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Acad Med. 2017 Apr 25. doi: 10.1097/ACM.0000000000001725. [Epub ahead of print]

Opposition to Obamacare: A Closer Look.

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P.R. Gordon is professor, Department of Family and Community Medicine, University of Arizona, Tucson, Arizona; ORCID: L. Gray is a second-year medical student, University of Arizona, College of Medicine, Tucson, Arizona. A. Hollingsworth is assistant professor, Indiana University-Bloomington, School of Public and Environmental Affairs, Bloomington, Indiana. E.C. Shapiro is clinical professor, Department of Pediatrics, University of Arizona, College of Medicine, Tucson, Arizona. J.E. Dalen is dean emeritus, University of Arizona College of Medicine, Tucson, Arizona.


Prior telephone surveys have reported two main reasons for opposition to the Affordable Care Act (ACA): distrust of government and opposition to the universal coverage mandate. The authors set out to elucidate the reasons for this opposition. This article describes how the authors used qualitative methods with semistructured interviewing as a principal investigative method to gather information from people they met while bicycling across the United States from April through July 2016. During this time, the authors conducted open-ended, semistructured conversations with people they met as they rode their bicycles from Washington, DC, to Seattle, Washington. Informants were chosen as a convenience sample. One hundred sixteen individuals participated as informants. The majority of comments were negative toward the ACA. Conversations were categorized into four themes, which included the following: (1) The ACA has increased the cost of health insurance; (2) government should not tell people what to do; (3) responsibility for ACA problems is diffuse; and (4) the ACA should not pay for other people's problems. These face-to-face conversations indicated that opposition to the ACA may be due to the fact that many Americans have experienced an increase in the cost of insurance either through increased premiums or greatly increased deductibles. They blame this increase in cost on the ACA, President Obama, the government or insurance companies, and the inclusion of "others" in insurance plans. The authors discuss how these findings can influence medical education curricula to better prepare future physicians to discuss health policy issues with patients.

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