* 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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