Knowledge and Perceptions of the Affordable Care Act Among Working Uninsured and Underinsured of Luzerne Country

Karla C. Bagley1, Kathryn Cannon1, Joiceann R. Compton1, Anitha Daniel1, Robert Decker1, Patrick Harris1, Patricia Melvin1, Kaitlyn Sweeney1, Mushfiq Tarafder 1, Kathleen Hirthler2

1The Commonwealth Medical College, Scranton, PA; 2Volunteers In Medicine, Wilkes-Barre, PA

BACKGROUND METHODS The aim of the Affordable Care Act (ACA) is to provide standardized healthcare coverage in the United States. •  Effective on March 23, 2010 •  Three main objectives

1.  Equal access to affordable health insurance 2.  Minimize healthcare costs to individuals 3.  Reduction of the federal deficit

•  Between 2010 - 2019, the major components of the ACA will become effective

•  Targeted populations: underinsured and uninsured in America •  Working families and low income individuals ineligible

for Medicaid and unable to afford private coverage •  According to the U.S. Census Bureau, 49.9 million Americans

were uninsured in 2010 •  ACA mandates that the majority of individuals must buy

insurance •  Premiums are granted based upon income

•  In 2019, the Congressional Budget Office estimates coverage to 33 million people

•  Knowledge and perception of the impact of ACA maybe inadequate among individuals who are likely to be affected.

•  A total of 165 surveys were collected •  Study was approved by The Wright Center IRB •  An implied consent statement was included in the survey Data Analysis: •  155 surveys were included in data analysis.

o  Reasons for non-inclusion: §  ACA knowledge/perceptions part was not filled out §  Not a patient at the clinic

•  Broad variable categories: socio-demographic, health conditions, ACA knowledge and ACA perceptions

•  Knowledge and Perceptions measured in likert scale •  Proportions were calculated for all dichotomous and

categorical variables •  Summary statistics were calculated for all discrete variables •  T-test and ANOVA were performed for perception score •  Microsoft Excel and EpiInfo were used for data management

and analysis

RESULTS

SPECIFIC AIMS 1. To investigate the perceptions, awareness, and knowledge of the Affordable Care Act (ACA) among the working uninsured and working underinsured populations who receive health care at the VIM clinic in Luzerne County, PA. 2. To identify a possible association between demographics or socioeconomic status and level of knowledge of the ACA in the source population mentioned in the specific aim #1.

Figure 2: Distribution of responses to statement regarding awareness and knowledge of the ACA.   Figure 3: Distribution of responses to statement regarding direct and financial impact of the ACA.            

Figure 4: Distribution of responses to statement regarding the impact of various aspects of the ACA.                 Table 1: Association between socioeconomic and demographic factors, and average ACA perception Score (range: 1 – 5).                                        

•  Most people (60.6% to 78.7%) reported having “No Knowledge” of the aspects of the Affordable care act

•  From 32% to 51.6% rated themselves as “Not Aware” of the various portions of the ACA.

•  Most aware and knowledgeable about changes to parental coverage for children up to the age of 26 and new policies that require coverage of preexisting conditions by health insurance companies.

•  Least knowledgeable and aware of the expansion of Medicare, the creation of healthcare exchanges, and new health insurance requirements for businesses.

•  Most individuals stated they had no opinion (neutral) regarding whether the ACA would have a positive impact on them or whether it would have any direct impact at all. o  Of those who did have an opinion, most agreed that the

affordable care act would have a direct impact on them and believed that many of the aspects, especially the creation of healthcare exchanges, coverage of preexisting conditions, and coverage of children up to 26 would have a positive impact on them.

•  Most respondents who expressed an opinion doubted that the ACA would save them money, and believed that the enactment of penalties for not having health insurance would not have a positive impact on them.

•  Individuals with a college degree (Bachelor’s, Master’s, Doctoral, or Professional) a significantly higher ACA perception score.

BIBLIOGRAPHY   •  Gruber, J. (2011). Health care reform: what is it ,why it’s necessary, how it works.

New York: Hill and Wang. •  Hastings, D. (2010). “The Timeline for Accountable Care: The Rollout of the

Payment and Delivery Reform Provision in the Patient Protection and Affordable Care Act and the Implications for Accountable Care Organizations.” March 2010; Clinical Advisory Board interview and analysis

•  United States Census Bureau. "Income, Poverty and Health Insurance Coverage in the United States: 2011.“ www.census.gov. U.S. Census Bureau, n.d. Web. 30 Oct. 2012.

FUTURE DIRECTION •  We hope our findings can be used to fuel education

programs targeted at the working under-insured and uninsured.

•  The education programs would elucidate the benefits and relevant effects of the Affordable Care Act so that the working population can reap all the healthcare benefits entitled to them under this new sets of laws.  

DISCUSSION AND CONCLUSION

MATERIALS AND METHODS Study Subjects: •  Participants were uninsured or underinsured patients at the

VIM clinic. •  Participation restricted to

o  English speaking patients o  between ages eighteen and sixty-five years old o  visited the clinic between Jan. 22 and Feb. 22, 2013

Data collection: •  Duration: January 22- February 22, 2013 •  Surveys were administered to patients with their check-in

paperwork from 8a-12p on Monday- Friday. •  At check-in, patients were asked if they would be willing to

participate in the study •  If patients agreed to participate and had not previously

completed the survey they were given a survey to complete •  Surveys were administered by VIM staff as well as by

research group members

ACKNOWLEDGMENTS The authors gratefully acknowledge the community members and health professional who worked with us on this project. Particularly, the Wilkes-Barre VIM clinic staff and clinicians, Department of Family Community and Rural Health of TCMC, Lori Kishel, and Christopher Cannon.

0%   20%   40%   60%   80%   100%  

Affordable  Care  Act/General  

New  Individual  Requirements  

New  Buisness  Requirements  

Coverage  for  Children  up  to  26  

Expansion  of  Medicare  

CreaJon  of  Healthcare  Exchanges  

Coverage  of  PreexisJng  CondiJons  

Tax  Credits/PenalJes  for  Health  Insurance  

33  

31  

29  

56  

26  

26  

52  

39  

51  

51  

50  

36  

52  

42  

45  

48  

66  

66  

70  

58  

69  

80  

50  

61  

5  

7  

6  

5  

8  

7  

8  

7  

At  Least  Some  Knowledge   Aware  But  No  Knowledge   Not  Aware   No  Response  

0%   20%   40%   60%   80%   100%  

Affordable  Care  Act  (All  Aspects)  

Coverage  for  Children  up  to  26  

Expansion  of  Medicare  

CreaJon  of  Healthcare  Exchanges  

Coverage  of  PreexisJng  CondiJons  

Tax  Credits  for  Health  Insurance  

PenalJes  for  Not  Having  Health  Insurance  

9  

14  

8  

5  

4  

8  

29  

16  

15  

18  

8  

8  

23  

20  

83  

71  

82  

86  

61  

81  

61  

29  

31  

31  

37  

49  

25  

23  

6  

12  

6  

8  

24  

7  

14  

12  

12  

10  

11  

9  

11  

8  

Strongly  Disagree   Disagree   No  Opinion  

Agree   Strongly  Agree   No  Response  

RESULTS Figure 1. Distribution of Demographic and Socioeconomic Factors.

Figure 1a: Sex Figure 1b: Race Figure 1c: Age Figure 1e: Education Figure 1f: Past Insurance History Figure 1g: Employment Status Figure 1i: Household Income Figure 1j: Chronic Conditions

Female  74%  

Male  26%  

18-­‐29  19%  

30-­‐39  24%  40-­‐49  

25%  

50+  32%  

7%  

37%  

43%  

12%  

1%   Bachelor's,  Master's,  Doctoral,  or  Professional  Degree  High  School  Diploma  

Some  College  or  Associate's  Degree  

Some  High  School  

17%   1%  

82%  

No  No  Response  Yes   27%  

3%  70%  

No  

No  Response  

Yes  

1%  

92%  

3%  4%   $50,000  or  more  

Less  than  $50,000  No  Response  

Unsure  

39%  

27%  

34%  

1  to  2  

3  or  More  

No  Chronic  CondiJons  

Variable   Count   Mean   Median   Standard  Devia3on  

Min   Max   ANOVA  P-­‐value  

Sex   Female   109   3.124   3.111   0.668   1.0   4.625   0.587  Male   39   3.063   3.0   0.388   2.0   3.889  

Race   White,  Non-­‐Hispanic   92   3.07   3.0   0.548   1.0   4.625   0.663  White,  Hispanic   20   3.096   3.0   0.706   1.0   4.5  

Black   26   3.238   3.111   0.779   1.0   4.556  Other  Race   10   3.144   3.0   0.406   2.556   4.111  

Age   18-­‐29   28   3.051   3.0   0.495   1.0   3.889   0.409  30-­‐39   36   3.261   3.222   0.425   2.333   4.111  40-­‐49   37   3.062   3.0   0.759   1.0   4.625  50+   47   3.062   3.0   0.647   1.0   4.5  

Educa3on   Bachelor’s,  Graduate,  or  Professional  Degree  

9   3.742   3.889   0.608   2.889   4.556   0.011  

Some  College  or  Associate’s  Degree  

64   3.083   3.0   0.549   1.778   4.444  

High  School  Diploma   56   3.083   3.0   0.556   1.0   4.625  Some  High  School   18   3.076   3.222   0.643   1.0   3.778  

Employed   Yes   104   3.101   3.0   0.629   1.0   4.625   0.782  No   40   3.132   3.056   0.584   1.0   4.0  

Ever  had  Insurance  

Yes   122   3.126   3.0   0.6   1.0   4.625   0.475  No   25   3.03   3.0   0.656   1.0   4.111  

Number  of  Chronic  

Condi3ons  

1-­‐2   60   3.1   3.0   0.624   1.0   4.5   0.441  3  or  More   40   3.023   3.0   0.768   1.0   4.625  

None   48   3.189   3.056   0.399   2.333   4.111  

0%   20%   40%   60%   80%   100%  

ACA  will  have  a  direct  impact  on  me  

ACA  will  save  me  money  

7  

11  

5  

24  

75  

84  

44  

20  

13  

5  

11  

11  

Strongly  Disagree   Disagree   No  Opinion   Agree   Strongly  Agree   No  Response  

Black  17%   White,  

Hispanic  13%  

Other  7%  

White,  Non-­‐

Hispanic  63%