Progressive Messaging for the Health Care Debate

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Health Care for America Now!
Progressive Messaging for the Health Care Debate
Prepared by Lake Research Partners for Health
Care for America Now! info_at_healthcareforamericanow
.org September 2008 1825 K Street NW 4th
Floor Washington, DC 20005
1726 M Street, NW, Suite 500 Washington, DC
20036 tel. [phone] fax [phone]
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Voters and Health Insurance

• As a reminder, 94 of voters in 2006 had some
  members of their household covered, 79 had
  everyone covered.

SEIU/AHC polling by Lake Research Partners,
November 2006.
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Voters are becoming more comfortable with a
government role in health care reform, possibly
as a result of the current presidential campaigns.
Do you favor or oppose providing access to
affordable, quality health care for all Americans
even if it means a major role for the federal
government? Do you feel strongly or not strongly
about that choice?  
Favor
Oppose
66
28
September 2007
February 2008
69
23
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Voters strongly identify the health insurance
industry with negative traits of putting profits
ahead of people and being greedy, not caring, and
bureaucratic. Terms like reliable and unreliable
are more middling.
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Text of Candidate As Progressive Plan
Americans would be guaranteed to have a
choice of health plans they can afford, either
from a private insurer, or from a public plan.
Everyone would pay on a sliding scale based on
income. To maintain quality and allow fair
cost comparisons, health insurance companies and
the public plan would be required to provide at
least a standard, comprehensive package of
benefits including preventive care and all needed
medical care. Employers and individuals could
choose to keep their current health plans.
The public plan would be paid for through a
modest payroll tax on employees and employers and
by rolling back tax breaks for those who make
over 200,000 a year. Small businesses would pay
a lower rate. No insurer could deny
coverage or charge higher premiums to people with
pre-existing conditions.  
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Nearly two-thirds of voters rate Candidate As
plan (the progressive plan) a six or higher.
34
65
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When asked head-to-head, voters prefer Guaranteed
Affordable Choice over health savings accounts,
tax credits, or a single payer plan by about
three-to-one.
67
20
65
20
64
22
Even among the health care base, intense support
for single-payer is far lower than for GAC.
LRP Poll on behalf of The Herndon Alliance.
N1000, 9/15-27/2007.
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Text of GAC, HSA, Tax Credits, and Single Payer
plan.
Guaranteed Affordable Choice language An
approach that would guarantee affordable health
insurance coverage for every American with a
choice of private or public plans that cover all
necessary medical services, paid for by employers
and individuals on a sliding scale. Health
Savings Account language A Health Savings
Account program that would provide tax-deductible
savings accounts to all Americans if they
purchase a private insurance plan with at least a
thousand dollar deductible. Tax Credits
language An approach that would provide tax
credits that will reimburse individuals and
families for 25 to 50 percent of the cost of
their private health insurance policies. Single
Payer language A single government-financed
health insurance plan for all Americans financed
by tax dollars that would pay private health
care providers for a comprehensive set of medical
services.
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Focus group participants liked that under
Candidate As plan they would have choices in
their health care and that they would not have to
fear being denied.
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Text of Candidate Bs Plan
The proposal would level the financial
playing field for all health purchasers, so
individuals and families can purchase their own
health insurance with a universal refundable tax
credit of 2,500 to 5,000 dollars in place of the
current employer sponsored health insurance tax
exclusion.   Access to Health Savings
Accounts would be expanded and improved by
streamlining rules and regulations, allowing
families to maximize the value of health services
tailored to their needs.   Families would be
able to purchase health insurance nationwide,
across state lines, to maximize their choices,
and heighten competition for their business that
will reduce overhead, administrative, and
excessive compensation costs from the system.  
Low-income families would receive supplemental
aid through their state's Medicaid funds and
states could choose to allow the use of private
insurance in Medicaid.
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Voters are less favorable toward Candidate Bs
plan (the free market approach) with a majority
rating it a five or less.

51
47
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When asked to choose between the two plans, a
majority opt for Candidate As progressive plan
including 2-in-5 who say they strongly support it.

55
28
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Support for candidate As plan is strong across
urban, suburban, and rural counties.
Based on these two health care reform proposals,
which candidate would you prefer?
Support For Plan by Nielsen Code Total Large Metro Small/ Medium Metro Small Town Rural
Candidate A 55 55 57 56 59
Candidate B 28 27 26 30 27
Und/DK/Neither 16 17 18 14 14
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Republican men and independent men are the most
likely to support Candidate B, but both groups
are still net supportive of Candidate A.
Margin for Candidate A
Candidate A
Candidate B
51
36
11
37
0
23
15
Voters in all regions support Candidate As plan,
most strongly in the South Atlantic and with the
smallest margin in the West North Central.
Margin for Candidate A
Candidate A
Candidate B
21
28
7
40
15
30
29
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Region Definitions
Mid-Atlantic Respondents who live in New
Jersey, New York, or Pennsylvania. East North
Central Respondents who live Ohio, Indiana,
Illinois, Michigan or Wisconsin. West North
Central Respondents who live in Minnesota, Iowa,
Missouri, North Dakota, South Dakota, Nebraska,
or Kansas. South Atlantic Respondents who live
in Delaware, Maryland, District of Columbia, West
Virginia, Virginia, North Carolina, South
Carolina, Georgia or Florida. West South
Central Respondents who live in Arkansas,
Louisiana, Oklahoma, or Texas. Mountain Responden
ts who live in Montana, Idaho, Wyoming, Colorado,
New Mexico, Arizona, Utah or Nevada. Pacific Resp
ondents who live in Washington, Oregon, or
California.
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A Big Government attack on Candidate As plan
raises doubts among 65 of voters.
Candidate As plan sounds good, but it just wont
work. It will be just another big government
bureaucracy like the IRS and the DMV, operating
inefficiently and costing taxpayers hundreds of
billions of dollars. We will end up paying
higher taxes and getting low quality health care
with long waiting lines to get treatment and lots
of red tape and paperwork. Instead of a big
government program to bring socialized medicine
to America, we need to give consumers more of
their own money back, and more options to choose
the health insurance plan thats right for them.
65 Doubt
Does that raise SERIOUS doubts, SOME doubts,
MINOR doubts, or NO real doubts in your mind
about the health care proposal from Candidate A?
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The attack on Candidate Bs plan is farther
reaching, raising doubts among over three
quarters of voters.
Candidate Bs plan is misleading. Candidate B
doesnt tell you that with those Health Savings
Accounts you will need to buy a health care plan
with deductibles of 11 hundred to 11 thousand
dollars. He doesnt tell you that even if you do
manage to get a tax deduction or credit it will
pay for only a quarter to a half of your cost of
health insurance. And his plan doesnt do
anything to regulate insurance company practices,
like not covering pre-existing conditions,
denying claims or restricting your choice of
doctors. And theres nothing in the plan to
control skyrocketing premiums or insurance
company profits. We dont need a plan that leaves
us on our own with the insurance industry. We
need a guarantee of quality affordable health
care for all of us.
77 Doubt
Does that raise SERIOUS doubts, SOME doubts,
MINOR doubts, or NO real doubts in your mind
about the health care proposal from Candidate A?
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After attacks on both sides, voters continue to
favor Candidate As plan and the margin increases
from 27 to 32.
55
23
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All messages generated solid ratings, with the
strongest response to the Guarantee message.
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Similar messages test well with swing voters1,
but they are even more supportive of government
involvement.
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The best messages in the poll centered on the
guarantee of health care and criticize the harsh
and unfair insurance industry and affordability
contrasting rising insurance premiums to wages.

• Guarantee We need an alternative to the harsh
  and unfair practices of the health insurance
  industry. The right approach recognizes that we
  are all part of the solution. We need a guarantee
  of quality, affordable health care for all of us.
  We need to set and enforce the rules so insurance
  companies put our health care before their
  profits. We need to be able to keep the health
  care that we have and we need the choice of a
  public plan, so were not left at the mercy of
  the same private insurance companies that have
  gotten us into this mess.
•  
• Guarantee with government We need an alternative
  to the harsh and unfair practices of the health
  insurance industry. The right approach recognizes
  that we are all part of the solution. We need a
  guarantee of quality, affordable health care for
  all of us. We need government to be an advocate
  for us and set and enforce the rules so insurance
  companies put our health care before their
  profits. We need to be able to keep the health
  care that we have and we need the choice of a
  public plan, so were not left at the mercy of
  the same private insurance companies that have
  gotten us into this mess.
•  

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• Cant keep up rules If you work hard, pay
  taxes, and play by the rules, you ought to have
  access to quality, affordable health care, but
  its getting tougher and tougher today to make
  ends meet and afford good health care. Health
  insurance premiums are going up three times
  faster than workers wages or inflation. None of
  us should be left behind. As Americans we can and
  must provide a real solution. Candidate As
  proposal is a common sense plan to make sure we
  all have access to the highest quality health
  care in the world.
•  
• Cant keep up struggle No matter how hard we
  work and struggle to make ends meet, its getting
  tougher to get good affordable health care.
  Health insurance premiums are going up three
  times faster than workers wages or inflation.
  None of us should be left behind. As Americans we
  can and must provide a real solution. Candidate
  As proposal is a common sense plan to make sure
  we all have access to the highest quality health
  care in the world.

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Attacks on Candidate Bs plan are consistently
effective, though no message is a silver bullet.
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Voters are most convinced by messages noting that
Candidate Bs plan costs consumers, helps
insurance companies, and fails to rein in their
greedy and unfair practices.
Helping insurance companies Candidate Bs plan
is designed to help the insurance companies, not
us. Thats why the insurance companies like it
so much. They get to keep charging us whatever
they want no matter how many people they deny
coverage to or how much profit they make. They
can keep excluding people with pre-existing
conditions from getting any health coverage at
all. And they get even more tax subsidies to
keep treating people this way. Thats a bad deal
for people who need good affordable health care.
(68 convincing, 40 very)   Misleading w/ tax
credits The proposal from Candidate B is
misleading. It doesnt tell you that the health
plans you need to buy in combination with those
Health Savings Accounts are actually plans with
deductibles of 11 hundred to 11 thousand dollars.
It doesnt tell you that even if you do manage to
get a tax deduction or credit it will pay for
only a quarter to a half of your cost of health
insurance. It leaves us on our own to fend for
ourselves in a complicated health insurance
market. Tax credits dont guarantee health care.
(67 convincing, 38 very)   Huge tax increase
The proposal from Candidate B is really a huge
tax increase on working families. Under his plan,
workers would get hit with a brand-new tax on the
premiums that businesses pay for employee health
insurance. Being taxed on the value of our
health care benefits doesnt do anything to solve
the health care mess and it makes health care
more expensive for working people, not less. (67
convincing, 37 very)
Split sampled question
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Also convincing are messages that accuse
Candidate B of being misleading and not
regulating the insurance industry.
Misleading The proposal from Candidate B is
misleading. It doesnt tell you that the health
plans you need to buy in combination with those
Health Savings Accounts are actually plans with
deductibles of 11 hundred to 11 thousand dollars.
It doesnt tell you that even if you do manage to
get a tax deduction or credit it will pay for
only a quarter to a half of your cost of health
insurance. It leaves us on our own to fend for
ourselves in a complicated health insurance
market. (66 convincing, 35 very)   On our own
The proposal from Candidate B doesnt do anything
to regulate insurance company practices, like
requiring coverage of pre-existing conditions,
ending wrongful denial of claims and restricting
your choice of doctors. And theres nothing in
the plan to control premiums or insurance company
profits. This proposal leaves us out on our own
with the insurance companies with no guarantees.
(66 convincing, 35 very)   Big business
Candidate Bs plan is all about letting big
business off the hook for providing health
insurance to workers. It gives them an excuse to
let people buy their own insurance. And since
insurance companies can set the terms, it helps
the insurers as well. Thats why they like it
so much. Working people will pay more and will
get less. (62 convincing, 35 very)
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• Voters are most convinced by messages noting that
  Candidate Bs plan costs consumers, helps
  insurance companies, and fails to rein in their
  greedy and unfair practices.
• Also convincing are messages that accuse
  Candidate B of being misleading and not
  regulating the insurance industry.

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Following all messages, support for Candidate As
plan increases slightly and the margin expands to
38.
59
21
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As voters learn more through the survey,
Candidate A gains some additional support and
Candidate Bs support slowly erodes margins
grow from 27 to 32 to 38.
Margin for Candidate A
Candidate A
Candidate B
27
Initial
Post-Attack
32
Final Post-Messaging
38