The Affordable Care Act's Missing Consensus: Values, Attitudes, and Experiences Associated with Competing Health Reform Preferences

Inducing collective action intentions for healthcare reform through medical crowdfunding framing

As a response to the shortcomings of the U.S. healthcare system, Americans are increasingly turning to crowdfunding platforms to bankroll their health-related costs. However, although medical crowdfunding has rapidly become institutionalized as part of the U.S. healthcare financing landscape, empirical evidence on how Americans perceive its role in healthcare and the impact it might have on public attitudes is scarce. To shed more light on the above, we analyze data from one correlational and one experimental study conducted over September-November 2021. Our correlational study reveals that political orientation is associated with Americans' views on medical crowdfunding. Specifically, we find that those who self-identified as conservative perceived medical crowdfunding as a valid part of the system, and more positively than a universal healthcare system. In contrast, medical crowdfunding is perceived less positively, as hindering a system of universal and affordable healthcare by those more liberally-oriented. In our experimental study, we explore how medical crowdfunding narratives can induce social attitudes conducive to change. Specifically, we test the effect of politicized narratives (vs. control) on group efficacy and subsequently on collective action intentions for healthcare reform, as a function of political orientation. Our results show that politicized narratives might induce collective action intentions through higher group efficacy, but only among those who self-identified as conservative. Liberally-oriented individuals held high collective action intentions for healthcare reform and were not affected by the manipulation. Our work is the first to establish empirically that medical crowdfunding, when employing politicized narratives, can induce collective action intentions, but this effect is moderated by political ideology.

COVID-19 may have increased global support for universal health coverage: multi-country observational study

Introduction

The multiple risks generated by the COVID-19 pandemic intensified the debate about healthcare access and coverage. Whether the burden of disease caused by the coronavirus outbreak changed public opinion about healthcare provision remains unclear. In this study, it was specifically examined if the pandemic changed support for governmental intervention in healthcare as a proxy to support for universal health coverage (UHC). It also examined which psychological factors related to the socioeconomic interdependence exposed by the pandemic may be associated with a potential change.

Methods

Online survey data was collected over 18 months (from March 2020 to August 2021) across 73 countries, containing various social attitudes and risk perceptions related to COVID-19. This was a convenience sample composed of voluntary participants (N = 3,176; age 18 years and above).

Results

The results show that support for government intervention in healthcare increased across geographical regions, age groups, and gender groups (an average increase of 39%), more than the support for government intervention in other social welfare issues. Factors related to socioeconomic interdependence predicted increased support for government intervention in healthcare, namely, social solidarity (ß = 0.14, p < 0.0001), and risk to economic livelihood (ß = 0.09, p < 0.0001). Trust in the government to deal with COVID-19 decreased over time, and this negative trajectory predicted a demand for better future government intervention in healthcare (ß = -0.10, p = 0.0003).

Conclusion

The COVID-19 pandemic may have been a potential turning point in the global public support for UHC, as evidenced by a higher level of consensus that governments should be guarantors of healthcare.

Underlying Factors of Health Insurance Use Among Blacks and Hispanics With Ambulatory Care-Sensitive Conditions

This study examined satisfaction with and confidence in understanding health insurance use among Blacks and Hispanic Americans with ambulatory care-sensitive conditions. Using the 2013-2016 Health Reform Monitoring Survey data sets, descriptive statistics and ordinary least-square regressions estimated the association between satisfaction and confidence scores and racial or ethnic groups with ambulatory care-sensitive conditions. Compared with their White counterparts, Black (β = -.13; 95% confidence interval [CI], -0.19 to -0.06) and Hispanic (β = -0.41; 95% CI, -0.48 to -0.33) participants' standardized confidence scores were significantly lower. Research is needed to identify factors that may enhance this population's confidence level.

Health Insurance Loss during COVID-19 May Increase Support for Universal Health Coverage

CONTEXT

The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. Millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context.

METHODS

Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) and the Affordable Care Act (ACA) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic person who lost employer-sponsored coverage during COVID-19.

FINDINGS

We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p < 0.01) with greater M4A support and with more favorable views of extending the ACA (19.3 pp, p < 0.01). Experimental exposure to the vignette increases M4A support by 6 pp (p = 0.05).

CONCLUSIONS

In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA.