THE FIELD POLL

Release #2450 By Mark DiCamillo and Mervin Field

THE INDEPENDENT AND NON-PARTISAN SURVEY OF PUBLIC OPINION ESTABLISHED IN 1947 AS THE CALIFORNIA POLL BY MERVIN FIELD

Field Research Corporation

601 California Street, Suite 900 San Francisco, CA 94108-2814 (415) 392-5763 FAX: (415) 434-2541 EMAIL: fieldpoll@field.com www.field.com/fieldpollonline

Embargoed for Print Publication: Wednesday, August 21, 2013

MOST CALIFORNIA VOTERS EXPRESS OPTIMISM ABOUT THE STATES IMPLEMENTATION OF THE AFFORDABLE CARE ACT; WHILE FEW VOTERS KNOW MUCH ABOUT THE STATES COVERED CALIFORNIA HEALTH EXCHANGE, INTEREST IN LEARNING MORE ABOUT IT IS HIGH.

Majorities of California voters are optimistic when asked about the states chances of successfully implementing the Affordable Care Act. Two in three (66%) expect implementation of the law overall to be successful, and similar majorities also believe the state will achieve many of its more specific goals, such as reducing the number of uninsured, providing consumers with more insurance choices, and providing Californians with better consumer protections. However, opinions are highly partisan, with Democrats extremely upbeat in their assessments and Republicans much more skeptical. A major challenge facing the state will be to first make those eligible for coverage benefits under the law aware of their eligibility and then have them apply for these benefits. The survey finds low voter awareness of the states Covered California health insurance exchange, with just 25% of voters under age 65 saying theyve heard a lot or some about it. When delving deeper, the survey finds that fewer than half of voters whose income, age and insurance status qualify them for coverage benefits under the law know of their eligibility. For example, just 48% of low-income voters eligible to receive free health coverage next year under the expanded Medi-Cal program know that they are eligible. Similarly, just one in three (33%) moderate-income voters not currently covered under an employer, union or government insurance program who are eligible to receive tax credits to reduce the costs of their insurance are aware of their eligibility. Nevertheless, expressed interest in obtaining more information is high. Statewide 65% of voters under age 65 say theyre interested in learning more about Covered California and the kinds of health insurance plans and coverage options available there. Interest is particularly high among many of the exchanges key target audiences. This includes uninsured voters (83%), Latinos (79%), African-Americans (82%) and non-English speakers (83%).

The Field Poll Wednesday, August 21, 2013

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These are the topline findings from the third in a series of Field Poll reports from the 2013 TCWFField Health Policy Survey conducted June 26 - July 21, among 1,687 California registered voters in seven languages under a grant from The California Wellness Foundation. Voter expectations about the states implementation of the Affordable Care Act Two in three California voters (66%) expect the state will be successful in its efforts to implement the Affordable Care Act, while 32% think it will be unsuccessful. This is a somewhat more optimistic assessment than was found two years ago when this question was last asked. Majorities of Californians are also optimistic when asked about the likelihood of the state achieving some of specific goals of the law. For example, between 60% and 66% of voters believe California will be successful in achieving the following . . . encouraging more low and moderate income residents who are currently uninsured to get coverage (66%). obtaining the federal funds needed to fully implement the law (64%). establishing a one-stop place where it will be easy for consumers and small businesses to shop for health insurance online (63%). providing consumers with more insurance choices (61%). regulating the insurance market so the average Californian has better consumer protections (60%). However, voters are divided when it comes to one other intended goal of the law limiting the rate increases that insurance companies can charge their customers each year. Only half of the voting public (50%) thinks the state will be successful in achieving this goal, while 47% feel it will not be. Voter views about each of these matters are highly partisan, with Democrats very optimistic in their assessments and Republicans much more skeptical. Awareness of Covered California among voters under age 65 Voter awareness of Covered California health exchange, the online health insurance exchange or marketplace currently under development, remains quite low. Just 25% of voters age 18-64 statewide say theyve heard a lot or some about Covered California. Much larger proportions report having heard only a little about it (33%) or nothing at all (42%). Awareness is also lower among many of the key constituencies being targeted for Covered Californias services. For example, just 18% of voters who are currently uninsured say theyve heard a lot or some about it. Similarly, only 18% of voters under age 30 report this level of awareness, as do 16% of African-Americans and 20% of non-English speakers.

The Field Poll Wednesday, August 21, 2013

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Awareness of eligibility among specific populations who would benefit under the ACA Two specific subgroups of voters who would directly benefit from the Affordable Care Acts provisions were identified by the survey and asked whether or not they knew of their eligibility to receive health coverage benefits under the law. The first includes low-income voters under age 65 who are eligible to receive free health coverage under the expanded Medi-Cal program and are not currently covered through an employer, labor union or government program. A second subgroup includes moderate-income voters under age 65 not currently receiving health coverage from an employer, union or government program who are eligible to receive tax credits to reduce the costs of their health insurance. The survey finds that fewer than half of these voters are aware of their eligibility for these benefits. For example, 48% of low-income voters eligible for free health coverage under the expanded MediCal program currently know of their eligibility. In addition, just 33% of moderate-income voters not currently covered under an employer or government health insurance program are aware of their eligibility when applying for it at Covered California. Interest in learning more about Covered California Nevertheless, there is considerable interest among voters under age 65 in learning more about Covered California and the kinds of health insurance plans and coverage options offered there. Statewide 65% of these voters report being interested, while 34% are not. Interest is highest among many of the exchanges key constituencies. Greater than eight in ten uninsured voters under age 65 (83%) say theyre interested, as do 79% of Latinos, 82% of AfricanAmericans, and 83% of non-English speakers. One complicating factor relating to voter interest in Covered California has to do with the fact that interest in the exchange is also influenced by a voters partisan and political leanings. For example, while three in four Democrats under age 65 (75%) express interest in learning more about it, significantly fewer Republicans (54%) say this. Similarly, while 79% of strong liberals say theyre interested in what the exchange has to offer, just 53% of strongly conservative voters express interest.

The Field Poll Wednesday, August 21, 2013

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Likelihood of applying for insurance coverage benefits among voter populations who would benefit under the ACA When voters eligible to receive coverage benefits either through expanded Medi-Cal or through Covered Californias insurance tax credits are told of their eligibility and of the governments $95 penalty should they choose to go without insurance coverage, most but not all affected voters say they would likely apply. Three in four low-income voters (74%) eligible for free health coverage under expanded Medi-Cal who are not currently insured through Medi-Cal or an employer or labor union say theyd likely apply for coverage when it becomes available next year, but 22% say theyre not inclined to do so. Similarly, 66% of moderate-income voters eligible for tax credits say its likely they would go to Covered California to shop for health insurance next year, but 27% are not. Non-English speakers preferred language to receive information There is a strong preference among the non-English speakers to receive information from Covered California in their own native languages. Statewide, 77% of the surveyed non-English speakers under age 65 say this, while 20% say it would be acceptable to them to receive this information in English. Will Californias health care system be able to handle the expanded patient load? By a five to three margin (59% to 35%) California voters do not think there will be enough primary care physicians to handle the additional patients expected to receive health care benefits once the Affordable Care Act is fully implemented. Views about this tend to be partisan-based. Democrats are evenly divided, with 46% believing there will be enough doctors to handle the additional patients and 47% saying there will not be. Republicans, on the other hand, are more skeptical, with five times as many believing there will not be enough doctors to handle the expanded patient load (80% to 16%). One proposal that is currently being discussed among state lawmakers to address the burden of an expanded patient load is to change state law to allow nurse practitioners to expand the kinds of primary care services they can provide to patients. When asked about this proposal, voters are strongly supportive. Nearly three in four voters (73%) endorse the idea of expanding the services nurses can provide patients, while just 21% are opposed. Support extends across party lines, with 79% of Democrats, 76% of non-partisans and 60% of Republicans in favor of this proposal. -30-

The Field Poll Wednesday, August 21, 2013

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About the Survey The 2013 TCWF-Field Health Policy Survey is the seventh in an annual series of health policy surveys conducted among California voters by The Field Poll through a grant from The California Wellness Foundation. This years findings are based on a survey of 1,687 California registered voters completed by telephone in seven languages and dialects English, Spanish, Cantonese, Mandarin, Korean, Vietnamese and Tagalog. The survey included interviews with a random wsample of 1,199 registered voters statewide and was supplemented with 488 additional interviews among the Asian American and African-American voters. A total of 1,298 of the interviews were conducted in English and 389 in non-English languages. Interviewing was conducted June 26 July 21, 2013 from Field Research Corporations 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. Interviews were completed on either a voters landline phone or a cell phone. After the completion of interviewing, the overall sample was weighted to align it to the proper statewide distribution of voters by race/ethnicity and 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. The Foundation prioritizes eight issues for funding: diversity in the health professions, environmental health, healthy aging, mental health, teenage pregnancy prevention, violence prevention, womens health, and work and health. It also responds to timely issues or special projects outside these funding priorities. Since its founding in 1992, the Foundation has awarded 6,919 grants totaling more than $852 million. For more information, visit the Foundations website, www.calwellness.org or contact Cecilia Laich, communications officer, at (818) 702-1900.

2013 TCWF-Field Health Policy Survey (Part 3 of 3)

Voter Assessments of the Implementation of the Affordable Care Act in California

The Field Poll
Conducted by

The California Wellness Foundation

Wednesday, August 21, 2013
for release

for

About the Survey

Population surveyed: California registered voters.

Number of interviews: 1,687 interviews, including a random crosssection sample of 1,199 voters and augmented samples of 488 interviews among AsianAmerican and African-American voters.
Data collection: June 26-July 21, 2013 by cell and landline telephone using live interviewers from Field Researchs central location call center. English, Spanish, Cantonese, Mandarin, Tagalog, Korean and Vietnamese. 1,298 in English and 389 in non-English languages. Overall findings have a sampling error of +/- 2.6 percentage points at the 95% confidence level.
1 The Field Poll

Languages of administration: Sampling error:

The California Wellness Foundation

Graph 1a

Voter opinions of how successful California will be in implementing the Affordable Care Act (2011 vs. 2013)
No opinion 3% Not at all successful 13% Very successful 13% No opinion 2% Not at all successful 13%

Very successful 18%

Not too successful 24%

Somewhat successful 47%

Not too successful 19%

Somewhat successful 48%

2011
The California Wellness Foundation 2

2013
The Field Poll

Graph 1b

Voter opinions of Californias success in implementing the Affordable Care Act by party
California will be
Successful Not successful

Total registered voters

66%
32% 81% 17%

Democrats

Republicans

41%
55% 66% 31%

No party preference/other

Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.
The California Wellness Foundation 3 The Field Poll

Graph 2

Voter opinions about how successful California will be in achieving specific goals of the ACA
California will be
Successful Not successful

Encouraging more low and moderate income residents who are currently uninsured to get coverage Obtaining the federal funds needed to fully implement the law Establishing a one-stop place where it will be easy for consumers/small businesses to shop for health insurance online Providing consumers with more insurance choices Regulating the insurance market so the average Californian has better consumer protections Limiting the rate increases that insurance companies charge to their customers each year
The California Wellness Foundation 4

Democrat Republican

66% 32% 64% 32% 63% 33% 61% 36% 60% 37% 50% 47%

78% 21 76% 22 77% 20 75% 22 76% 21 62% 34

49% 48 47% 49 44% 52 39% 58 38% 58 30% 67

The Field Poll

Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.

Graph 3a

Extent of voter awareness of the states Covered California Health Insurance Exchange (among voters under age 65)
25%

Heard a lot 6%
Heard some 19%

Heard nothing 42%

Heard only a little 33%

The California Wellness Foundation

The Field Poll

Graph 3b

Voters under age 65 who have heard a lot or some about Covered California by insurance status, household income and age
% Heard a lot or some Total voters under age 65 Insurance status Uninsured Total insured Continuously covered past 2 years Coverage intermittent past 2 years Household income and Federal Poverty Level Less than 139% FPL 139%400% FPL More than 400% FPL 18% 26% 28% 24% 25%

22% 22% 30% 18% 26% 22%

Age 18-29 30-39 40-49 50-64

The California Wellness Foundation 6

32%
The Field Poll

Graph 3c

Voters under age 65 who have heard a lot or some about Covered California by race/ethnicity and language
% Heard a lot or some Total voters under age 65 Race/ethnicity White non-Hispanic Latino African-American Asian-American Language spoken English Non-English 20% 16% 25% 25%

27% 23%

26%

The California Wellness Foundation

The Field Poll

Graph 4

Voter awareness of their eligibility to receive free health coverage under the expanded Medi-Cal program (among those under 65 whose income qualifies them for Medi-Cal who are not currently enrolled)

Dont know 27% Yes, eligible 48% No, not eligible 25%

The California Wellness Foundation

The Field Poll

Graph 5

Voter awareness of their eligibility to receive tax credits when applying for insurance through Covered California (among voters eligible for tax credits not currently covered under an employer, union or government program)

Dont know 39%

Yes, eligible 33%

No, not eligible 28%

* Includes voters under age 65 whose household income is 139%-400% of the Federal Poverty Level who are not currently covered for insurance through their employer or through a government program. The California Wellness Foundation The Field Poll 9

Graph 6a

Voter interest in learning more about Covered California and the kinds of health insurance plans and coverage options offered there (among voters under age 65)
1% No opinion

Not at all interested 17% Not too interested 17%

Very interested 30%

Somewhat interested 35%

Interested 65%

The California Wellness Foundation

10

The Field Poll

Graph 6b

Proportions of voters under age 65 interested in learning more about Covered California by insurance status, household income and age
% Interested
Very Somewhat

Total voters under age 65 Insurance status Uninsured Total insured Continuously covered past 2 years Coverage intermittent past 2 years Household income and Federal Poverty Level Less than 139% FPL 139%400% FPL More than 400% FPL Age 18-29 30-39 40-49 50-64
The California Wellness Foundation

30% 48% 28% 27% 30%

35%

65% 35% 83% 63% 60% 70%

35% 33% 40%

36% 32% 27%

40% 76% 36% 68% 31% 58%

17% 31% 35% 37%

11

44% 33% 33% 31%

61% 64% 68% 68%

The Field Poll

Graph 6c

Proportions of voters under age 65 interested in learning more about Covered California by race/ethnicity and language
% Interested
Very Somewhat

Total voters under age 65 Race/ethnicity White non-Hispanic Latino African-American Asian-American Language spoken English

30%

35%

65%

25% 37% 46%

31%

56% 42% 36% 79% 82%

27%

37%

64%

28%
52%

35%

63%
31% 83%

Non-English

The California Wellness Foundation

12

The Field Poll

Graph 6d

Proportions of voters under age 65 interested in learning more about Covered California by party and political ideology
% Interested
Very Somewhat

Total voters under age 65 Party registration Democrat Republican No party preference/other Political ideology Strongly conservative Moderately conservative

30%

35%

65%

39% 20% 27% 34% 34%

36% 54% 61%

75%

24%

29%

53%

23%
27% 36% 48%
13

39%
37% 39%

62%
64% 75% 79%
The Field Poll

Middle-of-the-road
Moderately liberal Strongly liberal
The California Wellness Foundation

31%

Graph 7

Stated likelihood of voters eligible for expanded MediCal coverage to apply for it next year (among eligible voters not currently insured through Medi-Cal or an employer or union)
4% Dont know Not at all likely 11% Not too likely 11% Somewhat likely to apply 23%

Very likely to apply 51%

Likely 74%
The California Wellness Foundation 14 The Field Poll

Graph 8

Stated likelihood of voters eligible for tax credits to visit Covered California to apply for tax credits (among eligible voters not currently covered through an employer or government program)
Dont know 7% Not at all likely 12% Not too likely 15% Somewhat likely 30% Likely 66%

Very likely 36%

The California Wellness Foundation

15

The Field Poll

Graph 9

Preferred language in which non-English-speaking voters would like to receive information about Covered California (among non-English speakers under age 65)
Not reported 3% English 19%

Native language 78%

The California Wellness Foundation

16

The Field Poll

Graph 10

Voter opinions about whether California will have enough primary care physicians to handle the additional patients expected to receive health care benefits under the Affordable Care Act
No opinion 6%
Will have enough 35% Will not have enough 59%
Will have enough Will not have enough

Party registration Democrats 46% 47% 16% 80% 38% 55%

Republicans

No party preference/ other

The California Wellness Foundation

17

The Field Poll

Graph 11

California voter reactions to the idea of allowing nurse practitioners to expand the kinds of primary care services they can provide
No opinion 6% Oppose 21% Party registration Democrats 79% 14% 60% 34% 76% 18%
Favor Oppose

Favor 73%

Republicans

No party preference/ other

The California Wellness Foundation

18

The Field Poll

Field Research Corporation San Francisco, CA 2013 TCWF-Field Health Policy Poll

600-044

Part 3: Voter Assessments of the Implementation of the Affordable Care Act in California 1. Overall, how successful do you think the state of California will be in implementing the health care law very successful, somewhat successful, not too successful, or not at all successful?
VERY SUCCESSFUL ............................. 18% SOMEWHAT SUCCESSFUL.................... 48 NOT TOO SUCCESSFUL........................ 19 NOT AT ALL SUCCESSFUL .................... 13 NO OPINION ........................................... 2

2.

I am going to read some of the goals that California is hoping to achieve when implementing the health care law. Please tell me how successful you think it will be in achieving each goal. (READ ITEMS IN RANDOM ORDER, ASKING:) How successful do you think California will be 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 low and moderate income residents who are currently uninsured to get health insurance coverage...........................................................23%.......... 43.............20 ............ 12.........2 ( ) b. regulating the health insurance market so that the average Californian has better consumer protections .....14%.......... 46.............22 ............ 15.........3 ( ) c. obtaining the federal funding needed to fully implement the law .............................................................21%.......... 43.............20 ............ 12.........4 ( ) d. providing California consumers with more health insurance choices .............................................................18%.......... 43.............22 ............ 14.........3 ( ) e. limiting the rate increases that insurance companies charge to their customers each year ................................13%.......... 37.............25 ............ 22.........3 ( ) f. establishing a one-stop place where it will be easy for consumers and small businesses to shop for health insurance online ................................................................21%.......... 42.............21 ............ 12.........4 3. Many residents who currently do not have access to regular care are expected to receive health care benefits under the new law. Given this, do you think that California will or will not have enough primary care physicians to meet the states expanding needs? Do you favor or oppose changing state law to allow nurse practitioners to expand the kinds of primary care services they can provide patients in California?
WILL .................................................... 35% WILL NOT............................................. 59 DONT KNOW/REFUSED ......................... 6

4.

FAVOR ................................................ 73% OPPOSE .............................................. 21 DONT KNOW/REFUSED ......................... 6

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IF UNDER AGE 65:

California is currently developing Covered California, a health insurance exchange or marketplace where consumers and small businesses will be able to shop for health insurance online. At the Covered California website, competing insurance companies will offer different policies at different premium levels, deductibles and co-pays to allow consumers to choose a plan that best fits their needs and budget. Low and moderate-income residents will also be able to obtain tax credits or receive subsidies to lower or fully pay for their insurance costs. 5. How much have you heard about the states Covered California health insurance exchange a lot, some, only a little or nothing at all?
A LOT .................................................... 6% SOME .................................................. 19 ONLY A LITTLE ..................................... 33 NOTHING AT ALL .................................. 42 NO OPINION ............................................* VERY INTERESTED............................... 30% SOMEWHAT INTERESTED ..................... 35 NOT TOO INTERESTED ......................... 17 NOT AT ALL INTERESTED ..................... 17 NO OPINION ........................................... 1

6.

How interested are you in learning more about Covered California and the kinds of health insurance plans and coverage options offered there very interested, somewhat interested, not too interested or not at all interested?

IF NON-ENGLISH SPEAKER:

7.

If you needed to obtain more information about Covered California, in which language would you prefer to receive this information English or (LANGUAGE OF INTERVIEW)?

ENGLISH.............................................. 19% LANGUAGE OF INTERVIEW ................... 78 DON'T KNOW ......................................... 3

IF < AGE 65 & INCOME < 138% FPL & NOT ALREADY INSURED THROUGH EMPLOYER OR GOVERNMENT PROGRAM:

8.

Beginning next year, most people will be required to have health insurance or pay a tax penalty of $95 or 1 percent of their household income to the government. However, lower income Californians will be able to receive health coverage free under the states Medi-Cal program. As far as you know, will you be eligible or not eligible to receive free health insurance coverage from the states Medi-Cal program next year? (As you know) (It happens that) people in your income bracket will be eligible to apply for health insurance coverage for free under the states Medi-Cal program. How likely are you to apply for health coverage under the states Medi-Cal health insurance program next year very likely, somewhat likely, not too likely or not at all likely?

YES, ELIGIBLE...................................... 48% NO, NOT ELIGIBLE ................................ 25 DON'T KNOW ....................................... 27

9.

VERY LIKELY ........................................ 51% SOMEWHAT LIKELY .............................. 23 NOT TOO LIKELY .................................. 11 NOT AT ALL LIKELY................................ 11 NO OPINION ........................................... 3

IF < AGE 65 & INCOME BETWEEN 138% AND 400% FPL & NOT ALREADY INSURED THROUGH EMPLOYER OR GOVERNMENT PROGRAM:

10.

Beginning next year, most people will be required to have health insurance or pay a tax penalty of $95 or 1 percent of their household income to the government. However, some Californians will be able to receive tax credits to reduce the costs of their insurance by applying for it at Covered California. As far as you know, will you be eligible or not eligible to receive tax credits to reduce the costs of your health insurance coverage next year? (As you know) (It happens that) people in your income bracket will be eligible to receive tax credits to reduce the costs of their health insurance when applying for it at Covered California. How likely are you to go to Covered California to shop for health insurance next year very likely, somewhat likely, not too likely or not at all likely?

YES, ELIGIBLE...................................... 33% NO, NOT ELIGIBLE ................................ 28 DON'T KNOW ....................................... 39

11.

VERY LIKELY ........................................ 36% SOMEWHAT LIKELY .............................. 30 NOT TOO LIKELY .................................. 15 NOT AT ALL LIKELY................................ 12 NO OPINION ........................................... 7

* Less than of 1%
H:\600044\Report\Press releases\Marginals - Story #3.doc