Sep. 30, 2013 at 8:32 PM ET
Americans are more worried than confused about the new health insurance exchanges that open Tuesday, a new poll shows. Most wonder whether the main provisions of the health reform law will end up costing them money.
The Kaiser Family Foundation/NBC survey found an anemic level of enthusiasm about the program among ordinary people and splits among party lines.
Just over half said they were worried, while slightly less said they were confused. Twenty-nine percent said they were angry about the ACA, compared to just 24 percent who described themselves as enthusiastic.
It doesn't surprise Health and Human Services Secretary Kathleen Sebelius. "I think it still isn't real for a lot of people. And there is a lot of confusion," Sebelius told NBC Nightly News in an interview.
"But for the 15 percent in and out of the market, not insured at all, this will be a new chance, a new choice for health security. But they need to see it and make it real. And that will happen starting tomorrow."
Still, Sebelius acknowledged that the administration shares some blame for the confusion on the eve of the roll-out.
"I think we bear part of the responsibility of not being able to get through a lot of the noise," she said.
Lauren Cathis, 49, of Canton, Ohio, is relieved she is covered by Medicare and doesn't have to navigate the purchase of insurance in the coming months.
"It's so complex, how can I believe any of the numbers I've been given?" she asked.
Those numbers are the source of much of the anxiety surrounding the biggest change in health care in years.
Nearly three-fourths of those surveyed said they were very or somewhat worried that they would have to pay more for their health care or health insurance and that their income would be outpaced by rising costs.
"I'm really confused, but one thing I know is I can't afford it," said Earle Griffis, 46, a commercial fisherman from Milton, Fla., who was one of the 1,503 people polled between Sept. 12-18.
Griffis said he doesn't have health-care insurance now because it costs too much, so he's left a hernia that runs from his navel to his rib cage and heart problems untreated.
When enrollment begins Oct. 1, he and other uninsured Americans will be asked to go shopping for a plan in state-based exchanges that are supposed to keep premiums low and provide low-income discounts.
Griffis doesn't plan to sign up.
He fears health insurance would cost him up to $700 a month in premiums — or 20 percent of his income — though he conceded that was based on prices he was quoted for coverage before Obamacare.
Those required to buy insurance under the law who opt out will pay a penalty: $95 per adult or 1 percent of their income, whichever is higher, for the first year, and rising in subsequent years.
Underscoring some of the misinformation and confusion surrounding the rollout, Griffis said he had heard he would be fined $200 a month.
"I can't pay that," he said. "I guess they'll have to haul me to jail."
In Boise, Idaho, 25-year-old Bryan Neba was also bewildered by some of the components of the ACA. But one thing was crystal clear to him: Next year, he will be able to have an operation on an injury he's "just been living with."
Because he has a pre-existing condition, Neba said, he's been rejected by insurance companies or quoted prices as high as $500 a month, which would have been a third of his income at the time.
He thinks he'll pay less than $200 if he buys insurance through his state exchange. "Insurance companies would not be able to turn me down," he said. "I'm pretty optimistic about it."
Even as a solid supporter of the ACA, however, he had concerns, including whether the government can foot the bill.
"I want it to be feasible," he said. "I don't want the government to go broke.'
The polling data shows that attitudes toward the law differ somewhat according to whether someone already has insurance. More of the uninsured are worried or confused than those who are already covered and don't have to enroll by 2014.
But it's the political fault lines that run the deepest, as they have been since the law was proposed.
While just a quarter of Democrats say they are worried about it, three-fourths of Republicans fret. More than half of Republicans say they're angry, with numbers even higher among Tea Party members; only 12 percent of Democrats say they feel the same.
Not even half of Democrats -- 44 percent -- describe themselves as enthusiastic about Obamacare. But compare that to the Republicans: a mere 5 percent. Even among Independents, enthusiasm is scarce at 18 percent.
"I hate it," said Raymond Mitchell, 55, a lawyer and registered Republican who lives in Cape Pearl, Fla. "I think it's unconstitutional."
Mitchell is uninsured but says he's in good enough shape that paying out pocket for medical care isn't a burden. He has no plans to buy in during open enrollment -- and damn the consequences.
"Absolutely not," he said. "I think it's an illegal law. And I'm not paying the fine, or I'm going to try not to."
He contends the costs of covering everyone will be disproportionately shouldered by people like him.
"I think it's unfair and unjust to rob people who want to be healthy and make them pay for the people who are irresponsible, and who are drug addicts and have wild sex."
Lee Smith, 36, a Democrat from Beloit, Wisc., said he would be willing to pay more to ensure that everyone has access to medical care.
"The need is so drastic," he said.
Smith, a married hotel industry worker, has insurance but said the perils of being without it have hit close to home. He said his aunt was repeatedly denied coverage because she has congestive heart failure and simply didn't go to the doctor because she didn't have the money.
"It was crippling for the family to see her go through that," he said. "Now she will be able to afford proper care and procedures."
Despite the political divide in the data, respondents say their affiliations aren't fueling their opinions of the law.
"The view I have is that there should be something to accommodate people who do not have insurance," Smith said. "I don't have any concerns that it will be a burden or cost me, but even if it did, I would be for it because I know it will help people."
"I'm a Republican, but that's got nothing to do with it," said Griffis. "Everyone I know says they don't know what they'll do to pay the insurance."
Still clueless about Obamacare? Ask your questions on Twitter, Facebook or Google+ with the hashtag #AskDrNancy, and NBC chief medical editor Dr. Nancy Snyderman will answer some of the most important or common queries. See all our health care coverage here.