Americans Are Divided About Health Reform Proposals Overall, But the Public, Including Critics, Becomes More Supportive When Told About Key Provisions

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January 22, 2010

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Americans AreDivided About Health Reform Proposals Overall, But the Public, IncludingCritics, Becomes More Supportive When Told About Key Provisions

MENLO PARK, CA –A new Kaiser Family Foundation poll finds thatAmericans are divided over congressional health reform proposals, but also thatlarge shares of people, including skeptics, become more supportive after beingtold about many of the major provisions in the bills.

The January Kaiser HealthTracking Poll, conducted before the Massachusetts Senate vote, finds opinion isdivided when it comes to the hotly debated legislation, with 42 percentsupporting the proposals in the Congress, 41 percent opposing them and 16percent withholding judgment. However, a different and more positivepicture emerged when we examined the public’s awareness of, and reactions to,major provisions included in the bills. Majorities reported feeling morefavorable toward the proposed legislation after learning about many of the keyelements, with the notable exceptions of the individual mandate and the overallprice tag.

For example, after hearingthat tax credits would be available to small businesses that want to offercoverage to their employees, 73 percent said it made them more supportive ofthe legislation. Sixty-seven percent said they were more supportive when theyheard that the legislation included health insurance exchanges, and 63 percent feltthat way after being told that people could no longer be denied coveragebecause of pre-existing conditions. Sixty percent were more supportive afterhearing that the legislation would help close the Medicare “doughnut hole” sothat seniors would no longer face a period of having to pay the full cost oftheir medicines. Of the 27 elements of the legislation tested in thepoll, 17 moved a majority to feel more positively about the bills and two moveda majority to be more negative.

In some cases elements of thelegislation were popular enough to prompt a majority of skeptics to softentheir opposition, including the tax credits for small businesses (62% ofcurrent opponents said it made them more supportive), the fact that mostpeople’s existing insurance arrangements would not change (59%), and thestipulation that no federal money would go to abortion (55%).

A smaller number ofprovisions cut the other way. When told that nearly all Americans would berequired to have health coverage, for instance, 62 percent of people said itmade them less likely to support the legislation and 51 percent said they wereless likely to support the reform package after learning it will cost at least$871 billion over 10 years.

It’s one thing totalk about the public’s perception of health care reform legislation, whichright now is in some ways negative, but it’s another to tell people what’s actuallyin the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.

The poll finds that evenafter a year of substantial media coverage of the health reform debate, manyAmericans remain unfamiliar with key elements of the major bills passed by theHouse and Senate. About half are aware that tax credits would be available tosmall businesses, one of the most popular provisions. And 44 percent recognizethat the legislation would help close the Medicare “doughnut hole.”

Awareness can matter. Amongthe least known elements of the bills, those with the biggest potential tochange minds include the fact that the Congressional Budget Office has saidhealth reform would reduce the deficit (only 15% expect the legislation toreduce the deficit, but 56% said hearing that makes them more supportive) andthat the legislation would stop insurers from charging women more than men (37%are aware that the legislation would do this, but 50% said this provision makesthem more supportive). There were no lesser known provisions that would pusha majority of supporters away from the bill.

Independents Occupy TheMiddle Ground In the Debate

Americans’ views of healthreform generally track with their politics: Most Democrats (64%) support theproposals on Capitol Hill, while an even larger majority of Republicans (76%)oppose them. The middle ground is left to independents, with 41 percent infavor and 43 percent opposed– even as a narrow majority (52%) backs the generalidea that it is more important than ever to take on health reform now.

As with the public overall,independents say the elements most likely to push them in the direction ofsupporting the legislation include the tax credits for small businesses (74%); theinsurance exchanges (69%); and the stability in coverage for most people withemployer-sponsored plans (66%). Similarly, they are turned off by theindividual mandate (67% say this makes them less supportive) and the overallcost of health reform (57%).

Independents do differ insome ways from those with declared partisan leanings. They are much more likelythan Republicans to say that they feel more supportive of the legislationbecause it would provide coverage for the uninsured (61% of independentscompared to 22% of GOP members). And they are more concerned than Democratsabout the bills’ multi-billion dollar price tag; 57 percent of independents saythe cost makes them feel less supportive, compared to 34 percent of Democrats.

Many Seniors Are Unawareof Effort To Close The Medicare “Doughnut Hole”

The new survey finds that America’sseniors, a politically important group, lean against the proposed legislation,with 48 percent opposed, 37 percent in favor and 15 percent offering noopinion. However the survey finds that, somewhat surprisingly, seniors wereless likely than younger Americans to be aware that the legislation includesprovisions to close the “doughnut hole.” Thirty-seven percent of seniors wereaware of such provisions, compared to 53 percent of those under age 40. Six in10 seniors say that if the legislation did work to close the doughnut hole theywould feel more supportive of it, a level of support identical to that foundamong younger Americans.

There is a generationalsplit, however, on proposals that would limit future increases in some Medicareprovider payments. Younger Americans favor such measures by almost a 2-to-1margin while the opposite is true of seniors.


The survey was designed andanalyzed by public opinion researchers at the Kaiser Family Foundation and wasconducted January 7 through January 12, 2010, among a nationally representativerandom sample of 2,002 adults ages 18 and older. Telephone interviewsconducted by landline (1,350) and cell phone (652, including 255 who hadno landline telephone) were carried out in English and Spanish. Themargin of sampling error for the total sample is plus or minus 3 percentagepoints. The questions about specific elements of health reform legislationwere asked of random quarter-samples of respondents, and for these questionsthe margin of sampling error is plus or minus 5 percentage points. For resultsbased 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.

The Kaiser Family Foundation is a non-profit privateoperating foundation, based in Menlo Park, California,dedicated to producing and communicating the best possible information andanalysis on health issues.


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