Henry J. Kaiser Family Foundation

1
Public Opinion, Election 2008 and Health Care
PolicyMollyann Brodie, Ph.DVice President,
Director, Public Opinion Survey
Research,Kaiser Family FoundationDecember 9,
2008
2
Looking back Health care as a voting issue
National exit polls
2004
2006
Moral values
Corruption/ethics
Economy/Jobs
Economy
Terrorism
Terrorism
Iraq
Traditional values
Iraq
Health care
Taxes
Illegal immigration
Saddam Hussein verdict
Education
Source 2004 Presidential 2006 Congressional
election exit polls by Edison/Mitofsky for the
National Election Pool
3
Most important issue
Thinking about the campaign for the presidential
election in 2008, what two issues would you most
like to hear the presidential candidates talk
about?
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
4
And the 08 exit poll says.
Which ONE of these five issues is the most
important facing the country?
The economy
The war in Iraq
Health care
Terrorism
Energy
Source Edison/Mitofsky, National Exit Poll,
sponsored by the National Election Pool.
Conducted November 4, 2008
5
How 08 issue voters voted
Vote choice among those who named each as their
top issue
Voted Obama
Voted McCain

The economy (63)
The war in Iraq (10)
Health care (9)
Terrorism (9)
Energy (7)
Source Edison/Mitofsky, National Exit Poll,
sponsored by the National Election Pool.
Conducted November 4, 2008
6
Economy and health care intertwined
Percent who said they or their family had a
serious problem with each as a result of recent
changes in the economy
Problems paying for gas
Problems getting a good-paying job or a raise in
pay
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
Problems paying yourrent or mortgage
Source Kaiser Health Tracking Poll Election
2008 (conducted Oct. 8-13, 2008)
7
08 Exit poll bears this out
How worried are you about being able to afford
the health care services you need?
Very worried
Not at all worried
65 Worried
33 Not worried
Somewhat worried
Not very worried
Source Edison/Mitofsky, National Exit Poll,
sponsored by the National Election Pool.
Conducted November 4, 2008
8
Worried voters more likely to back Obama
How worried are you about being able to afford
the health care services you need?
Voted McCain
Voted Obama

Very worried
Somewhat worried
Not very worried
Not at all worried
Source Edison/Mitofsky, National Exit Poll,
sponsored by the National Election Pool.
Conducted November 4, 2008
9
Health reform and the downturn
Which comes closer to describing your own views?
Given the economic challenges facing the country
it is more important than ever to take on health
care reform
we cannot take on health care reform right now
Dont Know/ Refused
Source Kaiser Health Tracking Poll Election
2008 (conducted Oct 8-13, 2008).
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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
Expanding health insurance coverage for the
uninsured
Improving the quality of care and reducing
medical errors
Improving Medicare and the prescription drug
program
Reducing spending on government health programs
like Medicare and Medicaid
Note Dont 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).
11
Agreement on goals
Do you favor or oppose the federal government
doing more to help provide health insurance for
more Americans?
Favor
Oppose
Dont know/ Refused
Source Kaiser Health Tracking Poll Election
2008 (conducted Sept. 8-13, 2008).
12
... Many paths popular, but no single answer
Percent of registered voters who favor each way
to expand coverage
MOST preferred option
Tax breaks to businesses
Expanding Medicaid/ SCHIP
Expanding Medicare
Tax credits to people
Employers pay or play
Individual mandate
Single government plan
50
Note Not exact wording of options Source
Kaiser Health Tracking Poll Election 2008
(conducted Sep. 8 -13 , 2008)
13
Nothing New Level of Support for 3 Health Reform
Plans, 1945
Percent saying good or fair idea
Percent favoring in forced 3-way choice
Insurance company plan
Federal government plan
Doctor organization plan
Source Opinion Research Corporation Poll, 1945,
cited in Payne, Stanley. 1946. Some opinion
research principles developed through studies of
social medicine. Public Opinion Quarterly, 10
(1), 93-98.
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• The Public Opinion Landscape and the Prospects
  for Health Care Reform
• Challenges

15
Majorities satisfied with own situation
Among those with health care coverage, percent
who
Rate health insurance coverage "excellent" or
"good"
Satisfied with ability to get latest treatments
Satisfied with quality of care
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)
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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
Percent saying the Clinton Health Care Reform
Plan would have a positive effect on
Cost of your/your familys health care
Quality of care available to you
Availability of treatment to you/your family
You personally
Quality of your/your familys health care
Amount you pay for medical care
Your/your familys choice of doctors hospitals
Your choice of doctors
Note Dont know/Refused responses not
shown Source Kaiser Health Tracking Poll
Election 2008 (Sep. 8 -13, 2008)
Source Gallup/CNN/USA Today Poll, April 1994
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Fear of change II
Among those insured through an employer
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.
Easier
Harder
No difference
Get a good price for insurance
Find or keep insurance if you are sick
Handle administrative issues
Find a plan that matches your needs well
Note question wording is abbreviated. No opinion
responses not shown. Source Kaiser Health
Tracking Poll Election 2008 (conducted July
29-August 6, 2008)
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Dont Believe Many Things Would Lower Costs
Percent saying each would lower costs a lot
Reduce fraud and waste
Promote healthy lifestyles prevention
Reduce medical malpractice lawsuits
Reduce unnecessary care
Everyone gets covered by insurance
Promote competition btw. insurance
Electronic health records
Tax credits to individuals to help buy ins.
50
Note Not exact wording of options Source Kaiser
Health Tracking Poll Election 2008 (conducted
June 3 - 8, 2008)
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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 Dont 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)
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Partisans disagree Main Goal Should Be
The main goal to improve US health care should be
to
make health insurance more available
affordable in the private marketplace, even if
everyone doesnt get covered
Dont know/ Refused
make sure that EVERYONE is covered by health
insurance
Republicans
Democrats
Independents
Source Kaiser Health Tracking Poll Election
2008 (conducted June 3 - 8, 2008)
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Partisans disagree Timing of health reform
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
Republicans
Independents
Democrats
Note Dont Know/refused not shown. Among
registered voters. Source Kaiser Health
Tracking Poll Election 2008 (conducted Oct.
8-13, 2008)
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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 thats run by the
government and financed by taxpayers?
Dont know/ Refused
Current System
Universal System
STILL support, even if
Meant there were waiting lists for some
non-emergency treatments
Meant youd 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
Limited your own choice of doctors
Source Kaiser Health Tracking Poll Election
2008 (conducted Sep. 8 -13 , 2008)
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Debates and Messaging Matter Clinton Health
Reform Plan Debate
Change in public support for Clinton Health
Reform Plan over time
Favor
Oppose
Favor
Oppose
No opinion
No opinion
Source Gallup/CNN/USA Today Polls, Sept. 24,
1993 and April 16, 1994.
24
Debates and Messaging Matter Truman Health
Reform Plan Debate
Change in public support for Truman Health Reform
Plan over time
Oppose
Favor
Oppose
Favor
No opinion
No opinion
Source Gallup Polls, 1949 and 1950.
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• Opportunities

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Level of public concern steady since 1990s
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
Source ABC News/Washington Post Poll (Dec.
1991), ABC News/Money Poll (Sept. 1999), CBS
News/NYT Poll (Jan. 2006)
27
Insecure about costs, losing coverage
Percent saying they are VERY worried about the
following
Note asked only of those with health
insurance Source Kaiser Family Foundation Polls
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Real problems paying
Percent who say in the past 12 months, they or
another family member in their household had any
problems paying medical bills
Mar-02
Apr-05
Sep-06
Oct-08
Note Dont Know/refused not shown Source
Kaiser Health Tracking Poll Election 2008
(conducted Oct. 8-13, 2008)
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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?
More than 1,000
500 - 1,000
No
Yes
100 - 500
Less than 100
Dont know
Source Kaiser Health Tracking Poll Election
2008 (conducted Oct. 8-13, 2008)
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Opportunity Linking reforms to costs
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?
A little
A lot
Mostly beyond their control
Dont 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).
31
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
Works fine as is
Dont know/ Refused
57
67
82
1
1
Democrats
Republicans
Independents
Source Kaiser Family Foundation/Harvard School
of Public Health, Pre-Election Poll Voters,
Health Care and the 2008 Election (conducted Sept
10-21, 2008).
32
Opportunity to combine approaches Example
Health insurance mandates
Requiring individuals to purchase insurance role
for employers, the government and insurance
companies
Requiring individuals to purchase insurance
Support
Oppose
Support
Oppose
Note Not exact wording of options Source
NPR/KFF/HSPH The Public on Requiring Individuals
to Have Health Insurance (Feb. 14-24, 2008)
33
Top down, not bottom up
Percent naming health care one of two most
important issues for government to address
Clinton Health Care Reform Debate
September 2008 21
Note "Don't know" responses were included in the
base when percentages were calculated.
Source NBC/Wall Street Journal Harris Polls
34
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