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.

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.

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.

• Report:

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.

• Report: Analysis Of The California Health Security System (Proposition 186)

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.

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

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.

• Report: Implementing Health Care Reform: Issues and Options for State Executives

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.

Return to top

Statewide Surveys of Californians:Press Release Survey

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.

• Report: Health Reform Legislation: A Comparison of House and Senate Majority Leadership Bills