Voter Attitudes on a Public Health Care Plan

1
Voter Attitudes on a Public Health Care Plan

• Findings From A Survey of 800 Likely Voters
  Nationwide

2
Methodology

• Lake Research Partners designed and administered
  this survey that was conducted by telephone using
  professional interviewers between January 8-13,
  2009.
• The survey reached a total of 800 likely voters
  nationwide.
• Telephone numbers for the sample were generated
  by random digit dial (RDD) methodology. The
  margin of error for this survey is /- 3.5.

3
Key Findings

• 7 in 10 voters overwhelmingly support a public
  health insurance plan as part of national health
  care reform. Voters always prefer having a
  choice of public or private insurance over having
  either option alone.
• Even after hearing multiple attacks against a
  public plan option, voter support remains
  overwhelming.
• Attacks against a public plan do not work well.
  In paired statements supporting and attacking a
  public plan, a solid majority supports a public
  plan every time, and the response beats the
  attack by double digit margins.
• Conservative attacks that a public plan will
  increase costs, contribute to unfair competition,
  cause rationing, and that employers will drop
  their private insurance are not believable to
  most voters.

4
Key Findings

• Despite voters economic concerns, a majority
  support reform to provide quality, affordable
  health care for all, even if it means raising
  taxes.
• Voters also support reform even if it means a
  large federal government role.
• Voters believe a public plan option will increase
  competition, contain costs, and help control the
  cost of health care. They believe it will give
  private insurers incentives to control their
  costs and become more efficient, not less.
• Voters favor the principle of having guaranteed
  health coverage and having a choice. A public
  plan increases their peace of mind.
• These principles resonate most strongly with
  women.

5
Key Findings

• Referring to Obamas health care proposal further
  intensifies support for a public plan.
• Referring to Obama is effective with Democrats
  and Independents but cuts support with
  Republicans.
• Using Medicare as an analogy for a public plan
  helps most when referring to Medicare as a
  guarantee and providing peace of mind, especially
  with women, seniors, and minority voters.
• Medicare is less effective with men, especially
  men under 55 and college-educated men.
• When referring to the plan, call it a public
  health insurance plan.
• Emphasize choice of public and private plans.

6
Overwhelming support for a public plan choice
over 7 in 10 voters prefer having a choice of a
public or private health insurance plan.
Which of the following three approaches to health
care reform do you prefer one, everyone getting
health insurance through private health insurance
plans two, everyone getting health insurance
through a public health insurance plan or three,
everyone having a choice of private health
insurance or a public health insurance plan?
7
Support for a public plan is strong across the
board, and solid majorities support it.
Prefer Choice of Private or Public Plan
8
The broad consensus in support of a choice of
public or private plan remains overwhelming
even after hearing a battery of arguments against
a public plan.
Sometimes in a survey like this people change
their minds. Which of the following three
approaches to health care reform do you prefer
one, everyone getting health insurance through
private health insurance plans two, everyone
getting health insurance through a public health
insurance plan or three, everyone having a
choice of private health insurance or a public
health insurance plan?
Initial Ballot
Final Ballot
9
When comparing Obamas plan for reform with the
plan supported by the insurance companies,
Obamas plan wins by a margin of more than 2-to-1.
Support for Obamas Plan
43 points
Darker color indicates intensity
Asked of half of sample.
10
Text of Health Plans

• AHIP PLAN Under Plan A, proposed by the health
  insurance industry, the government would require
  all private health insurers to offer at least a
  set amount of health coverage through a
  high-deductible plan. Insurance companies would
  determine how much to charge in premiums. The
  government would subsidize the cost of health
  insurance for low income and some middle-income
  families. Insurance companies would not be
  allowed to deny people coverage for pre-existing
  conditions. Everyone would be required to get
  health insurance. Most people would be covered
  through private health insurance, with seniors
  covered by Medicare as they are now.
• OBAMAS PLAN Under Plan B, proposed by
  President-elect Obama, the government would
  require all health insurers to offer at least one
  standard, comprehensive health plan with
  guaranteed benefits. The cost of coverage would
  depend on a familys income. Insurance companies
  would not be allowed to deny people coverage for
  pre-existing conditions and would have
  restrictions on how much they can charge.
  Employers would be required to provide health
  coverage or contribute to the cost of coverage,
  with tax credits for small business. Everyone
  would be able to keep the health insurance they
  have, or have a choice of private insurance or a
  public insurance plan, with seniors covered by
  Medicare as they are now.

11
Despite some tax sensitivity in a weak economy, a
majority of voters favor progressive reform, even
if it means raising taxes.
Do you favor or oppose providing access to
affordable, quality health care for all Americans
even if it means raising taxes? IF FAVOR/OPPOSE,
ASK Do you feel strongly or not so strongly
about that choice?
Health Care Despite Tax Raise
Darker color indicates intensity
Asked of half of sample.
12
Over 7 in 10 voters accept a major government
role in health care, the highest level of support
in over a year.
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? IF FAVOR/OPPOSE, ASK Do you feel
strongly or not so strongly about that choice?
Major Role For Federal Government
Darker color indicates intensity
Asked of half of sample.
13
Quality Voters reject an attack claiming that a
public plan will lower quality. Two thirds agree
with the response that the public plan will
provide an affordable option with a wide choice
of doctors.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
QUALITY - COMPREHENSIVE
40 points
A public health insurance plan will force people
into lower quality care including long waiting
times and rationing of care.
A public health insurance plan will provide
people the choice of an affordable plan that
includes a standard, comprehensive package of
benefits, including a wide choice of doctors.
The response is strongest with older women, older
non-college educated voters, Democrats, and those
in the East North Central region.
Asked of half of sample.
14
Quality A response to the same quality attack
that mentions the same benefits as members of
Congress tests nearly as well.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
QUALITY - CONGRESS
A public health insurance plan will force people
into lower quality care including long waiting
times and rationing of care.
38 points
A public health insurance plan will provide
people the choice of an affordable plan that
includes at least the same benefits as members of
Congress get, including a wide choice of doctors.
This response is strongest with African
Americans, younger women, older non-college
educated men, and Democrats.
Asked of half of sample.
15
Bureaucracy By over two to one, voters reject an
attack on big government bureaucracy, agreeing
that the public plan will provide real
competition and help lower costs.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
BUREAUCRACY
A public health insurance plan will be another
big, government bureaucracy that will increase
costs to taxpayers.
34 points
A public health insurance plan will lower health
care costs by providing real competition with
private insurance while spending less on
administration, marketing, and executive
salaries, and it wont have to generate a profit.
This response is strongest with older non-college
educated women and Democrats.
Asked of half of sample.
16
Costs Most voters dont buy an attack that a
public plan will make insurance more expensive
due to underpayment and cost shifting. They
believe that a public plan will help control
health care costs and provide competition.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
UNDERPAYMENT
36 points
Like Medicare and Medicaid, a new public health
insurance plan will reimburse doctors and
hospitals at much lower rates, causing many
doctors and hospitals to shift higher costs onto
people who buy private health insurance.
A public health insurance plan will be able to
control overall health care costs for everyone by
using its purchasing power to drive competition
and lower the prices paid for health care
services and prescription drugs.
This response is strongest with under 40 and
women under 55.
Asked of half of sample.
17
Using the VA as an example to counter the
underpayment attack increases support among
seniors, women over 55, and those with a high
school education or less.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
UNDERPAYMENT W/ VA
Like Medicare and Medicaid, a new public health
insurance plan will reimburse doctors and
hospitals at much lower rates, causing many
doctors and hospitals to shift higher costs onto
people who buy private health insurance.
45 points
A public health insurance plan will be able to
control overall health care costs for everyone by
using its purchasing power - like the Veterans
Administration does now - to drive competition
and lower the prices paid for health care
services and prescription drugs.
This response is strongest with seniors, older
women, and those high school educated or less.
Asked of half of sample.
18
Competition Voters believe a public plan can
help increase competition and set rules.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
UNFAIR ADVANTAGE
A public health insurance plan will have an
unfair competitive advantage over private
insurance because the government will set rules
that favor the public plan.
30 points
A public health insurance plan option will
increase competition and rein in costs because
the private and public plans will have to play by
the same set of rules.
This response is strongest with older men.
Asked of half of sample.
19
Competition Voters are convinced a public plan
will help increase competition and rein in costs.
A direct challenge to private insurance plans
increases support with older women and voters
with a college degree.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
UNFAIR ADVANTAGE W/ EFFICIENCY
37 points
A public health insurance plan will have an
unfair competitive advantage over private
insurance because the government will set rules
that favor the public plan.
A public health insurance plan option will
increase competition and rein in costs. If
private insurers are really more efficient than
government, then they wont have any trouble
competing with a public health insurance plan
option.
This response is strongest with older women and
those with at least a college degree.
Asked of half of sample.
20
The argument that a public plan will promote
quality and control costs is strong across the
board. Only a small minority of voters believes
that competition among private plans is enough.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
COMPETITION
The best way to promote quality and control costs
is through competition among private health
insurers without adding another government plan.
34 points
The best way to promote quality and control costs
is through competition between public and private
health insurance plans.
This response is strongest with Democrats and
those in the Middle Atlantic region.
Asked of half of sample.
21
Voters are skeptical of private insurers and 6 in
10 believe that a public plan is necessary to
control costs, as opposed to simply setting basic
rules and regulations.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
RULES AND REGULATIONS W/ NON-PROFIT
We dont need a new government health insurance
plan. Private health insurance can control costs
and provide quality affordable health care if the
government sets basic rules and regulations, such
as requiring private health insurers to accept
people with pre-existing conditions.
33 points
Private health insurers will always find ways to
put profits before people. Thats why we need an
independent non-profit public health insurance
plan that is not driven by making higher profits,
in order to control costs and guarantee access to
quality affordable health care.
This response is strongest with seniors,
post-graduates, and Independent men.
Asked of half of sample.
22
A response that does not use the words
independent non-profit is not quite as strong.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
RULES AND REGULATIONS
We dont need a new government health insurance
plan. Private health insurance can control costs
and provide quality affordable health care if the
government sets basic rules and regulations, such
as requiring private health insurers to accept
people with pre-existing conditions.
16 points
Private health insurers will always find ways to
put profits before people. Thats why we need a
public health insurance plan that is not driven
by making higher profits, in order to control
costs and guarantee access to quality affordable
health care.
Asked of half of sample.
23
Attacks claiming a government health insurance
plan will cause people to lose their coverage do
not hold up well.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
MILLIONS LOSE COVERAGE - GOVT INSURANCE
Establishing a government health insurance plan
will mean that millions of people will lose their
private health insurance coverage because
employers will drop their private insurance and
dump people in the public plan.
47 points
Under the current system, millions of people are
already losing their health coverage every year.
Having a choice of public or private health
insurance plans will make sure that Americans
always have an option for quality affordable
health care.
Asked of half of sample.
24
An attack based on the cost of a government plan
in a bad economy is ineffective when the cost of
private insurance is cited in response.
Which statement comes closer to your own view?
(FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?
BAD ECONOMY - GOVT INSURANCE
A new government health insurance plan will cost
taxpayers a huge amount of money we cannot afford
right now during an economic slowdown, and
because the government is involved, it will make
the health system less efficient and increase
costs.
31 points
Private insurance companies currently have little
incentive to control premiums and deductibles,
reaping huge profits while working families
struggle to pay the bills. A public health
insurance plan that competes directly with
private insurers will help.
Asked of half of sample.
25
Messages in support of a public plan test very
strongly, and support is highest when referring
to Obamas plan. Voters are also reassured by
having a guaranteed backup for peace of mind.
Next Im going to read you a few short statements
that have been made in favor of including a
public health insurance plan option as part of
health care reform. For each one, please tell me
if the statement is a very convincing, somewhat
convincing, not very convincing, or not at all
convincing reason to support a public health plan
option.
Convincing (intensity in dark)
26
Text of Positive Messages
Obamas plan President-elect Obamas health
care proposal includes the choice of a public
health insurance plan. Under Obamas plan, if
you lose your job or lose your current health
coverage for any reason, youll always be covered
because the public insurance plan option will be
a guaranteed backup. Lobbyists for the private
insurance industry are using scare tactics to try
to get rid of the public plan option, which would
cut the heart out of Obamas plan. Congress
should listen to the voters, not the insurance
companies, and enact Obamas health plan. Peace
of Mind w/Medicare Its just wrong for people
who work hard and pay taxes to go without
affordable, quality health care. Many
hard-working middle class people are finding it
harder to afford health care they can count on
for themselves and their families. We need a
public health insurance option like Medicare as a
guaranteed backup that will always be there to
ensure quality, affordable health care coverage
is available no matter what happens. It would
give millions of hard-working families peace of
mind. Peace of Mind Its just wrong for people
who work hard and pay taxes to go without
affordable, quality health care. Many
hard-working middle class people are finding it
harder to afford health care they can count on
for themselves and their families. We need a
public health insurance option as a guaranteed
backup that will always be there to ensure
quality affordable health care coverage is
available no matter what happens. It would give
millions of hard-working families peace of mind.
27
The top message for Democrats, Independents and
middle-aged voters is Obamas Plan. For
Republicans and seniors, Choice and Quality with
Medicare is most effective.

• Top Among Democrats, Independents, and
  Middle-Aged Voters
• Obamas plan President-elect Obamas
  health care proposal includes the choice of a
  public health insurance plan. Under Obamas
  plan, if you lose your job or lose your current
  health coverage for any reason, youll always be
  covered because the public insurance plan option
  will be a guaranteed backup. Lobbyists for the
  private insurance industry are using scare
  tactics to try to get rid of the public plan
  option, which would cut the heart out of Obamas
  plan. Congress should listen to the voters, not
  the insurance companies, and enact Obamas health
  plan.
• Top Among Republicans and Seniors
• Choice and Quality w/Medicare We need an
  alternative to the harsh and unfair practices of
  the health insurance industry. 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 have a choice of
  keeping the health insurance we have, or choosing
  a public health insurance plan like Medicare, so
  were not left at the mercy of the same private
  insurance companies that have gotten us into this
  mess.

28
In a test of plan names, 3 in 4 voters like the
terms public health insurance plan or national
health insurance plan.
3.4
3.4
3.3
3.2
3.1
Now Im going to read you some different names
that could be used to describe the public
insurance plan option we have been talking about.
For each one, please tell me on a scale of 0 to
5 how favorable you feel toward that name, where
a 5 means the name is very favorable, and a zero
means the name is very unfavorable, and you can
rate it anywhere in between.
29
Referring to government or a federal government
sponsored plan is less effective than a public
health insurance plan.
3.0
3.1
3.0
2.9
2.8
2.8
Now Im going to read you some different names
that could be used to describe the public
insurance plan option we have been talking about.
For each one, please tell me on a scale of 0 to
5 how favorable you feel toward that name, where
a 5 means the name is very favorable, and a zero
means the name is very unfavorable, and you can
rate it anywhere in between.
30
Key Messaging Points

• Voters strongly support having a choice of public
  or private insurance.
• In messaging, voters respond positively to
  arguments that a public plan will help contain
  costs, increase competition, provide choice, and
  be a guaranteed backup.
• Referring to Obamas health care proposal
  sharpens already strong support for a public plan
  option among Democrats and Independents.
• Attacks on the public plan claiming increased
  costs, big government or lower quality do not
  hold up when effective responses are made.

31
Key Messaging Points

• Using Medicare as an analogy for a public plan
  helps most when referring to Medicare as a
  guarantee and providing peace of mind.
• Medicare resonates most strongly among women,
  especially women over 55 and non-college women,
  as well as with seniors and minority voters.
• Medicare is less effective with men, especially
  men under 55 and college-educated men.
• Naming it a public health insurance plan
  generates strong support across the board.
• Key is to mention both public AND health
  insurance and to emphasize choice.

32
Voter Attitudes on a Public Health Care Plan

• Findings From A Survey of 800 Likely Voters
  Nationwide