MENLO PARK, CA -- A slim majority of Americans continues to favor moving forward on health care reform now despite an intensifying ad war and a political climate of contentious town hall meetings that coincide with rising concerns about the reform effort, according to the August Kaiser Health Tracking Poll.

Fifty-three percent of the public believes that tackling health reform is more important than ever, compared to 42 percent who say we cannot afford to take on health care reform right now. The gap between those points of view has narrowed in recent months as criticisms and doubts about reform plans seem to be registering.  Sixty three percent of the public say they are "hopeful" about reform, 41 percent are "afraid" and 46 percent are simply "confused".

The August poll was conducted during a period in which politically active members of the public vented their fears and hopes about reform plans in fiery and widely-publicized town hall meetings with elected officials, and at a time when an increasing number of Americans (45% compared to 31% in July) reported seeing advertisements having to do with proposed changes in the health care system.

"The August health reform wars about hot button issues have definitely made the public more anxious but they have not caused public support to unravel," said Kaiser President and CEO Drew Altman.  "When the Congress returns the debate will refocus on core issues such as how to pay for health reform and meet the public’s expectations for help with their health insurance problems."

Better Off/Worse Off for Me and the Country

The intensifying debate appears to have impacted some key tracking poll indicators over the last month.  One key indicator in the debate is the percentage of Americans who think that they or their families would be better off if the president and Congress enacted major health reform legislation.  The largest group (36%) continues to say their family will be better off if health reform passes -- a proportion that has held relatively steady all year.  However, the share who believes their family will be worse off has jumped 10 percentage points since July and now stands at 31 percent.   

Similarly, while a larger proportion of Americans continues to believe the country as a whole would be better off if Congress passed health care reform than think it would be harmed (45% vs. 34%), the gap between those viewpoints has shrunk over the course of the summer.  The share of Americans who see negative consequences for the country has climbed and the share anticipating benefits has fallen.  Just one month ago, for instance, 51 percent thought the country would be better off if the president and Congress pass health reform, while 23 percent thought it would be worse off.

The uptick in fears of negative outcomes is driven in large part by a big jump in concerns among Republicans.  This month, 61 percent of Republicans say they would be personally worse off if health reform passes, up 22 percentage points from July.  Similarly, 68 percent of Republicans said the country would be worse off if reform passes, up 25 percentage points from July.

In addition, for the first time this year, more independents say they personally will be worse off rather than better off if health reform passes (36% vs. 30%).  And independents now are roughly divided on whether or not health care reform will benefit the country, in contrast to previous months where optimists outnumbered pessimists in this group.  Democrats have remained fairly steady in their perception of how health reform might affect them personally; a majority (53%) say they and their family would be better off if health reform passed.

Support for Individual Reform Proposals Remains High, and Expanding and Subsidizing Coverage and Insurance Reform Top the List of Most Important Goals

Despite the increasingly passionate debate this summer, public backing for key individual elements of health reform remains steady.  Substantial majorities continue to say they support individual reform components designed to expand coverage, including a public plan option (59%), an expansion of state programs such as Medicaid (80%), an individual mandate (68%) and an employer mandate (68%).

Asked which elements of health reform are the "most important" to them, members of the public cited expanding and subsidizing health coverage to Americans who have been unable to afford it as their top choice (32%), followed by insurance reform (24%), and strengthening prevention programs (19%).  Reining in the amount of money the country spends on health care came in fourth (9%).

Attention to the Debate

There is heightened attention to health reform, with 33 percent of Americans saying they are following the debate "very closely", up from 27 percent in July.  Those who think they personally will be worse off if health reform is enacted are more likely to say they are following the debate "very closely" than those who think they personally will be better off (55% to 30%).

Moreover, with the ad wars becoming more intense, there has been a big spike in the share of Americans who say they have seen a health care reform-related ad over the course of the past week.  Nearly half (45%) say they have seen, heard or read some sort of message on health reform, pro or con, over the past seven days, up from 31 percent last month and 21 percent in June.  So far the pro-reform ads have a slight edge.  Of those who saw an ad, 40 percent say the ad they saw was pro-reform, compared to 32 percent who said the ad they saw was anti-reform.  Twenty-one percent said they had seen both kinds of ads.

Feelings About Reform Range Widely, and Seniors Are Most Likely to Feel Confused

As the summer’s debate has heated up, much of the media discussion has focused on the anger displayed at some town hall meetings across the country.  But the August survey finds that anger is hardly the only emotion about health reform.  Asked which terms described their feelings about health reform plans being discussed in Washington, most said "hopeful" (63%), followed by "frustrated" (57%), "optimistic" (50%), "confused" (46%), "pessimistic" (42%) and "afraid" (41%).

Americans’ feelings track strongly with whether they favor passing some sort of health care reform this year or whether they think the country cannot afford to take on the issue during a recession.  Among those who want reform now, the dominant emotions are hope (82%) and optimism (70%), while among those opposed the chief sentiments are frustration (69%) and fear (62%).

One key demographic group stands out as being most likely to report that they feel "confused" by the debate in Washington: senior citizens.  Overall, 62 percent of those over age 65 say they are confused about health care plans being considered by Congress, compared to 43 percent of those under age 65.  It is this confusion that may be driving some of the anxiety evident among seniors when it comes to health care reform plans.

Much of the recent debate has focused on the concerns of seniors and a discussion of how Medicare would be affected by any reform proposal.  Seniors are more likely to see Medicare as worse off than better off under health reform (37% vs. 20%), with 26 percent believing reform will not impact the program and another 17 percent unsure about what reform will mean.

The poll does not find that seniors are appreciably more likely than younger Americans to see themselves harmed by reform.  Instead, they are less likely to see themselves helped. Overall, 23 percent of seniors say they will personally be better off if health reform passes, compared to 39 percent of those under age 65.  About one in three seniors say they personally will be worse off if reform is enacted, roughly equivalent to the views of younger Americans.

"Seniors tell us they are confused about health reform," said Kaiser Vice President and Director of Public Opinion and Survey Research Mollyann Brodie.  "They are hearing both positive and negative things about how it will affect them and they are not sure what to believe.  Whether they will support any final proposal remains unclear -- and may depend heavily on what the specifics are and whether any sweeteners for seniors are included in the bill."

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted August 4 through August 11, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older.  Telephone interviews conducted by landline (801) and cell phone (402, including 123 who had no landline telephone) were carried out in English and Spanish.  The margin of sampling error for the total sample is plus or minus 3 percentage points.  For results based on subgroups, the margin of sampling error is higher.

The full question wording, results, charts and a brief on the poll can be viewed online.