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Americans still hold strong feelings about Obamacare and its future

When the Affordable Care Act (also known as "Obamacare") was passed in March 2010, its advocates and political supporters promised a brighter future for millions of uninsured Americans. Now, more than five years later, a new insuranceQuotes report suggests that Obamacare remains a source of optimism for some and a source of political discontent for others.

Princeton Survey Research Associates International conducted the survey in September, which polled 1,004 American adults, asking them how they feel about their health insurance accessibility now and in the future, whether they would repeal the law, and how important the issue will be in the next presidential election.

Find out what Americans said.

Americans show more optimism about Obamacare

According to the survey, worries about obtaining affordable health insurance have gone down.

Last year, 55 percent of survey respondents said they were very or somewhat worried about not having affordable health insurance in the future. As of September 2015, this number has dropped to 47 percent, and analysts say this is a sign the benefits of the ACA are beginning to impact Americans' perceptions of health insurance.

"The fact that we're seeing some reduction in people who feel vulnerable is exactly what the law is intended to do. I think this is a good sign," says Gerald Kominski, director of the UCLA Center for Health Policy Research. However, "insurance is still expensive, and there's still not 100 percent participation in the (state and federal health insurance) exchanges. People are still taking their chances and going uninsured because health insurance is still expensive."

This is of equal concern for Families USA, a Washington, D.C.-based nonprofit that advocates for lower health care costs.

In a written response to the survey, Families USA points out that many Americans are still unaware of a provision in the ACA that provides tax credits for low- and middle-income consumers to help subsidize premiums through official insurance exchanges.

"We still have a lot of work to do to let people know about the availability of financial assistance through the marketplace, as there are still significant knowledge gaps," says the organization. "We've found that 59 percent of those who say they can't afford coverage have not heard of the tax credit. Outreach, education and enrollment assistance will continue to be important to let people know what is available to them."

For the most part, optimism also prevailed when respondents were asked whether they feel their health insurance situation is better, worse or about the same as last year. According to the survey results, 14 percent of Americans feel better, 16 percent feel worse and 68 percent feel about the same.

Despite the predominantly promising picture, some analysts are concerned by the 16 percent of Americans who said they feel worse about their current health insurance circumstances.

"There's a great deal of optimism about the millions of Americans who have health insurance for the first time because of the ACA," says A. Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan. "But I think you're seeing that concerns persist over the adequacy and cost of plans, particularly for those who are socially and economically vulnerable."

Will health insurance be affordable in the future?

When it comes to anxieties about affordable health insurance, Americans are somewhat divided along demographic lines.

For instance, according to the survey, 43 percent of Hispanic respondents are "very worried" about having affordable health insurance in the future (the highest percentage of any group), while just 21 percent of white non-Hispanic respondents said the same.

Meanwhile, 38 percent of black non-Hispanic respondents said they were "not at all worried" about not having affordable health insurance in the future.

What's more, the survey shows that 84 percent of black non-Hispanic respondents want to keep the ACA in place, and 54 percent of white non-Hispanic respondents want to repeal the law.

According to Kominski, these demographic divides are difficult to interpret without also considering how they may correlate to income. For instance, he points out that certain populations -- such as Latino Americans -- fall into income categories that qualify for ACA benefits.

"So it's not surprising they would have greater concerns about the affordability of health insurance and also be the same people who are more likely to support the ACA," says Kominski. "We've seen that here in California, for instance. The uninsured skew much more heavily toward the African-American and Latino populations."

Likewise, upper-class white Americans are less likely to need governmental assistance provided through the ACA, and in some instances may favor repealing it because they feel as though they are burdened by subsidizing health insurance for others.

"People who already had insurance probably felt like the ACA was addressing a problem that didn't exist for them," says Dr. Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health. "However, for the uninsured or for those who had insurance policies they didn't like, the ACA is much more valuable."

See also: Obamacare myths debunked

Young people worry less about being uninsured

How one feels about future health insurance will also depend on one's age.

According to the survey, 61 percent of participants ages 18 to 29 said they weren't worried about having affordable health insurance in the future. Fifty-four percent of those in this age group also favor keeping the ACA in place.

"This is not at all surprising," says Fendrick. "First of all, young people think they are going to be healthy forever, so they feel their need for health insurance is less, which also means they don't worry about it as much. And secondly, this is also the result of one of the most popular aspects of the ACA, which is that children can stay insured through their parents until age 26. So there's really no reason most 19-year-olds have to worry about being uninsured."

Obamacare and the 2016 presidential campaign

Even before its passage in 2010, feelings about the ACA were sharply divided down political lines. Not much has changed.

According to the survey, 74 percent of Democrats want to keep the ACA in place, while 77 percent of Republicans want to repeal it. But, according to Kominski, this divide is about something "much bigger" than politics.

"This is not about health insurance. Rather, conservatives feel that the ACA represents a direct expansion of a federal program targeted to low- and middle-income families, which is why I think this continues to be such a political lightening rod," says Kominski.

To that end, 41 percent of respondents said a 2016 presidential candidate's view on the ACA will be very important to them. However, Sommers isn't convinced that any candidate's future will hinge on his or her feelings about the law.

"It will certainly be discussed, and both parties will say it's important," says Sommers. "But it's so completely polarized on both sides of the aisle that it's hard to imagine this will swing the election. Republicans oppose it, and Democrats support it. So it will probably play less of a role this time around than in the last election, when Obamacare was really on the line."

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