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This paper presents the results of a survey of 39 states and their DSH payments and the special financing arrangements in those states.
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:
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.
A study tracking and analyzing how sexual activity and messages related to contraception, unplanned pregnancy, and HIV prevention are communicated in several of the top-rated daytime soap operas.
An analysis of the potential financial impact of the California Health Security Act — the single payer initiative defeated by voters on the November 1994 ballot — on the state’s budget and health expenditures, businesses, and families. Potential barriers to implementation such as waivers, exemptions, and legislative changes, particularly with respect to ERISA, the Federal Employee Retirement Income Security Act, are also discussed.
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.
Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option.
An examination of the major decisions states face in designing health reforms, as well as their capacity to implement them. The analysis identified a core set of five functions that need to be addressed by states under either national or state initiated health care reforms: 1) getting started; 2) establishing and operating purchasing groups; 3) certifying and monitoring health plans; 4) integrating public programs; and 5) paying for implementation of reform, including capacity building.
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.”
A comparison of the House (Gephardt/Foley) and Senate (Mitchell) leadership health reform bills and the Administration’s Health Security Act to the current health care system in each of 14 different categories.
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.
Statewide Surveys of Californians:Press Release Survey
