Public Opinion, Election 2008 and Health Care Policy Mollyann Brodie, Ph.D Vice President, Director, Public Opinion & Survey Research, Kaiser Family Foundation December 9, 2008

Looking back: Health care as a voting issue National exit polls 2004 Moral values Terrorism Economy/Jobs Iraq Health care Taxes Education 2006 Corruption/ethics Terrorism Economy Traditional values Iraq Illegal immigration Saddam Hussein verdict Source: 2004 Presidential & 2006 Congressional election exit polls by Edison/Mitofsky for the National Election Pool

Note: Adds up to more than 100% due to multiple responses. Open-ended item. Top 4 responses shown among registered voters. Source: Kaiser Health Tracking Poll: Election 2008 Thinking about the campaign for the presidential election in 2008, what two issues would you most like to hear the presidential candidates talk about? “Most important issue”

Which ONE of these five issues is the most important facing the country? The economy The war in Iraq Terrorism Energy And the ’08 exit poll says…. Health care Source: Edison/Mitofsky, National Exit Poll, sponsored by the National Election Pool. Conducted November 4, 2008

How ’08 issue voters voted… Vote choice among those who named each as their top issue Voted ObamaVoted McCain The economy (63%) The war in Iraq (10%) Terrorism (9%) Energy (7%) Health care (9%) Source: Edison/Mitofsky, National Exit Poll, sponsored by the National Election Pool. Conducted November 4, 2008

Economy and health care intertwined Problems paying for gas Problems getting a good-paying job or a raise in pay Problems paying your rent or mortgage Losing money in the stock market Problems paying for health care and health insurance Problems with credit card debt or other personal debt Problems paying for food Source: Kaiser Health Tracking Poll: Election 2008 (conducted Oct. 8-13, 2008) Percent who said they or their family had a “serious problem” with each as a result of recent changes in the economy:

’08 Exit poll bears this out… How worried are you about being able to afford the health care services you need? Very worried Somewhat worried Not at all worried Not very worried 65% Worried 33% Not worried Source: Edison/Mitofsky, National Exit Poll, sponsored by the National Election Pool. Conducted November 4, 2008

Worried voters more likely to back Obama Voted Obama Voted McCain Very worried Somewhat worried Not at all worried Not very worried How worried are you about being able to afford the health care services you need? Source: Edison/Mitofsky, National Exit Poll, sponsored by the National Election Pool. Conducted November 4, 2008

Which comes closer to describing your own views? Given the economic challenges facing the country… …we cannot take on health care reform right now …it is more important than ever to take on health care reform Source: Kaiser Health Tracking Poll: Election 2008 (conducted Oct 8-13, 2008). Health reform and the downturn Don’t Know/ Refused

Note: “Don’t know/Refused” responses not shown. Based on registered voters. Source: Kaiser Family Foundation/Harvard School of Public Health, Pre-Election Poll: Voters, Health Care and the 2008 Election (conducted Sept 10-21, 2008). Affordability! Now thinking specifically about health care, which one of the following health care issues would you most like to see the next president take action on? Making health care and health insurance more affordable Improving the quality of care and reducing medical errors Improving Medicare and the prescription drug program Expanding health insurance coverage for the uninsured Reducing spending on government health programs like Medicare and Medicaid

Agreement on goals… Oppose Favor Do you favor or oppose the federal government doing more to help provide health insurance for more Americans? Source: Kaiser Health Tracking Poll: Election 2008 (conducted Sept. 8-13, 2008). Don’t know/ Refused

MOST preferred option Percent of registered voters who favor each way to expand coverage: Employers pay or play Expanding Medicare Tax credits to people Expanding Medicaid/ SCHIP Tax breaks to businesses Note: Not exact wording of options Source: Kaiser Health Tracking Poll: Election 2008 (conducted Sep , 2008)... Many paths popular, but no single answer Single government plan Individual mandate 50%

Nothing New: Level of Support for 3 Health Reform Plans, 1945 Percent saying “good” or “fair” idea Insurance company plan Doctor organization plan Federal government plan Percent favoring in forced 3-way choice Source: Opinion Research Corporation Poll, 1945, cited in: Payne, Stanley Some opinion research principles developed through studies of social medicine. Public Opinion Quarterly, 10 (1),

The Public Opinion Landscape and the Prospects for Health Care Reform Challenges…

Majorities satisfied with own situation Among those with health care coverage, percent who… Sources: ABC News Poll (Jul. 1994, Nov. 1995, Aug. 1997), ABC News/Washington Post Poll (Oct. 2003), ABC News/Kaiser Family Foundation/USA Today Poll (Sept. 2006), Kaiser Family Foundation (June 2008) Satisfied with quality of care Rate health insurance coverage "excellent" or "good" Satisfied with ability to get latest treatments

Evaluate by how affects own situation (Fear of change, I) Percent saying that a universal health insurance system would make each of the following better… Cost of your/your family’s health care Availability of treatment to you/your family Quality of your/your family’s health care Your/your family’s choice of doctors & hospitals Amount you pay for medical care Your choice of doctors Quality of care available to you You personally Percent saying the Clinton Health Care Reform Plan would have a positive effect on… Source: Gallup/CNN/USA Today Poll, April 1994 Note: “Don’t know/Refused” responses not shown Source: Kaiser Health Tracking Poll: Election 2008 (Sep , 2008)

What if your employer gave you the cash amount they would have contributed to your insurance, and you had to buy health insurance on your own. … Fear of change II Get a good price for insurance Find a plan that matches your needs well Find or keep insurance if you are sick Handle administrative issues Among those insured through an employer… Note: question wording is abbreviated. No opinion responses not shown. Source: Kaiser Health Tracking Poll: Election 2008 (conducted July 29-August 6, 2008) EasierHarderNo difference

Percent saying each would lower costs “a lot”: Everyone gets covered by insurance Reduce unnecessary care Promote healthy lifestyles & prevention Reduce medical malpractice lawsuits Reduce fraud and waste Note: Not exact wording of options Source: Kaiser Health Tracking Poll: Election 2008 (conducted June 3 - 8, 2008) Don’t Believe Many Things Would Lower Costs Promote competition btw. insurance Electronic health records Tax credits to individuals to help buy ins. 50%

Willingness to pay limited Would you be willing to pay more--either in higher health insurance premiums or higher taxes--in order to increase the number of Americans who have health insurance, or not? NOTE: “Don’t know/refused” responses not shown SOURCE: NBC News/Wall Street Journal Poll (Jun. 1991), Kaiser Family Foundation/Harvard School of Public Health Polls (Nov. 1996; Nov. 1998; Oct. 1999; Nov. 2000; Feb. 2003; and Nov. 2004), Washington Post/KFF/Harvard Survey (May 2007)

The main goal to improve US health care should be to… Democrats Republicans Independents Don’t know/ Refused Source: Kaiser Health Tracking Poll: Election 2008 (conducted June 3 - 8, 2008) Partisans disagree: Main Goal Should Be…… …make health insurance more available & affordable in the private marketplace, even if everyone doesn’t get covered …make sure that EVERYONE is covered by health insurance

Which comes closer to describing your own views? Given the economic challenges facing the country… Independents Democrats Republicans …we cannot take on health care reform right now …it is more important than ever to take on health care reform *Note: Don’t Know/refused not shown. Among registered voters. Source: Kaiser Health Tracking Poll: Election 2008 (conducted Oct. 8-13, 2008) Partisans disagree: Timing of health reform

Messaging matters… Which would you prefer – the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance; (or) a universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers? Source: Kaiser Health Tracking Poll: Election 2008 (conducted Sep , 2008) STILL support, even if… Limited your own choice of doctors Current SystemUniversal System Don’t know/ Refused Meant there were waiting lists for some non-emergency treatments Meant you’d have to pay more, either in higher health insurance premiums or higher taxes Meant that some medical treatments that are currently covered by insurance are no longer covered

Debates and Messaging Matter: Clinton Health Reform Plan Debate Source: Gallup/CNN/USA Today Polls, Sept. 24, 1993 and April 16, Favor Oppose No opinion Favor Oppose No opinion Change in public support for Clinton Health Reform Plan over time…

Source: Gallup Polls, 1949 and FavorOppose No opinion Favor Oppose No opinion Change in public support for Truman Health Reform Plan over time… Debates and Messaging Matter: Truman Health Reform Plan Debate

Opportunities…

Level of public concern steady since 1990s Source: ABC News/Washington Post Poll (Dec. 1991), ABC News/Money Poll (Sept. 1999), CBS News/NYT Poll (Jan. 2006) Percent who worry that future health care costs will not be taken care of Percent who are concerned “a lot” about current and future health care costs

Percent saying they are VERY worried about the following… Insecure about costs, losing coverage *Note: asked only of those with health insurance Source: Kaiser Family Foundation Polls

Percent who say in the past 12 months, they or another family member in their household had any problems paying medical bills: Mar-02Apr-05Sep-06Oct-08 *Note: Don’t Know/refused not shown Source: Kaiser Health Tracking Poll: Election 2008 (conducted Oct. 8-13, 2008) Real problems paying

Bills are substantial Would you say the amount of these medical bills was… ? (Based on total) In the past 12 months, did you or another family member in your household have any problems paying medical bills, or not? Yes No Don’t know Source: Kaiser Health Tracking Poll: Election 2008 (conducted Oct. 8-13, 2008) More than $1,000 $500 - $1,000 $100 - $500 Less than $100

Opportunity: Linking reforms to costs A little Mostly beyond their control A lot Do you think the cost of health care is something the president and Congress can do a lot about, do a little about, or is that mostly beyond their control? Don’t know/ Refused Source: Kaiser Family Foundation/Harvard School of Public Health, Pre-Election Poll: Voters, Health Care and the 2008 Election (conducted Sept 10-21, 2008).

Agree: Major changes needed Which one of the following comes closest to your view about the health care system in America today? Needs complete overhaul Needs major changes Needs minor changes DemocratsRepublicansIndependents Works fine as is Source: Kaiser Family Foundation/Harvard School of Public Health, Pre-Election Poll: Voters, Health Care and the 2008 Election (conducted Sept 10-21, 2008). Don’t know/ Refused 1% 57% 67%82%

Requiring individuals to purchase insurance Opportunity to combine approaches Example: Health insurance mandates Support Oppose Note: Not exact wording of options Source: NPR/KFF/HSPH The Public on Requiring Individuals to Have Health Insurance (Feb , 2008) Requiring individuals to purchase insurance; role for employers, the government and insurance companies

Source: NBC/Wall Street Journal; Harris Polls Percent naming health care one of two most important issues for government to address Note: "Don't know" responses were included in the base when percentages were calculated. Top down, not bottom up Clinton Health Care Reform Debate September %