Awareness and Understanding of the Affordable Care Act in a Low Income Population *

BACKGROUND: Low income individuals are intended high priority beneficiaries of the Affordable Care Act’s (ACA) efforts to expand access to health insurance. This analysis assesses awareness of the ACA in a population of low income adults.

METHODS: Data were collected during in-person interviews conducted July-December 2013 for the National HIV Behavioral Surveillance System (NHBS) in Long Island, NY. Suburban low income adult heterosexuals (18-60 yrs) at high risk for HIV infection were recruited using respondent-driven sampling. Locally developed questions gauged participants’ knowledge and understanding of the ACA. Data collection spanned the October 2013 Health Insurance Marketplace open enrollment period and overlapped with the sixteen day 2013 federal government shutdown.

RESULTS: Of 535 participants, 90% were black or Hispanic, 48% female, and 71% had an annual household income less than $20,000. The median age was 36 years. 71% of participants had not heard of the ACA, with Hispanics reporting less awareness (80% unaware) than blacks or whites (both 71%). All groups reported more awareness of “Obamacare” (71% Hispanics and 79% blacks and whites).  17% of participants reported no awareness of either ACA or “Obamacare”. Older participants (45+) were more likely (p value < 0.05) to have heard of the ACA (35%) compared to younger respondents (22%). Awareness of “Obamacare” was not different by age. Participants with low annual household income (<$20,000) compared to higher household income (≥$20,000) participants were less likely to have heard of the ACA (74% vs 61%; p < 0.05), as well as Obamacare (25% vs 14% p < 0.05). 28% of participants who knew of the ACA were insured versus 36% for the uninsured. There was no difference however, in Obamacare awareness by health insurance status (74% vs 76%; p > 0.05). More females were insured compared to male participants (93% vs 79%; p < 0.05). After October 1^st, knowledge of the ACA slightly increased (24% to 32%; p < 0.05) and awareness of Obamacare markedly increased (67% to 81% p < 0.05).

CONCLUSIONS: There was limited awareness of the ACA or Obamacare in this population during the early months of ACA implementation. Significant improvement in awareness of Obamacare was found after the open enrollment period and the federal government shutdown. Despite this knowledge gain, nearly 20% of this population at high risk for HIV infection report no knowledge even after the media attention surrounding the government shutdown.