But with health reform moving from the abstract to concrete legislative proposals, criticisms made during the policy debate appear to be having an impact on the public and several indicators have softened somewhat from earlier this year. A larger share of the public is worried that Congress and the president will pass a bill that's bad for their family (54%) than are worried that health care reform will not happen this year (39%). While a majority of the public favors health care reform now, the share that is supportive is down five percentage points since June (from 61% to 56%). The proportion who say passage of health care reform will make things worse for their own family, although relatively small, has doubled since February (from 11% to 21%), as has the proportion who say the country would be worse off if health care reform passed (from 12% to 23%). Specific proposals to cover the uninsured, while still supported by majorities, also show a weakening in support. For example, overall support for an employer mandate fell from 69 percent to 64 percent since last month and those who "strongly" favored the idea fell from 42 percent to 29 percent.
Financing health reform is front and center of the current debate. Roughly half (51%) of the public is willing to pay more for expanding health coverage - up ten percentage points from last month. And some revenue measures have strong support (taxing cigarettes, taxing Americans earning more than $250,000 annually, and taxing alcohol, beer and wine all have greater than 60% support). However, consistent with the overall pattern, support for revenue measures has softened across the board with a portion of the public shifting from "strongly" to "somewhat" supportive. For example, the percentage who strongly support taxing those earning more than $250,000 annually fell from 49 percent to 40 percent since last month.
One highly debated issue has been the establishment of a public health insurance plan to compete with private plans - six in ten support this idea. When asked if they would be interested in purchasing a public insurance plan if it were made available, about a quarter (23%) of the public say they would "very likely" look into it and about a quarter (23%) would be "not at all likely" to explore purchasing such a plan.
The proportion of the public following the health reform debate closely (27%) has not changed much over the past several months. But the proportion who report seeing an ad about health care reform is up 10 percentage points since last month (31% compared to 21% in June), with nearly as many reporting seeing a negative as a positive ad, another change from June when reported viewing of positive ads clearly dominated.
"The public wants help with their health care bills and supports health reform, but the hotter the debate and the longer it lasts, the more anxious the public will become," said Kaiser President and CEO Drew Altman.
More on the Public Plan
Echoing the policy debate, roughly four in ten people (43%) say a public plan would be more likely to drive private companies out of business, while just as many (45%) hold the opposite view, saying it would cause private companies to become more efficient and provide better products.
People's views on a public plan are moveable as the survey shows by replicating arguments used in the current reform debate. When those who initially support the public plan are told that this could give the government an unfair advantage over private companies, overall support drops to 35 percent. Conversely, when opponents are told that public plans would give people more choice or help drive down costs through competition, overall support jumps to roughly seven in ten.
Effective Arguments For and Against Health Care Reform
When offered a number of possible arguments used in the current health care debate, certain messages resonate more with the public than others.
Messages that make the public feel more favorable about a health care reform plan:
- Can keep own doctor or health plan (74% more likely to support reform if they heard)
- Would ensure financial health of Medicare (67%)
- Would cover pre-existing conditions (66%)
- Won't increase budget deficit (63%)
- Would provide financial help to get health insurance for those who need it (63%)
- Would save country money over time (63%)
- Higher quality of care for Medicare patients (59%)
Messages that make the public feel less favorable about a plan:
- Was going to increase premiums/out of pocket costs (66% less likely to support if they heard)
- Would result in cuts in Medicare that make doctors less willing to participate (62%)
- Limited own choice of doctors (62%)
- Get government too involved in your health care (59%)
- Would reduce quality of care in Medicare (58%)
- Would increase taxes (58%)
- Would increase budget deficit (45%)
"Public support for health reform will depend on which arguments get through to the American people and, ultimately, how they answer the question of how will health reform affect their family," said Kaiser Vice President and Director of Public Opinion and Survey Research Mollyann Brodie.
Is One Trillion Dollars for Health Reform a Significant Threshold?
A $1 trillion price tag for health care reform appears to be a significant marker to many stakeholders and policymakers in the reform debate, but less so to the public. When asked if $1 trillion over ten years was too much, too little, or about right to spend on reform, roughly four in ten of the public say it is too high (42%), while just over a third say it is the right amount (36%), and one in ten say it is too little (9%). Belief that $1 trillion is too much drops to about three in ten when three separate arguments are tested on those who initially say $1 trillion is too much.
