title: Social, Reproductive, and Attitudinal Factors Associated with U.S. Women's Disagreement with the Passage of the Affordable Care Act.
abstract: BACKGROUND
  Notably absent from research and public and policy dialogue on the Affordable Care Act (ACA) and reproductive health care are women's perspectives and a broader understanding of factors that shape ACA attitudes. We investigated social, reproductive, and attitudinal factors associated with women's disagreement with the passage of the ACA.
  
  
  METHODS
  Data were drawn from the Women's Health Care Experiences and Preferences Study, our population-based internet survey of 1,078 randomly sampled United States women ages 18-55 years conducted in September 2013. Items measured ACA attitudes, including disagreement with the ACA's passage. We examined relationships between ACA disagreement, sociodemographic and reproductive characteristics, health service experiences, and reproductive health care and policy attitudes with logistic regression.
  
  
  RESULTS
  Among women who had heard of the ACA (n=888), 35% disagreed with it and 38% did not know how they felt. Black women (adjusted odds ratio [aOR] 0.12, 95% confidence interval [CI] 0.03-0.55) and women with incomes of >$75k (aOR 0.38, CI 0.17-0.88), Medicare/Medicaid insurance (aOR 0.24, CI 0.10-0.61), and infrequent religious service attendance (aOR 0.57, CI 0.35-0.93) were less likely to disagree with the ACA's passage, compared with their counterparts. Republican party affiliation was the strongest predictor of ACA disagreement (aOR 17.10, CI 9.12-32.09). Negative beliefs about the ACA's ability to improve access to preferred care and regarding employers' and the government's roles in reproductive health care were positively associated with ACA disagreement.
  
  
  CONCLUSIONS
  Many women who could benefit from the ACA disagree with or do not know how they feel about its passage, which may influence participation in ACA benefits and services.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan.
authors.forename: Kelli Stidham
authors.initials: KS
authors.lastname: Hall
authors.affiliation: 2 L4000 Women's Hospital , Ann Arbor, Michigan.|3 Department of Obstetrics and Gynecology, The Ohio State University , Columbus Ohio.
authors.forename: Samantha Paturu
authors.initials: SP
authors.lastname: Nadella
authors.affiliation: 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Zochowski
authors.affiliation: 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan.
authors.forename: Divya
authors.initials: D
authors.lastname: Patel
authors.affiliation: 1 Department of Obstetrics and Gynecology, Program on Women's Health Care Effectiveness Research; Institute for Social Research, Population Studies Center, University of Michigan , Ann Arbor Michigan.
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage; D020407:Internet; D016015:Logistic Models; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D060728:Reproductive Health; D014481:United States; D016387:Women's Health; D055815:Young Adult