Obamacare Survey Template

Obamacare Survey Template offers questions that provide insights into the quality of healthcare services. This sample can be edited by the survey maker according to the required details about Obamacare healthcare services. Some of the question examples of this questionnaire are "Which political party are you affiliated with?", demographic questions such as "Which of the following group of race do you fit best?", "What is your family income?" et al.



   
 
 


Please take a few minutes to fill out this survey on Obamacare which was passed into law in March 2010. We value your feedback and your responses will be used to serve you better. Thank you for your input.

 
   
 
1.What is your gender?
 
Male
 
Female
 
   
 
4.Which political party are you affiliated with?
 
Republican
 
Democrat
 
I prefer not to answer
 
Other
 
   
 
5.What is the highest level of education you have attained?
 
Primary school
 
Some high school but not diploma
 
High school diploma
 
Some college but not degree
 
2 year college degree
 
4 year college degree
 
Graduate level degree
 
Other
 
   
 
6.What is your marital status?
 
Married
 
Widowed
 
Divorced
 
Separated
 
Single never married
 
   
 
7.Do you consider yourself disabled?
 
Yes
 
No
 
   
 
8.Please mark the level of your income per year?
 
$0 to $9999
 
$10,000 to $24,999
 
$25,000 to $49,999
 
$50,000 to $99,999
 
$100,000 to $249,999
 
$250,000 and up
 
   
 
9.Which of the following group of race do you fit best?
 
White
 
Black or African American
 
American Indian
 
Asian
 
Other
 
   
 
10.Overall how do you feel about the Affordable Care Act?
 
Extremely like
 
Moderately like
 
Slightly like
 
Neutral
 
Slightly dislike
 
Moderately dislike
 
Extremely dislike
 
   
 
11.Have you been able to obtain cover since the Act was introduced in March 2010?
 
Yes
 
No
 
   
 
12.Have you been unable to meet health care cost in the past?
 
Yes
 
No
 
   
 
13.Has the Affordable Care Act reduced your health care cost?
 
Yes
 
No
 
   
 
14.Has the Affordable Care Act improved your access to healthcare?
 
Yes
 
No
 

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