Poll Finds Most Mass. Residents Support New Health Reform Law, Including Individual Mandate, As Initial Deadline Nears

Wednesday, June 27, 2007

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The Main Reason: They Believe It is “the Right Thing to Do”

Many Residents Are Skeptical About the Affordability of Health Coverage for Families Required to Buy Insurance Without State Subsidies

As a key July 1 implementation milestone approaches, most Massachusetts residents support a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty, according to a new June poll of 1,003 Massachusetts residents.

The poll, conducted by the Kaiser Family Foundation, the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, finds support for the new health insurance law has increased. In this recent poll, two-thirds (67%) of state residents who have heard of the new health insurance law support it, compared with 16% who oppose it. In a poll conducted last September, six in 10 residents (61%) who had heard of the law said they supported it.

In addition, more than half (57%, compared to 52% in September) say they support the law’s individual mandate requirements, compared with 36% who oppose it.

“Given reports of sticker shock and ongoing debate about the law, we might have expected overall support to fall, but in fact, support is widespread and has gone up,” said Kaiser President and CEO Drew E. Altman, Ph.D. “If Massachusetts succeeds, it will have a big impact on the momentum for national health reform.”

Residents who support the law mainly say it is because they believe “it is the right thing to do” (90% of those who support say this is a major reason) and because they believe broader coverage will keep costs down by providing more incentives for preventive care (79%). Among the small group of residents who oppose the law, most say people shouldn’t be required to buy insurance if they can’t afford it (72%) or if they don’t want it (61%).

The random-sample telephone poll was conducted between May 29 and June 10 and has a margin of error of plus or minus 4 percentage points for results based on the full sample. The margin of error is higher for results based on subgroups.

Perceptions of who benefits and who gets hurt

The public sees the law as benefiting many key groups in the state, with large majorities saying it will help people who are uninsured (72%), poor people (66%) and young people (60%). Small businesses stand out as the one group that the public perceives will be hurt by the law (52%, compared with 25% who say small businesses will benefit).

In terms of personal impact in a state with a modest uninsured population, about one in four residents (24%) say the law will benefit them personally, about twice as many as who say the law will hurt them personally (12%). About six in ten (62%) say they do not expect the law to have much impact on them personally.

Although the new law does not include any proposed tax increases, a strong majority (66%) still believe the law will cause their taxes to go up in the future.

“After years of anti-tax sentiment, it is surprising that the law remains popular among a majority of people who believe it could cause their taxes to increase,” said Robert J. Blendon, Sc.D., professor of health policy and political analysis at the Harvard School of Public Health and the Kennedy School of Government.

Views of Connector Health Plans

The Massachusetts law requires state residents to obtain health coverage and created the Commonwealth Health Insurance Connector to offer affordable insurance plans. Uninsured residents with incomes less than three times the federal poverty level may receive subsidized coverage. Those with higher incomes who are ineligible for state subsidies must obtain coverage at their own expense or pay a penalty on their taxes equal to half the cost of coverage, unless insurance premiums exceed affordability thresholds established by the Connector.

When offered examples of health insurance plans that would be available to individuals and families of different incomes, strong majorities of residents say the subsidized plans available to moderate-income individuals and families are reasonably priced and would leave enrollees well-protected from high medical bills. More than half also say it would be fair to require people to sign up and pay for such plans.

However, the poll finds residents are more skeptical about the affordability of the unsubsidized plans, which would be available to higher-income residents without health insurance. When asked about two such plans, roughly six in 10 say that they are not reasonably priced, that they would leave enrollees vulnerable to high medical bills, and that it would be unfair to require people to buy them.

“I am pleased that the poll results demonstrate increased support for the new health care law. This support combined with growing awareness of the law means this legislation is right for Massachusetts,” said Jarrett Barrios, incoming president of the Blue Cross Blue Shield of Massachusetts Foundation.

Knowledge of the new law

The survey finds that the vast majority of Massachusetts residents say they have heard at least a little about the new health insurance law, with only 13% saying that they have not heard anything about the law. However, the very groups that are most likely to be impacted by the changes are more likely to report not knowing anything about the law – young people (21%), poor residents (26%), and those uninsured at some point over the year (22%).

More than seven in 10 (72%) also say they do not know the deadline to obtain health coverage in order to avoid paying a penalty on their taxes – and those who think they know the deadline are not always correct. Overall 16% cite the upcoming July 1 deadline (the date the individual mandate goes into effect and health insurance coverage is required) and another 2% cite December 31 (the date an individual must prove he or she had health insurance coverage to avoid paying a penalty).


The Kaiser Family Foundation/Harvard School of Public Health/Blue Cross Blue Shield of Massachusetts Foundation Massachusetts Health Reform Tracking Survey was conducted through a three-way partnership between the Kaiser Family Foundation (KFF), Harvard School of Public Health (HSPH), and Blue Cross Blue Shield of Massachusetts Foundation (BCBSMA Foundation). The survey was designed and analyzed by researchers at KFF and HSPH, with input and review from BCBSMA Foundation. This is the first in a series of surveys the partnership will conduct over the coming year to measure Massachusetts residents’ attitudes toward and experiences with the new health reform law.

A state-wide representative random sample of 1,003 Massachusetts residents ages 18 and older was interviewed by telephone from May 29 through June 10, 2007. Interviews were conducted in English and Spanish by International Communications Research of Media, Pennsylvania. The margin of sampling error for the survey is plus or minus 4 percentage points; for results based on subgroups, the margin of sampling error is higher. Sampling error is only one of many potential sources of error in this or any other public opinion poll.

The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: www.hsph.harvard.edu

The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. Through grants and policy initiatives, the Foundation works with public and private organizations to broaden health coverage and reduce barriers to care. The Foundation focuses on developing measurable and sustainable solutions that benefit uninsured, vulnerable and low-income individuals and families in the Commonwealth.

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