MENLO PARK, CA—After falling over the summer then ticking upward in September, key tracking measures of public support for health care reform held steady in October with more Americans backing an overhaul of the U.S. health system than opposing it, according to the latest Kaiser Health Tracking Poll.

Fifty-five percent of Americans believe that it is more important than ever to take on health care reform now, while 41 percent say the country cannot afford it right now, similar to last month. Just over half say the country will be better off if reform passes, unchanged from September.

"Our October poll finds no big change in public opinion that would move the debate, but the decisive moment for public opinion is still to come," said Kaiser President and CEO Drew Altman. "The key milestone—both in the political process and in public opinion—will be reached when there is a single bill that Americans can put under a microscope and debate."

Although the big picture was not dramatically different, the new poll did reveal some new wrinkles in public opinion.  

The Public Overestimates How Quickly Help Would Arrive

About half of the public believes that if reform passes, help for the uninsured and changes in insurance market rules would arrive within the first year, years ahead of the timetables contemplated in the legislation.  Roughly half (49%) of Americans think that if reform passes, the uninsured will start getting financial help within the next year. In reality, such help generally would not arrive until 2013. Similarly, 51 percent of the public thinks that, should reform pass, health insurance companies would have to begin accepting customers with pre-existing health problems within the next year, a timetable not envisioned under any of the leading reform bills.  

A Debate In Which the Winning Message Will Matter

On the key question of how health reform should be financed, the October tracking poll finds continuing majority support for taxing wealthy households (63%) and health insurance companies that offer the most costly policies (55%). However compared to September, support for taxing the wealthy is down seven percentage points, while opposition to taxing health insurance companies is up seven percentage points.

Moreover, the initial support for the insurer tax is quite malleable depending on what specific arguments are offered. Support plunges to 21 percent, for instance, when supporters are asked what their view would be if they heard that the cost of the tax might be passed on to consumers. Similarly, support for the insurer tax jumps to 68 percent if opponents are asked if their view would change if they heard that the tax will discourage expensive policies and could help lower health care costs for everyone.

"The public’s views on these ways to pay for reform can shift dramatically depending on what arguments get through," said Mollyann Brodie, vice president for Public Opinion and Survey Research at the Kaiser Family Foundation. "And it goes beyond the matter of whether to impose a new tax on insurance companies. We have seen similar movement in the public’s views on the individual mandate and on the public plan option."

Initially, 57 percent of the public say they favor the creation of a "government-administered public health insurance option," however the poll indicates that this support dips to one-third (32%) when initial supporters are told that such plans "could give the government plan an unfair advantage over private insurance companies."  Alternatively, support for the public plan rises to two-thirds (65%) when initial opponents are told that public plans would be "a fallback that would only kick in if not enough people had affordable health plans available through the private marketplace."

Americans Desire Reform But Still Worry About Its Impacts

Most Americans (53%) continue to believe that reform would be beneficial to the country as a whole. And the poll finds that more Americans say that reform would leave their own family better off (41%) than say that it would leave their family worse off (27%).

Yet there are signs that the public is still anxious about reform and its potential impacts. If reform passes, significant numbers of Americans think things would get worse in areas such as waiting times (41%), health care costs (35%) and choice of providers (34%). And while more Americans think health reform would help the economy in the long run than think it would hurt it (49% vs. 37%), the reverse is true when they are asked about the short-term economic impact, with 41 percent saying reform would hurt and only 32 percent saying it would help.

A new finding is that the public is evenly divided about the likely impact of health reform on small business, with 36 percent saying this key group of employers will be better off and nearly as many (33%) saying they will be worse off.

In another new finding, just over half (52%) say they think most of those now uninsured still will have trouble paying for adequate coverage in the wake of reform, compared to 40 percent who think the government will provide enough financial help.

Methodology

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted October 8 through October 15, 2009, among a nationally representative random sample of 1200 adults ages 18 and older.  Telephone interviews conducted by landline (800) and cell phone (400, including 141 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.