* 1. Do you have a pre-existing condition? If so, what conditions were you diagnosed with?

* 2. Were you insured prior to the ACA?

* 3. When the ACA became effective, did you have to select a new plan?

* 4. Has your premium increased? If so, by how much?

* 5. Has your deductible increased, decreased or remained about the same after enrolling in the ACA?

* 6. Has your coverage increased, decreased or did not change (in the services important to you)?

* 7. Has the price of your prescriptions increased, decreased or remained about the same?

* 8. Were you able to keep the same prescriptions that you had prior to the ACA?

* 9. Have you suffered adverse reactions due to drug changes?

* 10. Were you able to keep the same specialists through the ACA?

* 11. Were you better off before or after the ACA?

* 12. If you were uninsured prior to the ACA, was it due to having a preexisting condition or being unable to afford a premium?

* 13. Do you have concerns about the accessibility of specialists under the ACA?

* 14. Do you have an autoimmune disease and have been treated with an immunosuppressant (biologics)
and experienced a significant improvement to your quality of life and ability to work?

* 15. If you were previously uninsured, were you able to enroll in the ACA?

* 16. Which category below includes your age?

* 17. What is your gender?

18. Zip code

19. Additional comments?

20. We may want to contact you for further information or clarification regarding the answers that you submitted. Please submit your email address. This is optional.

21. If you would like a free copy of this report when it is completed, please provide the email address at which you would like to receive the report. Thank you for your participation.

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