Thursday, August 6, 2009

Health Reform and the Polls


For all the back and forth about the “public option,” Congressional Budget Office estimates and proposed tax hikes, the fundamentals are really what make health-care reform a hard sell to American voters. As members of Congress head home for the August recess, they should take a close look at some poll numbers before they attempt to pass any new legislation.

The most important fundamental is that 68% of American voters have health-insurance coverage they rate good or excellent. That number comes from polling conducted this past weekend of 1,000 likely voters. Most of these voters approach the health-care reform debate fearing that they have more to lose than to gain.

Adding to President Barack Obama’s challenge as he sells health-care reform to the public is the fact that most voters are skeptical about the government’s ability to do anything well. While the president says his plan will reduce costs, 53% believe it will have the opposite effect.

There’s also the reality that 74% of voters rate the quality of care they now receive as good or excellent. And 50% fear that if Congress passes health-care reform, it will lead to a decline in the quality of that care.

Advocates of health-care reform on Capitol Hill are up against something bigger than voters’ reactions to a variety of specific proposals. Our polling in February found that by a 2-1 margin, voters believe that no matter how bad things are Congress can always make matters worse. That’s one reason 78% believe passage of the current congressional health-care proposals is likely to mean higher taxes for the middle class.

However, there are some numbers congressional Democrats can celebrate. Specifically, 63% of voters agreed with the president earlier this year when he said, “We must make it a priority to give every single American quality affordable health care.” Yet while they agree in theory, only 28% are currently willing to pay higher taxes to achieve that goal.

Another point in the reformers’ favor is that a significant number of the voters we polled in May had experienced financial hardship brought on by health issues. One in four Americans—26%—say that health-care costs have at some point caused them to miss credit-card, rent or mortgage payments. That figure includes 21% of those who have health insurance coverage.

Finally, voters strongly believe that medical care should be provided when needed, regardless of insurance coverage. In May, Rasmussen Reports found that just 31% of voters believe young and healthy adults who choose not to buy health insurance should be forced to do so. But a follow-up question asked: “What if those who chose not to buy health insurance end up needing emergency room care?” Only 16% said treatment should be denied; 74% said they should be treated even if they did not have insurance.

Taken together, the data shows that at this point voters are pretty evenly divided. Last week’s polling showed that 47% at least somewhat favored the plan while 49% are somewhat opposed.

Though voters are torn about reform, there is intensity among the opposition. Just 25% strongly favor the reform effort, while 41% are strongly opposed. And that gets back to the very first point: 68% currently have good or excellent coverage. It’s going to be hard to generate passionate support for change among this group of voters.

Those opposed to Mr. Obama’s reform appear to have momentum on their side. Polling last weekend showed that 48% of voters rate the U.S. health-care system as good or excellent. That’s up from 35% in May and up from 29% a year ago. Only 19% now rate the system as poor, down from 37% a year ago. It appears that the prospect of changing health care has made the existing system look better to a lot of people.

Beyond the intensity of the opposition and its momentum, there is also a huge partisan gap that puts congressional Democrats in a very difficult position. Currently, 76% of Democratic voters favor the health-care reform plan proposed by Mr. Obama and the congressional Democrats, and they are counting on their representatives to deliver.

But delivering for the Democratic base has the potential to hurt the party’s standing among independents. Among the unaffiliated, 35% are in favor of the Democrats’ health-care reform initiative, and 60% are opposed. Notably, just 16% of unaffiliated voters strongly favor the legislative effort; 47% strongly oppose it.

As the Democrats scramble to pass a health-care reform bill by the fall, they appear to have two choices. One is to stick with the broad outlines of the plan that has been laid out by various congressional committees. Those proposals would be well received within the party, but will cause some angst beyond it.

The other option would be to pass smaller scale reform and declare victory. That approach would probably be well received by voters in the middle, but create turmoil within the party.

In political terms, the most important reality will be how the reform affects the 68% who say they have good or excellent health-insurance coverage. If they end up having to change their coverage, pay significantly higher taxes, or encounter some other unpleasant reality, congressional Democrats will look back on this August as a time when they should have listened more closely to the folks back home.