Clues From Polling About How Opinion Might Change If We Had More Informed Health Policy Debate?
In an ideal world, we would have a fair fight for public opinion about the big health policy changes and spending cuts in the reconciliation bill. Republicans would lay out their proposals over a more reasonable period of time, Democrats would criticize them, and there would be lots of media scrutiny of the arguments made by both sides. The public would weigh them as best they could, and people would decide where they stand. That might, in turn, influence what policymakers do. Of course, we are miles from that fantasy land. Today the public is mostly uninformed, with many simply disengaged or only hearing the slant from one side or the other in their preferred information echo chambers. A reconciliation bill exacerbates all these problems with major policy changes compressed into one-big-incomprehensible bill—it’s too big and complex for the media to disentangle, and it’s moving faster than the public’s ability to follow and digest.
We try to address this, very imperfectly and partially, as a regular feature of our polling. Sometimes we do that by dedicating a series of questions to lay out the arguments for and against health policies for all our respondents, to see where the public would stand if they heard both sides at the same time or if they had more information. Sometimes we test arguments and facts on supporters and opponents of specific policies, to see if their views change and if so, by how much. Often in our polling, we are trying to simulate the effects of a debate about legislation, which with ad wars and spin, and often heated debate, is different than polling about policies in the abstract. When we do that, the arguments we test may not be wholly factual. That’s by design; the idea is to mirror a real debate.
Health policy can be wonky and arcane and, generally, we are operating in a low-information environment when we are polling about it, so respondents take partisan cues unless they get more information. Republican respondents may associate Trump and Republicans with a policy we ask about and answer one way, and the same is true of Democrats. After years of polling on the ACA, polling results became so driven by partisan affiliation that I came to the not entirely tongue-in-cheek conclusion that if we asked, “Will the ACA solve climate change and take us to Mars?” we would get a partisan yes/no response. We saw a similar dynamic throughout our polling on Covid—partisanship predicted almost every result.
Not surprisingly, the information starting point on reconciliation is low: Only about half of the public know that the “One Big Beautiful Bill” (OBBB) cuts Medicaid spending (by about $800 billion) or increases the deficit (by over $2 trillion).
Here is an example of giving our poll respondents more information about the reconciliation bill in our new poll:
We asked respondents if they had a favorable or unfavorable view of the OBBB and then asked two “what if you knew” follow-up questions. Public support for the legislation drops 14 percentage points to 21% after hearing that the legislation would decrease funding for local hospitals, and three-fourths of the public (74%) hold an unfavorable view of the legislation after hearing that the bill would increase the number of people without health insurance by about 10 million.
The chart shows you how opinion shifts in more detail. Notably, MAGA support for the OBBB drops 24 points when people hear that the bill will significantly increase the number of uninsured.
We also gave arguments and more information to supporters and opponents of Medicaid work requirements:
- Majorities of Republicans, independents and Democrats support the idea of work requirements, ranging from half of Democrats to nine in 10 Republicans.
- However, when supporters are told that most adults on Medicaid are already working and might lose coverage trying to do the paperwork to establish their eligibility, views flip. About half of supporters change their view, leading to two thirds (64%) opposing work requirements. The same happens when people are told work requirements will not have a significant impact on work: support drops 28 points to 40% overall.
- The alternative argument also has an impact. When those who oppose the requirements hear that they will save money and could help pay for Medicaid for low-income children and people with disabilities, support rises 11 points to 79%. (When arguments from both sides work, a lot depends on which side has the most effective messaging and messengers.)
We see a similar dynamic in poll findings we are releasing today on the critical issue of extending the enhanced ACA tax credits. Most Americans don’t even know the extension of the credits is an issue. When asked, most, in the abstract, are for it (77%), including even a majority of MAGA supporters. And again, arguments matter. Support drops 19 points when supporters hear paying to expand the credits is expensive and would increase the deficit.
Opposition is also influenced by information; it diminishes when people hear that CBO says letting the credits expire will increase the number of uninsured by about 4 million. Overall, hearing this argument increases support for extending the tax credits to nearly all Democrats (95%), nine in 10 independents (86%), nearly three-fourths (72%) of Republicans, and a surprising two-thirds (65%) of MAGA supporters.
In our current political system, many people are tuned out. Many hear only one side’s arguments and “facts.” Knowing how difficult it is to reach voters with policy information, policymakers and candidates (and presidents) exaggerate almost everything in order to be heard over the noise and get news coverage. So, it’s notable in our polling that we often get different results when we array the arguments and provide more information. It’s certainly not the same thing as a real policy or legislative debate, played out over months with intensive media coverage, ad wars, and communicators with different levels of skill and notoriety. But it is also telling. It means opinion and policy might sometimes be different if our political and information systems worked better and the public, including sometimes fierce partisans, knew more. It also means that while there is no simple solution to our fractured information system, those of us in the facts and information business need to try harder.