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Ratings of U.S. Health Care Quality No Better Under ACA

One in three rate U.S. health care coverage positively

A new Gallup poll finds that most Americans rate the quality of health care in the United States the same today as they did before the implementation of the Affordable Care Act.

Fifty-three percent of those surveyed said they considered the quality of health care to be excellent or good — similar to Gallup polls conducted in 2013, but down from the more positive ratings of 2008 to 2012. However, fewer than one in four Americans are satisfied with the total cost of health care. Only one in three rate health care coverage positively.

From 2005 to 2007, a slim majority of Americans rated the quality of health care in the U.S. as excellent or good. This percentage increased slightly in 2008 after President Barack Obama was elected, reaching a high of 62% in November 2010 and again in 2012 just after he was elected to his second term. Those higher ratings could reflect optimism about President Obama's promises to reform health care and the passage of the Affordable Care Act. However, since November 2013, shortly after the ACA insurance exchanges first opened, no more than 54% of Americans have rated the quality of health care in the U.S. as excellent or good.

Americans rate U.S. health care coverage far less positively than they do health care quality. The percentage of Americans rating U.S. health care coverage as excellent or good increased from 26% in 2008 to 38% in 2009. Since then, the percentage who view health care coverage in the U.S. positively has varied slightly from year to year, but remains higher than before President Obama took office.

Americans' satisfaction with the total cost of health care in the U.S. remains low, with 21% saying they are satisfied. Twenty-eight percent were satisfied in 2001, but satisfaction fell after that, rising again only in 2009, to 26%. This increase too may reflect optimism about the possibilities of President Obama's health care reform. However, satisfaction has since slipped.

Although Americans were more positive about the cost, quality, and coverage of U.S. health care in the early years of the president’s first term, that optimism has faded to some degree. Americans' ratings of health care coverage are not high, but remain higher than they were in George W. Bush's second term. This may have something to do with the ACA, especially as the U.S. percentage of uninsured people has dropped since the ACA exchanges opened. The ACA may not have had such obviously positive effects on cost and quality, which Americans generally regard as no better than before President Obama took office.

At the same time, Americans continue to rate their personal health care positively overall, although again without much improvement since the recent health care reform took effect. Americans are more negative about the health care system in the U.S. in general as opposed to their own health care. A similar phenomenon is found when Americans rate personal or local conditions compared with national conditions in areas such as education, government, and crime.

Source: Gallup, November 20, 2015.

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