A review of the progress toward the goal of universal coverage in six states — Florida, Hawaii, Massachusetts, Minnesota, Oregon, and Washington. The study found that while most states had put the many mechanisms in place to achieve universal coverage, there have been significant delays in their reform efforts, and there are serious financial constraints to state efforts in the absence of federal assistance. This report was released as part of the Foundation’s new national initiative to identify, analyze, and disseminate information on leading state health reform activities — “Innovations in State Health Reform.”

• Report: Keeping the Promise? Achieving Universal Health Coverage in Six States

California Election Night Survey On Ballot Initiatives

Anti-government Mood Defeats Proposition 186

A Perception That Undocumented Persons Use Costly Services Drives Vote For Proposition 187

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

For more information contact: Matt James or Tina Hoff

Menlo Park, CA — A Kaiser/Harvard survey of Californians in the 1994 election has found that the principal reason voters rejected Proposition 186, the state single payer initiative, was their concern that it would give government too much control of the health care system. These findings echo results from national surveys, which show a broad anti-government mood in the country.

The Kaiser/Harvard survey also looked at California voters opinions on Proposition 187, a proposal to limit services to undocumented persons and Proposition 188, a proposal to override local anti-smoking laws funded primarily by tobacco interests.

Proposition 186

By a margin of almost three to one (73 percent against and 27 percent in favor), Californians voted against the single payer plan. Fifty-seven percent of those who voted against Proposition 186 cited too much government involvement as the primary reason for their vote. Approximately one third of those who voted against the plan thought that the proposal would decrease the quality of their medical care (15 percent) or would increase the cost of their health care (14 percent).

“The themes struck by the opponents of the single payer initiative resonated loud and clear with California voters,” said Matt James, Vice President, Kaiser Family Foundation. “With the anti-government mood so strong, the timing for Proposition 186 could not have been worse.”

“Results of California voters show very definitively that though Americans see many things wrong with the health care system, they are ultimately not willing to turn the solution over to public sector agencies. Arguments about the success of either Medicare or our neighbors to the north fall on deaf ears in a climate where Americans have such little faith in their government,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University.

Among those who voted for Proposition 186, most said they did so because everyone in the state would have health insurance (39 percent). The next highest reason provided was because they believed the “health care system would be fairer” (16 percent). Only 15 percent gave “eliminating the role of insurance companies,” a major theme in the proponents’ campaign, as the reasoning behind their vote.

Republicans (95 percent), conservatives (82 percent) and business people (80 percent) were among the groups who most strongly opposed Proposition 186. Hispanics (64%), those uninsured (58 percent) and Democrats (54 percent) were among the groups who most strongly supported the single payer initiative.

Proposition 187

Californians passed Proposition 187 (59 percent in favor and 41 percent against), a proposal to limit services for undocumented persons. What has not been available to date is what voters’ principal reasons were for supporting this measure. The poll shows that the most important reason (61 percent) given by those who voted for this proposition was the belief that undocumented persons use services that cost citizens too much money. The second most important reason (27 percent) were those who believed that “we have to do something to stop the flow of illegal immigrants into our country.”

As reported, a minority of voters cast their ballots against this measure. Of those, 38 percent said that the fact that it would have been unfair was the primary reason they voted against 187. The second most important reason among opponents (25 percent) was a concern about the potential problems the children of undocumented persons may face if they were excluded from public schools.

Our survey showed that Republicans (73 percent) and business people (64 percent) were among the groups most in favor of Proposition 187, and that Hispanics (94 percent) and Democrats (71 percent) were among the groups most opposed to the proposal. Women (56 percent), liberals (85%) and National Public Radio listeners (63 percent) also opposed the proposal, while men (67 percent), conservatives (76 percent) and Rush Limbaugh listeners (72 percent) generally supported the proposition.

Proposition 188

Californians rejected Proposition 188 (70 percent against and 30 percent in favor), a proposal to override local anti-smoking laws by a statewide provision. Among those most strongly opposed to Proposition 188 were people in households in which someone worked in the health care field (77 percent), liberals (73 percent) and women (68%). Those most strongly in favor of the provision were Hispanics (53 percent), Rush Limbaugh listeners (46 percent), and those with lower incomes (44 percent).

Our survey found that 77 percent of Californians had seen or heard advertisements in favor of Proposition 188. Of these respondents, 85 percent correctly stated that tobacco interests had put up the most money to support this proposition.

Methodology

The Kaiser/Harvard Election Day Survey was a random-sample, telephone survey of adults in California who said they voted in the November 8, 1994 election. The sample consisted of 1,000 California 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 is plus or minus 3.5 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 took no position for or against Proposition 186.

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Statewide Surveys of Californians:Press Release Survey

Warning: Inadequate Low-Income Subsidy Design Can Cause Problems for Health Care Reform

This report examines potential adverse consequences of low-income subsidy systems contained in the leading health care reform approaches including: work disincentives as a result of high marginal taxrates; employer incentives to drop coverage; and loss of coverage due to budgetary control mechanisms.

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could be reproduced. Please email order@kff.org if you would like to pursue this option.

Health Care Reform: The Long Term Care Factor

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could be reproduced. Please email order@kff.org if you would like to pursue this option.

A comparison of the key features of alliance design in the Clinton, Chafee/Thomas, and Cooper/Breaux health reform proposals of 1994, examining the trade-offs inherent in alternative alliance design.(For more information about alliances, see #2063, Permitting Voluntary Enrollment in Regional Alliances Under the Health Security Act: The Impact on Spending for Employers and the Federal Government.)

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could be reproduced. Please email order@kff.org if you would like to pursue this option.

Health Care Reform: Issues Relating to Managed Care

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could be reproduced. Please email order@kff.org if you would like to pursue this option.

A pamphlet describing the key issues in the 1994 national debate over health reform, including a review of the legislative approaches being considered and the pros and cons associated with the proposals.

Note: This publication is no longer in circulation. However, a copy may still exist in the Foundation’s internal library that could be reproduced. Please email order@kff.org if you would like to pursue this option.

Researchers, educators, lawyers, and public opinion experts address the health and value issues involved in the debate over whether condoms should be available in U.S. schools today. Individual papers discuss existing programs and research, funding and policy options, and legal considerations. This publication was produced as part of the Kaiser Forums program, an ongoing series of issue-specificbriefings at which policy makers, health experts, practitioners, and others discuss and debate controversial topics related to the Foundation’s core areas of interest.

Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be copied. Please email order@kff.org if you would like to pursue this option.

Leading reproductive health and family planning experts consider the social policy and public health implications of Norplant, a long-acting method of birth control. This publication was produced as part of the Kaiser Forums program, an ongoing series of issue-specific briefings at which policy makers, health experts, practitioners, and others discuss and debate controversial topics related to the Foundation’s core areas of interest.