1. 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%