1. Americans’ Views of the Uninsured Issue Surveys developed in collaboration with the Robert Wood Johnson Foundation and Kaiser Family Foundation Robert J. Blendon, Sc.D. Kennedy School of Government Harvard School of Public Health

2. The Insurance Status of the Public vs. Voters Insured Uninsured The Public 1 Insured Uninsured Voters (2000 election) 2 Sources: 1 U.S. Census Bureau, CPS (2003); 2 Kaiser Family Foundation/Harvard School of Public Health, post-election survey (Nov-Dec 2000).

3. Key Points 1)Dissatisfaction with health system growing, including concerns over uninsured 2) Rising costs, Medicare, and uninsured top issues 3) Driven by future fears/stories of uninsured 4) Support for wide range of uninsured proposals 5) However, support subject to challenges –Public lacks knowledge –Satisfied with own health care –Divided over taxes 6) When challenged, hybrid proposals do best

4. Dissatisfaction with Overall Health Care in the Country Today Source: 1 Employee Benefit Research Institute polls (1998, 2003); 2 Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (2003); 3 Washington Post/ABC News polls (2000, 2003). Health system (Fair or poor) 1 Uninsured problem getting worse (last 2 years) 2 Quality health care (dissatisfied) 3 2003 1998 2003 2000 2003

5. Dissatisfaction with the Availability and Affordability of Health Care Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR polls (December 2001, December 2003). % saying not at all satisfied

6. Most Important Issues for Government to Address Percent saying issue is one of two most important: 1. Economy/Jobs40% 2. War/Defense32% 3. Health Care16% 4(t). Terrorism11% 4(t). Education11% 6. Foreign policy (general)7% 7.Medicare6% Note: May sum to more than 100% because each respondent was asked to give up to two different answers. Source: Harris Interactive poll (December 2003)

7. Most Important Health Care Issues for Government to Address Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003). Cost Prescription drug costs Medicare Uninsured or inadequate insurance/coverage Percent of Americans saying issue is one of the two most important for government to address: Note: Does not sum to 100% because many Americans mentioned other issues or said they didn’t know. General costs

8. Public Worries about the Future Worried might lose health insurance (among insured) 1 Worried will not be able to afford health care/health insurance 2 Sources: 1 Kaiser Family Foundation/Harvard School of Public Health poll (December 2003); 2 Harvard School of Public Health/Robert Wood Johnson foundation/ICR poll (December 2003); 3 Washington Post/ABC News poll (October 2003). Think there will be rationing 3

9. The Uninsured in Media Polling Source: Washington Post/ABC News poll (October 2003). Put off Treatment for Serious Illness Last Year Dissatisfied with quality of care received Dissatisfied with ability to get latest treatments Uninsured Insured Uninsured Insured Uninsured Insured

10. Public Support for Ways to Guarantee Health Insurance for More Americans Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003). Expand Medicaid/SCHIP Employers required to offer plan Tax credit plan Individual coverage mandate plan Universal Medicare plan Single national government plan

11. How negative arguments affect support for proposals to cover the uninsured (1) Expanding existing state programs Employer mandate Tax credits and deductions for the uninsured What if you heard that expanding these programs would require raising taxes to pay for the cost? What if you heard that it would be so expensive that employers would be forced to lay off workers? What if you heard that the amount of tax relief would not be enough to cover the cost of a private plan? Initially favors Favors after challenge Note: Responses of Massachusetts adults Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).

12. How negative arguments affect support for proposals to cover the uninsured (2) Legally requiring all residents to have health insurance Single payer government plan What if you heard that even with the government’s help, people won’t be able to afford insurance and the law will cause financial hardship? What if you heard that you would have to wait longer for some hospital and specialty care? Initially favors Favors after challenge Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003). Note: Responses of Massachusetts adults

13. Public Preference: Current System or Universal Coverage? Source: Washington Post/ABC News Poll (October 2003).

14. The Public’s Perception of How Well Various Health Plans Are Run Source: 1 Harvard School of Public Health/ICR poll (2003); 2 Kaiser Family Foundation/Harvard School of Public Health poll (2003). Private employer plans 1 Medicare 2 Federal employees plan 1 Health plan of the Congress 1

15. Insured Americans’ Satisfaction with Their Own Health Care Source: 1 Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2 Washington Post/ABC News poll (October 2003). Health plan performance (A or B rating) 1 Quality of health care received 2 Ability to get most sophisticated treatment 2 Out-of-pocket costs 2 % satisfied

16. Americans’ Views About What Government Should Do About the Uninsured Percent saying the government should... Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (June 2003). Keep things the way they are Make limited effort to provide insurance to some of the uninsured, would mean more govt spending Make a major effort to provide insurance, may require a tax increase to pay for it Don’t know/ Refused

17. Conclusions/The Uninsured Broad support for larger vision Implementation over years Hybrid plans best Financing issues/toughest issue