Kaiser Family Foundation Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy in the United States, Canada, and the Netherlands1995

Unplanned pregnancy is a major problem facing Americans today. Approximately 3.5 million unplanned pregnancies occur each year in the United States. Women in the United States are almost twice as likely as women in Great Britain and three times as likely as women in the Netherlands to face an unplanned pregnancy.

Research has explored public opinion on these issues, but none has measured public knowledge. Hoping to help explain some of the variation in unplanned pregnancy rates between the U.S. and other developed nations, the Kaiser Family Foundation commissioned telephone surveys with adults in Canada, the Netherlands, and the U.S. to assess differences in public knowledge, opinions, and practices related to pregnancy and birth control. Canada was selected for comparison because it represents a culture similar to that of the United States, but has an unplanned pregnancy rate two-thirds that of the U.S. The Netherlands was selected because its culture is considered very different in its attitudes toward sexuality than the U.S. and it has an extremely low unplanned pregnancy rate — only one-tenth of the U.S. rate.

The three national telephone surveys were designed and analyzed by the Kaiser Family Foundation and Louis Harris and Associates, Inc. and conducted by Louis Harris and Associates, Inc. (A complete methodology is on the opposite page.) The surveys examined public knowledge of and attitudes toward issues related to unplanned pregnancy and contraception, including emergency contraception. Survey respondents were asked, for example, about such things as their perceptions about the magnitude of the problem of unplanned pregnancy in their country and their awareness of different contraceptive options.

Press releases have been issued from the data collected in the U.S. survey on public knowledge and attitudes about emergency contraceptive pills, abortion rates, men and contraception, teen sexuality and pregnancy, and other aspects of contraception and reproduction. To obtain the press releases and additional information on these topics, call the Kaiser Family Foundation’s publications request line at 1-800-656-4533.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, and HIV policy inthe United States, and health and development in South Africa.

Methodology

The Kaiser Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy are three separate random-sample telephone surveys of adults ages 18 and older living in the United States, Canada, and the Netherlands. The survey was designed by the Henry J. Kaiser Family Foundation in association with Louis Harris and Associates, Inc.

The sampling procedure was designed to produce representative samples of adults in telephone households in all three countries. Random digit selection was used to assure equal representation ofpeople in households that are listed and “unlisted” in telephone directories. An effort was made to match interviewers of the same sex as the randomly selected respondents. Interviews were conducted in English and Spanish in the United States. For the Canadian and Dutch surveys, the survey instrument was translated into French and Dutch, using culturally appropriate wording, and back-translated into English for verification.

The U.S. sample consisted of 2,002 adults in the 48 contiguous United States (excluding Alaska and Hawaii) and was conducted between October 12 and November 13, 1994. The margin of error in the nationwide U.S. sample is plus or minus 2 percent and plus or minus 3 percent for respondents of “reproductive age,” that is men and women age 18-44 (1,140 respondents). The Canadian sample consisted of 1,002 adults and interviews were conducted between December 9, 1994 and January 3, 1995. The margin of error for the Canadian sample is plus or minus 3 percent and plus or minus 4 percent for respondents of reproductive age (594 respondents). The Dutch sample consisted of 1,001 adults and interviews were conducted between December 15, 1994 and January 19, 1995. The margin of error for the Dutch sample is plus or minus 3 percent and plus or minus 4 percent for respondents of reproductive age (536 respondents).

Questionnaire and Toplines

I. Gender of Respondents

USA18+ USA18-44 CAN18-44 NETH18-44 Male 50% 49% 51% 51% Female 50% 51% 49% 49% II. Age of Respondents

USA18+ USA18-44 CAN18-44 NETH18-44 18-29 21% 18-24 22% 20% 24% 30-49 43% 25-34 40% 42% 39% 50-64 18% 35-44 38% 39% 37% 65 and over 17% A. Talking with Your Doctor

Now I’d like to ask you a few questions about your discussions with health care professionals. (If Necessary: If any question is not applicable to you, please say so, and we’ll move past it.)

A1. In the past two years, have you discussed birth control such as the use of condoms or birth control pills with your doctor or another health professional, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, discussed 21% 33% 34% 25% No, did not discuss 71% 63% 65% 73% Not applicable (Vol.) 9% 4% 1% 2% Not sure/Refused * * * * A2. Have you ever discussed birth control with a doctor or another health professional, or not?

Based on those who did not discuss or were not sure whether they discussed birth control with a doctor in the past two years.

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, discussed 38% 40% 45% 36% No, never discussed 61% 60% 55% 62% Not applic. (Vol.) 1% * 2% * Not sure/Refused * * * * A3. Has a doctor ever been the one to raise the subject of birth control, or not?

Based on those who have discussed birth control with a doctor. Asked only in the U.S.

USA18+ Yes, doctor raised subject 32% No, doctor did not 67% Not sure/Refused 1% B. Information Sources

B1. People can get information about birth control from a variety of sources. What sources would you say that you most typically rely on for information about birth control? What else? (Do Not Read List — Multiple Record)

USA18+ USA18-44 CAN18-44 NETH18-44 1. Health care professionals 63% 64% 68% 79% 2. Magazines 20% 23% 15% 13% 3. Your friends or peers 12% 14% 6% 5% 4. Television 11% 13% 8% 9% 5. Your family 9% 10% 5% 5% 6. Health and sex education courses in school 8% 10% 5% 3% 7. Reference books/medical journals/library 5% 5% 5% 3% 8. Church, clergyman 2% 2% * * 9. Newspaper 2% 2% * * 10. Planned Parenthood/ family planning agencies 2% 2% * * 11. Your spouse or partner 2% 2% 1% 1% 12. Pamphlets 1% 2% 2% 2% 13. Nowhere — don’t want/need/get any information 1% * 2% * 14. Other 3% 5% 13% 16% 15. Not sure/Refused 13% 9% 3% 8% C. Knowledge of Unplanned Pregnancy Problem

C1. Unplanned pregnancy is a pregnancy that a woman is not actively trying to have. It could be unintended, a mistake, unwanted, or not at the right time. Do you think unplanned pregnancies are a very big problem, a somewhat big problem, not a very big problem, or not a problem at all in your country?

USA18+ USA18-44 CAN18-44 NETH18-44 Very big problem 60% 60% 36% 6% Somewhat big problem 30% 33% 45% 35% Not a very big problem 5% 4% 13% 49% Not a problem at all 2% 2% 3% 4% Not sure/Refused 3% 1% 3% 5% C2. Compared with 10 years ago, do you feel the percentage of women in the your country who have unplanned pregnancies is now much higher, higher, about the same, lower or much lower?

USA18+ USA18-44 CAN18-44 NETH18-44 Much higher 27% 30% 14% 1% Higher 42% 42% 32% 13% About the same 20% 19% 28% 29% Lower 8% 7% 15% 45% Much lower 1% * 1% 5% Not sure/Refused 2% 1% 10% 6% C3. Do you feel that (Rotate: married women or unmarried women) are more likely to haveunplanned pregnancies?

Asked only in the U.S.

USA18+ Married women 9% Unmarried women 82% No difference (Vol.) 6% Not sure/Refused 2% C4. Do you feel that (Rotote: teenagers or women over the age of 19) are more likely to haveunplanned pregnancies?

Asked only in the U.S.

USA18+ Teenagers 86% Women over the age of 19 11% No difference (Vol.) 2% Not sure/Refused 2% C5. Do you think that (Rotate: Women in the United States or women in other developed countries, such as Canada, Great Britain or Germany) are more likely to have unplanned pregnancies?

Asked only in the U.S.

USA18+ United States 69% Other developed countries 11% Same (Vol.) 7% Not sure/Refused 13% C6. Would you say that (read each item) contributes to unplanned pregnancies very much,somewhat, or not at all?

Very Much Somewhat Not At All Not Sure/Refused a. A decline in moral standards USA 18+ 53% 36% 10% 1% USA 18-44 48% 40% 12% * CAN 18-44 29% 39% 28% 4% NETH 18-44 15% 33% 39% 12% b. Lack of education in general USA 18+ 48% 39% 12% 1% USA 18-44 46% 41% 13% * CAN 18-44 41% 38% 20% 1% NETH 18-44 16% 38% 44% 2% c. Lack of understanding about how to use birth control USA 18+ 27% 50% 22% 2% USA 18-44 26% 51% 22% * CAN 18-44 25% 45% 28% 2% NETH 18-44 14% 36% 47% 3% d. An inability to get birth control USA 18+ 21% 45% 33% 2% USA 18-44 21% 45% 34% * CAN 18-44 15% 36% 47% 2% NETH 18-44 13% 20% 64% 3% e. The cost of birth control USA 18+ 14% 40% 45% 2% USA 18-44 12% 40% 47% 1% CAN 18-44 14% 32% 49% 5% NETH 18-44 5% 29% 59% 7% f. A genuine desire to have children USA 18+ 12% 48% 37% 4% USA 18-44 11% 52% 36% 2% CAN 18-44 15% 37% 41% 7% NETH 18-44 8% 32% 42% 17%

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Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy:Survey Part One Part Two Part Three

Survey Shows “Two Faces” Of Public Opinion On Welfare Reform

Americans Support Time Limits and Tough Work Requirements, But Reluctant to Abandon Those In Need

Public Defines Welfare Broadly Understands Key Details of Welfare Programs

Embargoed for release: 9:00 a.m. EST, Thursday, January 12, 1995

For further information contact: Matt James or Tina Hoff

Menlo Park, CA — A new Kaiser/Harvard survey of Americans nationwide has found that the public supports strong welfare reform measures, such as time limits and work requirements, but is reluctant to simply cut people off and leave them without some means of basic support.

The survey identifies four core beliefs that shape the public’s policy preferences. Two lead the public to support time limits and other strong welfare policies: the belief that welfare causes more harm than good because it discourages work and causes family break up, and the belief that welfare costs the taxpayer too much money. But two other core beliefs make the public concerned that these same strong policies will leave low income people without basic support: the belief that lack of economic opportunity as much as personal responsibility is the reason people need welfare, and the belief that both government and people themselves have a shared responsibility for ensuring that people have a minimum standard of living.

Two-thirds (68%) of Americans favor ending welfare payments after two years for all able-bodied welfare recipients, including women with pre-school children, and requiring them to take a job. But support for cutting off payments drops to 26 percent if the job pays low wages that would make it difficult to support a family, and to only 16 percent if the person is unable to find a job.

Large majorities favor government providing job training (87%) and public service jobs (74%) for people on welfare, and providing child care to low-income mothers who work or are in job training (85%). After education, training, health and child care benefits have been provided, 56 percent believe welfare recipients should be required to do community service work in exchange for continued benefits or have benefits cut off after a specified period of time. Only 10 percent believe the government should end all aid under these circumstances, and 25 percent believe the government should cut recipients off only after guaranteeing they have a job.

The public’s desire to “do something” about welfare is also reflected in support for limits on welfare. Majorities favor requiring mothers to report the name of a child’s father before they can receive welfare (81%), setting limits or denying welfare to non-citizens, including most legal immigrants (64%), denying additional benefits to women who have more children while on welfare (59%), and government limiting how fast welfare programs can grow, regardless of how many people may need assistance (capping welfare) (57%).

Nearly equal proportions of Americans say: 1) “We shouldn’t let people who can’t get or hold a job go hungry or homeless, and we need to continue welfare payments to these people” (44%), and 2) “We should have a firm limit on how long people can stay on welfare, regardless of the consequences, in order to get them to work” (43%).

“The jury is still out on what the public will support on welfare reform. At the moment they want four things that may be incompatible — get people off welfare within two years, get them jobs that provide a minimum standard of living, don’t let families suffer severe hardship, and don’t raise taxes or cut government programs to do these things,” said Drew Altman, Kaiser Family Foundation president and former welfare commissioner in New Jersey under Governor Tom Kean.

Two-thirds of Americans (66%) oppose a proposal that would end welfare benefits for unmarried women and their children if that meant some of the children would have to be cared for in group homes or orphanages. If such a proposal were enacted, the public overwhelmingly prefers having the government pay for group homes where mothers and their children live together (56%), rather than providing orphanages for the children (8%) or doing nothing (8%). A fourth of respondents said none of the above.

One important caveat should be added. The public is not prepared to sacrifice very much to see reforms enacted. Only about half are willing to pay more taxes or see other programs cut to provide job training (53% willing to 40% unwilling) and public service jobs (47% to 45%).

Awareness of Reform Proposals

At this early stage, the public is not yet following the welfare reform debate closely. In sharp contrast to the 47% who said in October 1993 that they were following news stories and other information about health care reform very closely (Kaiser/Harvard Survey, October 1993), only 13% say in this survey they have been following stories about welfare reform very closely.

Only three in ten Americans say they understand President Clinton’s welfare proposals very (5%) or fairly well (25%). A similar proportion understand the Republican proposals very (7%) or fairly well (24%).

“Americans do not yet know the consequences of the various welfare reform proposals,” said Dr. Robert J. Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “As the debate continues and begins to focus on the implications of particular proposals — whether they be severe negative consequences for individuals and families or increased taxes or cuts in other government programs — the public is likely to become more cautious.”

Welfare Spending

Asked to choose from a list of six areas which two consumed the largest share of federal spending, only 14 percent correctly named Social Security and 37 percent named defense as one of the top two. Four-in-ten Americans (40%) thought welfare was one of the two largest areas of federal spending.

When asked to define welfare, the public identified the following six major federal government programs from a list of nine as being welfare programs: food stamps (93%), AFDC (Aid to Families with Dependent Children) (85%), public housing (85%), WIC (the Women, Infants, and Children program) (72%), the school lunch program (62%) and Medicaid (60%). Most did not regard Supplemental Security Income (SSI), the federal cash assistance program for the aged, blind, and disabled, as welfare. These six major programs labelled by the public as welfare make up 10.2 percent of the 1993 budget, ranking behind defense (21%) and Social Security (21%), and equal to Medicare (10.2%).

State and Federal Roles

The public wants to see the states play a major role in welfare reform. Given four choices, a majority (52%) thought government officials should experiment with reform at the state level, compared to 29 percent who preferred reform at the national level, 7 percent who wanted to leave welfare as it is, and 6 percent who would prefer to eliminate all welfare benefits.

But Americans are wary of letting states determine their own policies without some federal guidelines. While 36 percent thought each state should determine the best way to aid poor people, 50 percent believed the federal government needs to set guidelines when it gives money to states, in order to assure they will treat everyone fairly and do the right thing for poor people.

A majority of Americans (58%) also favor a “swap” proposal, where states would be in charge of welfare and the federal government would take responsibility for paying for the health care of poor people, instead of both responsibilities being shared as they are now. Twenty-four percent are opposed, and 18 percent said they didn’t know.

Core Beliefs and Values

Americans’ beliefs about what policies and reforms should be enacted can be related back to four core values they hold about welfare and poverty:

1. Americans see the welfare system as doing more harm (56%) than good (33%) because they believe it encourages the breakup of the family and discourages work.

The overwhelming majority (81%) think that most welfare recipients are able to work. The idea that welfare discourages people from working was identified by half of Americans (49%) as what bothers them most about the current welfare system ranking far ahead of concerns such as costing taxpayers too much (14%) and causing families to break up (13%). Two-thirds (68%) say that welfare encourages women to have more children than they would have if they were not able to get welfare.

• Most Americans believe the country spends too much (64%) or the right amount (17%) rather than too little (12%) on welfare.They are somewhat divided in their willingness to pay more taxes or see other programs cut to provide job training (53% willing to 40% unwilling) and public service jobs (47% to 45%). The public is also split nearly evenly on whether people who receive money from welfare could get along without it (46%) or really need this help (44%).
• Americans perceive a variety of reasons for people being on welfare, some rooted in individual responsibility and others in social conditions and lack of economic opportunities.When questioned about possible reasons people are on welfare, most often rated as major reasons were: welfare pays better than some jobs do (71%); people choose not to work (65%); poor education (64%); and women having babies in order to collect additional welfare benefits (62%). Americans are split on whether welfare recipients really want to work (40%) or choose not to (47%). More broadly, 38 percent believe lack of personal effort is the main reason for poverty in the U.S.; 42 percent lack of opportunities and jobs.But the public also sees economic and social obstacles that prevent people from leaving welfare. The vast majority of Americans (72%) believe there are jobs for most welfare recipients who really want to work. But only 22 percent believe that most of these jobs pay enough to support a family. While 42 percent say “It’s important for a mother with young children to stay at home even if it means having to provide her with welfare,” 35 percent believe “We should not pay welfare to mothers with young children because it’s so important that people work.” The survey suggests that because Americans believe that both individuals and society share in the responsibility for people being on welfare, Americans’ support for reform proposals may decline if they think that the reform will not lead to a minimal standard of living or will create severe hardship for families.
• Most Americans believe that government and welfare recipients have a shared responsibility for ensuring that people have a minimum standard of living.Asked who should be primarily responsible for making sure that non-working low-income people have a minimum standard of living, a majority (57%) said that responsibility should be shared between government and people themselves, friends, and voluntary agencies; 26 percent said people themselves and friends and voluntary agencies; and only 14 percent said government should be primarily responsible. Significantly, however, most of those who believe in shared responsibility want government’s role to last only for a limited time (71%). Only 25% said government responsibility should last “as long as it takes.” The theme is clear: the public believes that able-bodied people have an obligation to help themselves, but also that government has a role in maintaining a safety net for a reasonable but not unlimited period of time.

Public Knowledge

With some significant exceptions, the public is reasonably well informed about the welfare system. For example:

• the public (90%) knows that more women and children are on welfare than men. (In 1992, two-thirds of AFDC recipients, or 9.2 million, were children);

• a majority of the public (57%) knows responsibility for running welfare is shared between federal and state governments. (Federal funds pay on average 55% of AFDC benefits plus 50% of administrative costs);
• a plurality (32%) knows how much public assistance mothers are receiving each month. (The average benefit in 1993 was $399 per month for a family of three);
• seventy-one percent say that they know what Medicaid is and 43 percent know that it pays not only for hospital and doctor services for poor adults and children, but also for services for the elderly in nursing homes and the blind and disabled. (The public was least knowledgeable about Medicaid financing for the blind and disabled, the program’s fastest rising major cost).
• the public overwhelmingly believes most people on welfare are minorities. (In 1992, 39 percent of AFDC recipients were white, 37 percent black, 18 percent Hispanic, 3 percent Asian, 1 percent Native American, and 2 percent unknown);
• when asked how long people stay on welfare, 43 percent said continuously until their children grow up, 26 percent said on and off until their children grow up, and 15 percent said a few years before leaving welfare for good. (Thirty-four percent stay on welfare less than one year and another 44 percent for up to five years. A majority of those who leave welfare return later to the welfare rolls. Welfare dependency is characterized more by repeat spells of dependency than continuous dependency on public assistance.)

Methodology

The Kaiser/Harvard Survey was a random-sample, telephone survey of adults nationwide. The national sample consisted of 1,200 adults and was conducted between December 27 and 29, 1994. The survey was designed by the Harvard University School of Public Health’s Department of Health Policy and Management and the Kaiser Family Foundation, and was conducted by KRC Communications Research, a national opinion research firm located in Newton, Massachusetts. The margin of error in the national sample is plus or minus 3 percent. The survey is the first conducted under a new program, the Kaiser/Harvard program on the Public and Health/Social Policy, designed to monitor public knowledge, values and beliefs on health and health-related issues.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, HIV, and health and development in South Africa. The Foundation does not support any particular proposal or approach to welfare reform.

Note: This publication is not available on our website. However, the data from these surveys is still available through the Public Opinion and Media Research Group. Please email kaiserpolls@kff.org for more information.

G. Emergency Contraceptive Pills, or Morning-After Pills

G1. If a woman has just had sex and thinks she might become pregnant, is there anything that she could do in the next few days to prevent pregnancy, or not?

Asked only in the U.S. USA18+ Yes, there is something 36% No, there is not anything 47% Too late to prevent pregnancy (Vol.) 1% Not sure/Refused 17% G2. Have you ever heard of morning-after pills, also called emergency contraceptive pills, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, have heard of it 54% 53% 71% 96% No, have not heard of it 45% 47% 28% 4% Not sure/Refused * 1% * * G3. How soon after sexual intercourse do morning-after pills have to be taken — immediately, within 12 hours, within 24 hours, within 72 hours, or within one week?

Based on those who have heard of emergency contraceptive pills.

USA18+ USA18-44 CAN18-44 NETH18-44 Immediately 10% 10% 9% 4% Within 12 hours 31% 28% 30% 34% Within 24 hours 28% 32% 36% 49% Within 72 hours 9% 12% 11% 6% Within one week 5% 6% * * Not sure/Refused 16% 12% 13% 6% G4. (Ask Females: Have you/ Ask Males: Has your current or most recent partner) ever usedmorning-after pills, or not?

Based on those who have heard of emergency contraceptive pills.

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, have taken 1% 2% 9% 11% No, have not taken 98% 98% 86% 82% Not sure/Refused 1% 1% 5% 7% G5. Morning-after pills are a particular kind of birth control pills that are taken after sexual intercourse. If several of the pills are taken at the same time within 72 hours of sex, they may reduce the chance ofpregnancy by up to 75%.

From what you know about morning-after pills, would you say (you/your current or recent partner) would be very likely, somewhat likely, or not at all likely to take them if you had unprotected sex and wanted to prevent pregnancy?

USA18+ USA18-44 CAN18-44 NETH18-44 Very likely 23% 21% 19% 33% Somewhat likely 20% 24% 23% 17% Not at all likely 47% 52% 47% 31% Not applic. (Vol.) 7% 3% 7% 11% Not sure/Refused 3% 1% 5% 9% G6. Do you think morning-after pills should be widely available, like condoms or tightly controlled like drugs that require a prescription from you doctor?

USA18+ USA18-44 CAN18-44 NETH18-44 Widely available 37% 33% 27% 26% Tightly controlled 58% 64% 64% 71% Not sure/Refused 5% 3% 9% 3% G7. Would a method of birth control that is taken soon after intercourse, such as morning-after pills, pose ethical concerns for you, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, would pose concerns 36% 43% 31% 21% No, would not 61% 55% 65% 74% Not sure/Refused 3% 2% 5% 4% H. Abortion

H1. Of every 100 pregnancies in the United States, how many do you feel end in abortion?

Asked only in the U.S.

USA18+ Mean: 35 pregnancies Not sure/Refused 5% H2. Do you feel that the number of abortions per every 100 women in the United States is increasing, decreasing, or staying about the same each year?

Asked only in the U.S. USA18+ Increasing 49% Decreasing 8% Staying about the same 41% Not sure/Refused 2% H3. Of every 100 abortions that occur in the United States, how many do you feel occur among (Read each item — Do not rotate)?

Asked only in the U.S.

USA18+ Mean Not sure/Refused a. Teenagers 49 pregnancies 4% b. Lower income women 46 4% c. Minority women 42 6% H4. Of all women between the ages of 12 and 50, what percentage do you feel has had an abortion?

Asked only in the U.S. USA18+ Mean: 31% Not sure/Refused 7% H5. Is the percentage of women in the United States who have had an abortion higher, lower, or about the same as the percentage of women who have had an abortion in other developed countries like Canada, Great Britain or Germany?

USA18+ USA18-44 CAN18-44 NETH18-44 Higher in the U.S. 49% 57% 10% 16% Lower in the U.S. 16% 14% 43% 67% About the same 28% 24% 32% 7% Not sure/Refused 6% 5% 15% 10% I. Factuals

Now, I have just a few factual questions for the purpose of classification.

I1. Are you single, married, living as a couple with someone, widowed, separated, or divorced?

USA18+ USA18-44 CAN18-44 NETH18-44 Single 19% 29% 33% 24% Married 56% 53% 49% 55% Living as a couple 6% 9% 13% 17% Widowed 1% 1% 1% * Separated 2% 2% 2% * Divorced 7% 3% 3% 3% Not sure/Refused * * * * I2. Are you covered by any form of health insurance including Medicaid or Medicare, or not?

Asked only in the U.S.

USA18+ Yes 84% No 16% Not sure/Refused * I3. What is the highest level of school you have completed or the highest degree you have received? (Probe: If respondent says just “High School:” What was the highest grade youcompleted? If 12th Grade, code “Graduate.” If 11th Grade or less, code “Less Than.”)

The U.S. and Canada: USA18+ USA18-44 CAN18-44 Less than high school (grades 1-11, grade 12 but no diploma) 12% 7% 16% High school graduate or equivalent (e.g., GED) 42% 44% 26% Some college but no degree 25% 28% 20% College graduate 14% 15% 24% Postgraduate 6% 6% 15% Not sure/Refused * * 8% The Netherlands:

NETH18-44 Primary school 3% Lower technical and vocational education 16% Lower secondary school 14% Middle technical and vocational education 29% Higher secondary school 10% Higher technical and vocational education 21% University 7% Not sure/Refused * I4. Are you of Hispanic or Latino origin or descent, or not?

Asked only in the U.S.

USA18+ USA18-44 Yes 8% 10% No 90% 88% Not sure/Refused 2% 1% I5. Do you consider yourself white, (Rotate: Black or African-American), Asian or Pacific Islander, Native American or some other race?

Asked only in the U.S.

USA18+ USA18-44 White 80% 77% Black or African-American 12% 13% Asian or Pacific Islander 1% 2% Native American 2% 2% Other race 4% 5% Not sure/Refused 1% 1% I6. Which of the following income categories best describes your total 1993 household income? Was it (read list)?

USA18+ USA18-44 CAN18-44 NETH18-44 $7,500 or less 9% 7% 4% 7% $7,501 to $15,000 11% 10% 6% 8% $15,001 to $25,000 17% 18% 14% 27% $25,001 to $35,000 17% 17% 15% 21% $35,001 to $50,000 19% 21% 18% 7% $50,001 to $75,000 12% 13% 21% 4% $75,001 to $100,000 5% 5% 7% * $100,001 to $125,000 2% 2% 3% * Over $125,000 2% 3% 3% * Not sure/Refused 6% 4% 9% 25% I7. Did you vote in the 1992 presidential election, when about half of the American public voted, or not?

Asked only in the U.S.

USA18+ Yes 71% No 29% Not sure/Refused * I7a. Did you vote for George Bush, Bill Clinton, or Ross Perot?

Based on those who voted in the 1992 presidential election. Asked only in the U.S.

USA18+ George Bush 38% Bill Clinton 41% Ross Perot 14% Other 1% Not sure/Refused 5% I8. How frequently do you attend religious services? Would you say at least once a week, at least once a month, a few times a year, or never?

USA18+ USA18-44 CAN18-44 NETH18-44 At least once a week 37% 30% 18% 10% At least once a month 16% 18% 14% 10% A few times a year 28% 33% 38% 24% Never 18% 19% 30% 55% Not sure/Refused 1% * 1% 1% I9. Language interview was conducted in.

USA18+ USA18-44 CAN18-44 NETH18-44 English 99% 98% 71% * Spanish 1% 2% * * French * * 29% * Dutch * * * 100%

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Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy:Survey Part One Part Two Part Three

Nationwide surveys have explored public opinion on these issues, but few surveys have measured the public’s knowledge of unplanned pregnancy, abortion, contraceptive methods and other related topics. The Kaiser Family Foundation commissioned a survey of Americans to identify where the gaps and misperceptions exist in the public’s knowledge of reproductive health issues, in an effort to help dispel the myths and provide Americans with the facts. The national household survey of 2,002 Americans was designed and analyzed by the Kaiser Family Foundation and Louis Harris and Associates, Inc. and conducted by Louis Harris and Associates, Inc.

This paper presents the results of a survey of 39 states and their DSH payments and the special financing arrangements in those states.

• Report: Medicaid Disproportionate Share and Other Special Financing Programs: A Fiscal Dilemma

Among Issues, Voters See Health Reform As Top Priority for New Congress But Reject Major Overhaul of System For More Modest Approach

Embargoed for release: 12:00 p.m. EST Tuesday, November 15, 1994

For further information contact: Matt James or Tina Hoff

National Election Night Survey Also Finds: Voters Support Spending Cuts to Reduce Deficit in Theory, But Not in Practice When Specific Budget Areas Are Proposed

Menlo Park, CA — A Kaiser/Harvard election night survey of Americans nationwide who voted in the 1994 election has found that health care continues to be a key concern, but the voters are rejecting a major overhaul of the system. Instead, they strongly favor approaches to solving this national problem that are incremental and do not significantly expand government control of the health system.

When voters cast their ballots, candidates’ stands on issues are just one of many factors that determine their votes. Economic insecurity, values and ideology, attitudes about government and incumbents, and the perceived personal qualities of the candidates themselves all also play a major role. Among issues, however, health care (33%) was number one for voters in deciding who to vote for in the Congressional election, ahead of crime (29%) and taxes (23%). In addition, it was named as the top priority issue for the next Congress to deal with. [Tables 1 and 2]

In the survey, the voters also made it clear that they want Congress to take the lead in health reform next year, rather than the White House. [Table 3]

The survey shows that the voters’ vision of health care reform has shifted toward that held by many moderate Republicans and Democrats. Thirty-one percent of those surveyed said they were less supportive of major health reform than six months ago, with half of those citing as their reason that they did not think the government would do it right. More voters now want Congress to make modest changes in the health care system (41%), rather than enacting a major reform bill (25%). In addition, one in four voters favor leaving the system as it is. [Tables 4 and 5]

“These results say that voters want the new Congress to place health care high on their legislative agenda,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “But what the public means by health reform now comes closest to a more moderate vision: one which is more limited in scope, incremental, and that involves a much more limited role for government.”

A majority of voters (55%) believe that it is better to have the health insurance system run by private health insurance companies than by the government. This is especially the case among those who voted for Republican House candidates (66%). [Table 6]

When asked what worries them most about health care reform, a plurality said they worry that there will be too much government bureaucracy (36%) or quality will decline (22%). When asked who they would like to take the lead in health care reform, more than one half indicated a preference for state leadership (54%), a change from previous surveys. [Tables 7 and 8]

Voters are split over whether the priority should be guaranteeing universal coverage or making an incremental start. Republican voters favor starting with coverage for some groups who do not have health insurance, but not attempting to cover everyone at this time (45%). Democrats more strongly favor guaranteeing health insurance coverage for all Americans as part of whatever legislation is passed (52%). [Table 9]

If health insurance can not be provided to all Americans, voters favor covering children first (40%) and working people who are uninsured (24%). When asked how the Congress might improve the private insurance system, 29 percent favor requiring employers who offer insurance to provide a choice of at least three health plans, and 27 percent favor requiring all employers to contribute part of the cost of health insurance for their employees. [Table 10 and 11]

In order to see these changes made in the health care system, a slight majority (51%) of voters are willing to pay more in health insurance premiums or taxes. [Table 12]

The Deficit, Taxes, and Entitlements

The survey shows that the outcome of the election was also affected by the federal deficit and voters’ desire not to have their taxes increased. These were named as the third and fourth highest priorities for the next Congress. When asked what Congress should do about the federal deficit in the next session, two thirds of voters (67%) preferred cuts in major spending programs to raising taxes (10%) or “not dealing with the deficit problem now” (10%). [Tables 13 and 14]

Survey results reveal a dilemma for the new Congress. Voters support general cuts in government spending in principle, but not in practice when they relate to specific current government spending programs. When presented with a list of 25 selected policies to reduce the deficit, a majority of voters supported only four:

1. Having people over age 65 who earn more than $50,000 a year pay more for Medicare than other seniors (71% favor);

• Decreasing spending on food stamps (55%);
• Decreasing agricultural price supports (53%); and
• Decreasing defense spending (53%).

Voters expressed very low levels of support for spending cuts in Social Security (17%), Medicaid (17%), Medicare (8%), and veterans’ benefits (7%). Even when told that one in three dollars spent by the federal government go to Social Security, Medicare, and Medicaid, two thirds of voters (65%) stillprefer to see the biggest spending cuts come from other areas, while only 10 percent believe the biggest cuts should take place in these three major spending areas. [Tables 15 and 16]

These results point to a major obstacle facing the new Congress in its effort to reduce the federal deficit. Voters want Congress to address the deficit, but they do not want their taxes raised. They want spending cuts in principle, but are not willing to support major cuts in the programs that made up the largest part of the non-defense budget.

The poll results show sharp contrasts between Democrat and Republican voters. Democrat voters are willing to cut defense spending further in years ahead while Republicans are less willing. Republicans are more willing to cut AFDC (welfare payments); Democrats are less so. Voters in both parties are willing to cut spending on food stamps and agricultural price supports, and support asking those seniors who earn more than $50,000 per year to pay more for Medicare. [Table 15]

This situation is not aided by voters’ general lack of knowledge of what makes up the federal budget. They know what entitlement programs are, but they do not have a very good idea of what are major areas of spending in the federal budget. Asked which of five areas consumed the largest area of federal spending, only 15 percent correctly named Social Security and 30 percent named defense. One in four voters (27%) thought the most federal money was spent on foreign aid, which accounted for only 2% of the 1993 Federal Budget. [Tables 17 and 18]

“The public’s misconceptions about the Federal Budget is the Achilles heel in deficit reduction,” said Matt James, Vice President, Kaiser Family Foundation. “What the public is willing to embrace will not result in meaningful spending reductions. Policymakers need to do a better job in explaining which areas need to be addressed to achieve real savings or there will be a political price to pay when small-time reductions fail to result in big-time savings.”

Methodology

The Kaiser/Harvard Election Night Survey was a random-sample, telephone survey of adults nationwide who said they voted in the November 8, 1994 election. The national sample consisted of 1,200 voters. The survey was designed by the Harvard University School of Public Health’s Department of Health Policy and Management and the Kaiser Family Foundation, and was conducted by KRC Communications Research, a national opinion research firm located in Newton, Massachusetts. The margin of error in the national sample is plus or minus 3 percent.

The Kaiser Family Foundation, based in Menlo Park, California, is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health reform, reproductive health, HIV, and health and development in South Africa. The Foundation also maintains a special interest in health care in its home state of California. The Foundation does not support any particular proposal or approach to health reform.

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Medicare: Holes in the Safety Net

This report discusses findings from focus groups that consisted of those individuals who interact with the Medicare program, including beneficiaries, health professionals, caretakers, and program management staff. A press release summarizing the findings of 15 focus groups conducted nationwide on public attitudes toward and understanding of the Medicare system in the United States is available.

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