing. Currently,
56% say they are satisfied with the way the state's health care system is working, while 34% are
dissatisfied. This is a significant improvement from prior TCWF-Field Health Policy Surveys.
The Field Poll #2477
Tuesday, August 19, 2014 Page 2
The poll also finds two-thirds of California voters (66%) in support of the ACA's requirement that
private health insurance plans cover the full cost of birth control. In addition, most disagree (56%)
with the recent U.S. Supreme Court ruling allowing certain employers, whose owners object to birth
control on religious grounds, to be exempt from this requirement.
These are the findings from Part One of the 2014 TCWF-Field Health Policy Survey conducted
J une 26-J uly 19, 2014 by The Field Poll among 1,535 California registered voters in seven
languages and dialects, under a grant from The California Wellness Foundation. Part Two, for
publication tomorrow, will examine voter visits to and views of the Covered California health
insurance exchange website, the expansion of the state's Medi-Cal system under the ACA, and
proposals aimed at improving the state's health care system, including the proposal to extend Medi-
Cal to the state's undocumented immigrants and likely voter preferences regarding Proposition 45,
the "Approval of Healthcare Insurance Rate Changes" initiative on the upcoming November
election ballot.
"For those monitoring the implementation of the Affordable Care Act, it was clear that the
experience in California would be critical to the national success of this important reform," said
J udy Belk, president and CEO of The California Wellness Foundation. "The poll's findings related
to increased satisfaction among voters with the performance of the health care system in our state
indicate that the hard work of policymakers, advocates and others is paying off. More Californians
are now insured and able to access health care."
Voter support for the ACA moves higher in California
This most recent assessment of California voters' overall opinion of the ACA shows 56% in support
(35% strongly and 21% somewhat). This compares to 35% who are opposed (26% strongly and 9%
somewhat). The current 21 percentage-point plurality in favor is up from 15 points last year and is
the largest margin of support for the law in annual TCWF-Field Health Policy Surveys dating back
to 2010.
Like other Americans, Californians' views of the ACA are highly partisan. While California
Democrats support the law greater than five to one, Republicans oppose it greater than three to one.
However, compared to last year, Republican opposition in the state has moderated some, from
greater than four-to-one opposition last year.
Support for the law continues to be stronger in the nine-county San Francisco Bay Area and in Los
Angeles County than in other regions. However, most of this year's increase in regional support is
derived from somewhat greater support for the law among voters in the Central Valley and in areas
of Southern California outside of Los Angeles County.
While the state's ethnic voter population continues to be overwhelmingly supportive of the law, a
plurality of the state's white non-Hispanic voters now favors the law (50% to 44%).
When asked what further actions Congress should take with regard to the law, the proportion of
voters who favor expanding the law has grown from 38% last year to 43% this year. Another 12%
believes Congress should leave the law as is, while 36% of Californians favor repealing all or parts
of the law.
The state of California's implementation of the ACA viewed much more favorably than the
federal government's efforts
By a two-to-one margin (60% to 30%) voters believe the state of California has been successful in
implementing the ACA. This contrasts to a much more divided assessment of the way the federal
government has implemented the law. Statewide, 49% of Californians believe the federal
government's implementation of the law has been successful, while 46% say it has not.
Many more voters believe that the state has been successful than feel it has been unsuccessful in
achieving six of seven specific goals that California set out to achieve when it began implementing
the law. This includes encouraging more previously uninsured residents to get coverage, expanding
Medi-Cal to extend health insurance to more low-income residents, providing consumers with more
insurance choices, obtaining the federal funds needed to implement the law, providing insurance
buyers with better consumer protections, and establishing a one-stop place where consumers can go
to shop for health insurance online.
However, a plurality believes the state has not been successful in limiting the rate increases that
insurance companies charge to their customers. Statewide 46% of voters feel California has not
been successful in meeting this goal, while 37% feel it has, and 17% aren't sure.
Growing proportions of voters say they're satisfied with the way the health care system is
working in California
By a 56% to 34% margin, more voters now say they're satisfied than dissatisfied with the way the
health care system is working in California. This represents a significant improvement in voter
assessments of the state's health care system from prior measures. For example, in 2008 50% were
satisfied and 46% dissatisfied.
Overall satisfaction with the state's health care system is related to household income. By a greater
than two to one margin, voters with annual incomes of less than $40,000 now report being satisfied
with the way the state's health care system is working, a much more positive assessment than was
observed two years ago.
Nearly half report some difficulty paying for health care
Nearly half of voters statewide (46%) say they have difficulty paying the costs of their health care,
while 52% do not. About one in six voters (17%) say it's "very difficult." However, this is less than
the 21% of voters who felt it was very difficult for them to pay their health care costs in 2013. Most
likely to report that health care costs are very difficult to afford are the uninsured (46%).
In addition, 47% of voters say the total amount they are paying for health care increased over the
past year. Higher income Californians are more likely to say this than lower income Californians.
Californians support ACA's requirement that private health plans cover the full cost of birth
control; most disagree with recent Supreme Court ruling on the matter
Two-thirds of California voters (66%) support the health care law's requirement that private health
insurance plans cover the full cost of birth control, while 25% are opposed. However, opinions
about this divide sharply along party lines, with 83% of Democrats supporting it, compared to 39%
among Republicans.
Most Californians disagree with the recent U.S. Supreme Court ruling allowing certain employers,
whose owners object to birth control on religious grounds, to be exempt from this requirement. A
56% majority of voters who were interviewed after the High Court ruled on this issue on J une 30
say they disagreed with the decision, while 36% agreed. There were big differences in views of the
ruling by party, with 72% of Democrats disagreeing with it, compared to 31% among Republicans.

-30-
About the Survey
The 2014 TCWF-Field Health Policy Survey is the eighth in an annual series of health policy surveys
conducted among random samples of California registered voters by The Field Poll through a grant from The
California Wellness Foundation. This year's findings are based on a survey of 1,535 California registered
voters interviewed by telephone in seven languages and dialects English, Spanish, Cantonese, Mandarin,
Korean, Vietnamese and Tagalog. Interviews were completed on either a voter's landline phone or a cell
phone. In this survey 859 voters were contacted on their cell phone, while 676 were reached on a regular
landline or other phone.
In order to enable the survey to more closely examine the opinions of the state's growing ethnic voter
populations the survey included additional interviews with Asian American voters. A total of 1,167 of the
interviews were conducted in English and 368 in non-English languages.
Interviewing was conducted J une 26 J uly 19, 2014 from Field Research Corporation's central location call
center. Up to six attempts were made to reach and interview each randomly selected voter on different days
and times of day during the interviewing period. After the completion of interviewing, the overall sample
was weighted to align it to the proper statewide distribution of voters by race/ethnicity and by other
demographic, geographic and political characteristics of the California registered voter population.
Sampling error estimates applicable to any probability-based survey depend upon its sample size. According
to statistical theory, 95% of the time results from the overall sample are subject to a maximum sampling error
of +/- 2.6 percentage points. The maximum sampling error is based on percentages in the middle of the
sampling distribution (percentages around 50%). Percentages at either end of the distribution have a smaller
margin of error. Sampling error will be larger for analyses based on subgroups of the overall sample.

About The California Wellness Foundation
The California Wellness Foundation is a private, independent foundation created in 1992, with a mission to
improve the health of the people of California by making grants for health promotion, wellness education and
disease prevention. Since its founding in 1992, the Foundation has awarded 7,338 grants totaling more than
$890 million. For more information, visit the Foundation's website, www.calwellness.org, or contact Cecilia
Laich, communications officer, at (818) 702-1900.
Updating Voter Views of
the Affordable Care Act and the
Health Care System in California
Conducted by
The Field Poll

for
The California Wellness Foundation

for release
Tuesday, August 19, 2014
2014 TCWF-Field Health Policy Survey

Part 1
The Field Poll The California Wellness Foundation 1

About the Survey
Population surveyed: California registered voters.
Number of interviews: 1,535 interviews completed including an
augmented sample of Asian American voters.
Data collection: June 26-July 19, 2014 by cell and landline
telephone using live interviewers from Field
Researchs central location call center.
Languages of English, Spanish, Cantonese, Mandarin,
administration: Tagalog, Korean and Vietnamese. 1,169
completed in English and 368 in non-English
languages.
Sampling error: Overall findings have a sampling error of
+/- 2.6 percentage points at the 95%
confidence level.
Graph 1
Current public opinion of California voters
toward the Affordable Care Act (July 2014)
Support
strongly
35%
Support
somewhat
21%
Oppose
somewhat
9%
Oppose
strongly
26%
No
opinion
9%

Since 2013

-3

Since 2013

+4

Since 2013

+0

Since 2013

-1
52% 52%
54%
53%
56%
38%
39%
37%
38%
35%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2011 2012 2013 2014
Support
Graph 2
Trend of California voter opinions of the
Affordable Care Act
Oppose
Graph 3a
Current voter opinions of the Affordable
Care Act by region and party registration
56%
22%
79%
53%
67%
50%
48%
49%
62%
56%
Support
33%
69%
15%
41%
28%
40%
42%
41%
30%
35%
Oppose
Total
Region
Los Angeles County
South Coast
Other Southern CA
Central Valley
San Francisco Bay Area
Other Northern CA*
Party registration
Democrat
No party preference/other
Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.
* Small sample base.
Republican
+3
-2
+4
+9
+8
+1
+6
+5
+2

Since 2013
+2
-3
+2
-7
-9
-9
+3
-9
-6
-4

Since 2013
0
Graph 3b
Care Act by race/ethnicity and age
54%
57%
56%
55%
61%
66%
82%
62%
50%
56%
Support
36%
36%
37%
35%
32%
19%
10%
27%
44%
35%
Oppose

+3
+6
-4
0
+3
+4
-2
0
+7

Since 2013
+9
-3
-5
+1
-2
-4
+5
-1
-7

Since 2013
-9
-5
Total
Race/ethnicity
White non-Hispanic
African American
Age
1829
3039
4049
5064
65 or older
Latino
Asian/Pacific Islander
Graph 3c
Care Act by insurance status and type
68%
60%
57%
55%
57%
42%
56%
Support
18%
35%
31%
40%
35%
44%
35%
Oppose

+3
-10
+4
+2
+9
+4
+5

Since 2013
-3
+13
-4
-2
-10
-7

Since 2013
-4
Total
Insurance status and type
Uninsured
Through employer/union
Medi-Cal
Individual market
Insured (total)
Medicare
Graph 4
What further actions should Congress take
with regard to the Affordable Care Act

Since 2013
+1

Since 2013
+5

Since 2013
-3

Since 2013
-1
Keep
as is
12%
Repeal it
completely
23%
Expand
the law
43%
No
opinion
9%
Repeal
parts of it
13%

Since 2013
-2
Graph 5
California voter views about ACAs requirement that
private health insurance plans cover the full cost of
birth control
Oppose
25%
Support
66%
No
opinion
9%
68%
39%
83%
66%
No party
preference/other
Republican
Democrat
Total registered
voters
% Support
Party registration
Graph 6
California voters views about the U.S. Supreme Court ruling
allowing certain employers (whose owners object to birth
control on religious grounds) to be exempt from the ACAs
requirement to cover costs of prescription birth control in
their companys health plans
Disagree
56%
Agree
36%
No
opinion
8%
58%
31%
72%
56%
No party
preference/other
Republican
Democrat
Total registered
voters
% Disagree
Party registration
Note: Question added to the poll immediately after the U.S. Supreme Court issued its ruling on this case and was asked of 1,302 registered
voters statewide.
Graph 7
Opinions of how successful the federal
government and the state of California have been
in implementing the Affordable Care Act
Very
successful
Not at all
successful
22%
Not too
successful
24%
Somewhat
successful
41%
8%
No
opinion
5%
Federal Government
Not
at all
successful
12%
Not too
successful
18%
Somewhat
successful
45%
No
opinion
10%
Very
successful
15%
State of California
Graph 8a
Voter opinions about how successful California
has been in achieving specific goals of the ACA (1 of 2)
24%
31%
21%
24%
51%
57%
63%
64%
Obtaining the federal funds
needed to implement the law
Providing California
consumers with more
insurance choices
Expanding Medi-Cal to
extend health insurance to
more low-income Californians
Encouraging more
previously uninsured residents
to get coverage
Successful Not successful
California has been
Graph 8b
Voter opinions about how successful California
has been in achieving specific goals of the ACA (2 of 2)
46%
32%
28%
37%
50%
50%
Limiting the rate increases that
insurance companies charge to
their customers each year
Establishing a one-stop place where
it will be easy for consumers to shop
for health insurance online
Providing health insurance
buyers with better consumer
protections
Successful Not successful
California has been
Graph 9
Voters reported difficulty in paying for
health care

Since 2013
0

Since 2013
-4

Since 2013
+5

Since 2013
0
Very
difficult
17%
Somewhat
difficult
29%
No opinion
2%
Not too
difficult
29%
Not at all
difficult
23%

Since 2013
-1
23
20
16
12
15
46
17
27
32
27
29
29
27
29
50%
52%
43%
41%
44%
73%
46%
Medi-Cal
Individual market
Medicare
Through employer/
union
Insured (total)
Uninsured
Total registered voters
Very Somewhat
Graph 10
Difficulty in paying for health care by insurance
status and type
% Difficult
Insurance status/coverage type
-4
+1
0
-8
-13

Since 2013
-3
-2
Graph 11
Perceived changes in amount paid for
health care over the past year

Since 2013
-1

Since 2013
-3
Increased
47%
No opinion
4%
About
the same
40%
Decreased
9%

Since 2013
+4
Graph 12
Perceived changes in amount paid for health care over
the past year by household income
63%
52%
51%
38%
33%
47%
% Increased
6%
7%
10%
14%
13%
9%
% Decreased
40%
52%
39%
37%
47%
% About
the same
54%
Household income
Less than $20,000
$40,000 $59,999
$100,000 or more
$20,000 $39,999
$60,000 $99,999
51%
50% 50%
52%
56%
44%
46%
42%
40%
34%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2008 2010 2012 2014
Satisfied
Graph 13
Trend of voter satisfaction with the way the health
care system is working in California (2006 2014 )
Dissatisfied
Note: Differences between 100% and the sum of each years percentages equal proportion with no opinion.
Race/ethnicity
White non-Hispanic
African American
Latino
Asian/Pacific Islander
Household income
Less than $20,000
$40,000 $59,999
$100,000 or more
$20,000 $39,999
$60,000 $99,999
63%
67%
61%
52%
50%
53%
50%
62%
67%
56%
% Satisfied
24%
26%
27%
40%
42%
37%
39%
29%
24%
34%
% Dissatisfied

+4
+13
+10
+1
+1
+3
-4
+3
+3

From 2012
+7
-6
-15
-11
-4
-5
+4
-5
-2

From 2012
-13
-3
Graph 14
Satisfaction with the way the health care system in California
is working by household income and race/ethnicity
H:\600046\Report\Rls2477 Topline Findings.docx 1
Field Research Corporation 600-046
San Francisco, California 94108 081914

Topline Findings
2014 TCWF-Field Health Policy Poll Part 1
Updating Voter Views of the Affordable Care Act and the Health Care System in California

1. How satisfied are you with the way the health care system is
working in California? Are you very satisfied, somewhat
satisfied, somewhat dissatisfied or very dissatisfied?
VERY SATISFIED .................................. 22%
SOMEWHAT SATISFIED ........................ 34
SOMEWHAT DISSATISFIED ................... 16
VERY DISSATISFIED ............................. 18
NO OPINION ......................................... 10

As you know, about four years ago the Congress passed and President Obama signed into law the Affordable
Care Act, to reform the nations health care system and it is now being enacted.

2. Generally speaking, do you support or oppose the health
care reform law? (IF SUPPORT OR OPPOSE, ASK:) Do you feel
that way strongly or somewhat?
SUPPORT STRONGLY ........................... 35%
SUPPORT SOMEWHAT ......................... 21
OPPOSE SOMEWHAT ............................. 9
OPPOSE STRONGLY ............................ 26
NO OPINION ........................................... 9

3. What would you like to see Congress do when it comes to
the health care law leave it as is, expand it so the law does
more, repeal parts of it so the law does less, or repeal it
completely?
KEEP AS IT........................................... 12
EXPAND IT ........................................... 43
REPEAL PARTS TO DO LESS ................. 13
REPEAL IT COMPLETELY ...................... 23
NO OPINION ........................................... 9

4. In general, do you support or oppose the health care laws
requirement that private health insurance plans cover the full
cost of birth control?
SUPPORT ............................................ 66%
OPPOSE .............................................. 25
NO OPINION ........................................... 9

5. (ASKED FOLLOWING JUNE 30 SUPREME COURT RULING)
The U.S. Supreme Court recently ruled that certain
employers whose owners object to birth control on religious
grounds should not be required to cover the cost of
prescription birth control in their companies health plans,
even if this means their female employees will have to pay
the cost of birth control themselves. Do you agree or
disagree with the Supreme Courts ruling in this case?
AGREE ................................................ 36%
DISAGREE ........................................... 56
NO OPINION ........................................... 8

6. Regardless of whether you support or oppose the health
care law, how successful do you think the federal
government has been in implementing the law very
successful, somewhat successful, not too successful or not
at all successful?
VERY SUCCESSFUL ............................... 8%
SOMEWHAT SUCCESSFUL .................... 41
NOT TOO SUCCESSFUL ........................ 24
NOT AT ALL SUCCESSFUL .................... 22
NO OPINION ........................................... 5

7. How successful do you think the state of California has been
in implementing the law very successful, somewhat
successful, not too successful or not at all successful?
VERY SUCCESSFUL ............................. 15%
SOMEWHAT SUCCESSFUL .................... 45
NOT TOO SUCCESSFUL ........................ 18
NOT AT ALL SUCCESSFUL .................... 12
NO OPINION ......................................... 10

H:\600046\Report\Rls2477 Topline Findings.docx 2
8. I am going to read some of the goals that California initially set out to achieve when it began
implementing the health care law. For each, please tell me how successful you think the state has
been in achieving each goal. (ITEMS IN RANDOM ORDER) How successful do you think California has
been in achieving this goal very successful, somewhat successful, not too successful, or not at all
successful?
VERY SOMEWHAT NOT TOO NOT AT ALL NO
SUCCESSFUL SUCCESSFUL SUCCESSFUL SUCCESSFUL OPIN
( ) a. encouraging more previously uninsured
residents to get health insurance coverage ..................19% ........... 45 ........... 17 .............. 7 .........12
( ) b. providing health insurance buyers with better
consumer protections ....................................................... 8% ........... 42 ........... 18 ............ 10 .........22
( ) c. obtaining the federal funding needed to
implement the law ..........................................................12% ........... 39 ........... 15 .............. 9 .........25
( ) d. providing California consumers with more health
insurance choices ..........................................................15% ........... 42 ........... 18 ............ 13 .........12
( ) e. limiting the rate increases that health insurance
companies charge to their customers each year ............ 6% ........... 31 ........... 26 ............ 20 .........17

Think for a moment about the total amount of money you now pay out-of-pocket for health care. This includes
any costs you pay for insurance coverage, for paying any portion of your health care bills that you pay out of
pocket when you use health care services, such as deductibles and co-pays, as well as the amount you pay for
any health care services you receive that are not paid for by insurance.

9. Overall, how difficult would you say it is to pay for the costs
of your health care very difficult, somewhat difficult, not too
difficult or not at all difficult?
VERY DIFFICULT .................................. 17%
SOMEWHAT DIFFICULT ......................... 29
NOT TOO DIFFICULT ............................. 29
NOT AT ALL DIFFICULT ......................... 23
NO OPINION ........................................... 2

10. In the past year, has the total amount you pay for you and
your family's health care increased, decreased, or remained
the same?
INCREASED ......................................... 47%
DECREASED .......................................... 9
REMAINED THE SAME .......................... 40
NO OPINION ........................................... 4

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THE INDEPENDENT AND NON-PARTISAN SURVEY

OF PUBLIC OPINION ESTABLISHED IN 1947 AS

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