Friday, December 25, 2009

Via Pollster.com, here are some interesting overview articles about health care polling, from Frank Newport of Gallup (link) and Bruce Drake of Kaiser (link).

Happy holidays and best wishes for the new year!

Tuesday, December 22, 2009

Mellman on ACA Polling Results

Political strategist Mark Mellman has produced a memo for Democratic party senators, summarizing polling results that he claims demonstrate the popularity of specific provisions in health care reform legislation (via Daily Kos). Mellman also delves into the topic of opposition from the left, which may evolve into support if many liberals begin to accept the pending legislation as a substantial, albeit flawed, accomplishment. In fact, in line with other recent surveys, a new CNN poll (in the field December 16-20) shows that the combination of respondents who favor the bill before the Senate (42%) and those who oppose it for not being liberal enough (13%) comprises a clear majority of 55%.

UPDATE: Gary Andres and Whit Ayres provide a rebuttal to Mellman (via Pollster.com).

Thursday, December 17, 2009

How "P.O.'d" are Voters at the Dropping of the P.O.?

Early this week, word began filtering down from Senate Majority Leader Harry Reid (D-NV) that all semblance of the public option (opt-out, trigger, and even the Medicare buy-in that would have been limited to 55-64 year-olds) would be dropped from the Senate's health care reform bill.

The new NBC-Wall St. Journal poll was in the field December 11-14, during which rumblings of the reform bill being trimmed to accommodate Sen. Joe Lieberman (I-CT) emanated out of the nation's capital. Thus, the poll was able to gauge respondents' (anticipatory) reactions to changes associated with the public option. Of particular interest is the following item (with preface):

As health care legislation is being debated in Congress, some changes to the legislation are being proposed. I am going to read you some of these proposed changes, and for each one, please tell me whether that proposed change is acceptable to you or not acceptable to you.

The proposed legislation would no longer create a public health care plan administered by the federal government to compete directly with private health insurance companies.


Respondents saying "not acceptable" (45%) outnumbered those saying "acceptable" (42%). We cannot, of course, determine causation from correlational data, but there at least seems to be a plausible case from the NBC-WSJ poll that the Democrats' jettisoning of the public option and related proposals has harmed overall support levels for the bill. Now, just 32% of respondents say the Obama health care plan is a "good idea" (vs. 47% calling it a "bad idea"); in October, the last time this question was asked, 38% said the plan was a good idea. Also, 44% percent said it was better "to not pass this plan and keep the current health care system," compared to 41% favoring passage. The two previous times this item had been asked (in October and September), passage was preferred by identical 45-39 margins.

Not all recent polls are so pessimistic for the Obama/Democratic health bills, however. A Gallup poll in the field December 11-13 found nearly a dead heat, with 46% of respondents saying they would advise their representatives in Congress to vote for the bill and 48% saying they would advise against.

Saturday, December 12, 2009

Breaking Down Nov-Dec Decline in Support for HC Reform

As many observers have noted, support in public opinion polls for the overall health care reform bills before Congress has slipped several percentage points from October to mid-December. (Support for the public-option aspect remains high, but that will not be addressed in the present posting.)

Though the trend for support of overall reform bills is clearly down, not every poll follows this pattern. Take, for example, the FOX News and Economist-You Gov polls that were in the field right around the same time (December 8-9 and 6-8, respectively). FOX showed 34% support for reform, whereas the Economist showed 51%. That's quite a difference!

My first inclination when seeing apparent oddities in polling results is to investigate the partisan composition in polls' samples (i.e., what percentages of respondents are self-identified Democrats, Republicans, and Independents?). Indeed, the FOX poll contained the same percentages of Democratic and GOP respondents, whereas in the Economist poll, Democrats outnumbered Republicans by 14 percentage points. Pollster.com's aggregate averages currently have the Democrats up approximately 9 percentage points in general-adult samples and roughly 4.5 points up in registered- and likely-voter samples. Thus, FOX and the Economist each appear to diverge from middle-of-the-road estimates, albeit in different directions.

To test my hunch that differences in party ID composition might account in good part for different polls' health care reform support levels, I obtained a scatter plot and correlation coeffcient between the two variables. The resulting graphic is shown below (you can click on all graphics to enlarge them). I had hoped to restrict the polls in the analysis to very recent ones, but in order to have enough data points, I had to go back almost to the beginning of November; some otherwise usable polls did not report party ID breakdown, about which I continue to be frustrated and disappointed.

In addition to FOX and the Economist, I included the most recent polls from Public Policy Polling, Rasmussen (results; party ID), Ipsos, Democracy Corps, CBS News, ABC-Washington Post (results, party ID), Pew, Public Opinion Strategies, and Associated Press-GfK. (I used a correlation-graphing website to generate the plot, then took a screen capture and annotated the display in PowerPoint.)


As can be seen, there is a clear positive, linear relationship (.61 correlation, where 1.0 is the maximum possible), indicating that the greater the Democratic edge over Republicans in sample composition, the higher the support for health care reform.

Party ID turns out to be a substantial, but by no means comprehensive, factor in accounting for the various polls' differences in support for reform. Statistically, the .61 correlation must be squared, yielding the result that party ID accounts for 37% of the variance in support levels. More intuitively, one can see that even when holding partisan composition constant (such as in the two polls with +5 Democratic edges or three polls with +14 Democratic margins), support for reform still varies. Some of the predictive imperfection of party ID margin (as operationally defined as D minus R) might also stem from the fact that each poll's percentage of Independents is not taken into account (e.g., a poll with 40% D, 35 R, and 25 I, would be treated identically, as D+5, to one with 30 D, 25 R, and 45 I).

I next examined each poll's cross-tabs (where available) for reform support among Democrats, Republicans, and Independents, which are summarized in the following chart.


Support for reform among Republicans was very consistent from poll to poll, almost always at or near 10%. Support among Democrats varied widely (from 57-79%), as did support from Independents (25-47%). For whatever reason, the Economist-You Gov and ABC-Washington Post polls had not only the largest Democratic advantages in sample composition (along with Pew), but also the highest levels of support for health care reform among Democrats and Independents.

Regarding variation in reform support among self-identified Democrats, the issue of opposition to pending bills from the left -- due to many liberals' perception that their preferred reforms are being watered down in congressional negotiations -- has gotten attention recently, both on the present blog and elsewhere. Perhaps different polls' item wordings and question sequencing put Democratic respondents in different frames of mind, sometimes leading them to focus on what they would consider positive aspects of the pending bills (e.g., providing coverage to millions of uninsured) and sometimes making salient the negative aspects (e.g., the watering down).

I will leave this issue -- and possible reasons for Independents' varying levels of support in different polls -- for other analysts to explore.

Thursday, December 10, 2009

Pollster.com's Mark Blumenthal has an essay today on the recent decline in support for general health care reform, with a focus on the matter of opposition from the left.

Wednesday, December 9, 2009

A component of the latest Senate proposal to expand health insurance coverage is to let 55-64 year-olds purchase a policy under Medicare, the established government program for individuals 65 and older that is funded in large part by payroll taxes.

The Kaiser Family Foundation has polled for many months on the item "Expanding Medicare to cover people between the ages of 55 and 64 who do not have health insurance." As shown in this document, the percent of Americans supporting the idea has consistently been in the 70s.

Some of the provisions currently being considered in the Senate may not map exactly onto the policy implied in the survey item, however. For example, the survey's phrase "[e]xpanding Medicare to cover people..." may suggest to some respondents that 55-64 year-olds could participate in Medicare on the same basis as individuals 65 and older (i.e., with some of the costs financed by taxpayers), not that those 55-64 must "buy in" on their own (or possibly with some degree of subsidy).

Also, the qualifier "...who do not have health insurance" could be open to different meanings. It could theoretically refer to anyone 55-64 years old, as someone with employment-linked health insurance could drop it (and in that sense, not have insurance) and then purchase Medicare. Or it could refer only to people who have lacked health insurance for some length of time or with some chronicity. In the actual legislation, the segment of 55-64 year-olds eligible to purchase Medicare could be even narrower, as described in this article: "primarily those who have been uninsured for a certain amount of time, have a history of poor health or are unable to get insurance because of a preexisting condition."

Back in May, KFF issued a detailed study of health insurance coverage and health status of 55-64 year-olds. This report may be of interest to our more policy-wonkish readers.

Monday, November 30, 2009

Ipsos Polling Executives Discuss Health Care Surveying

In a guest posting over at Pollster.com, Cliff Young and Aaron Amic of Ipsos Public Affairs and the Ipsos McClatchy Poll, offer their wisdom on issue (as opposed to election) polling, with a specific focus on health care reform. The following passage captures this point:

...in presidential elections, our job as pollsters is made easy with ballot questions being basically fixed after the primaries. Simply put, we know which candidates will be running. This, in turn, all but defines our ballot question for us.

In contrast, issues like healthcare reform are quite fuzzy as no bill typically exists at the beginning of the process. This makes the construction of a single question impossible if not simply disingenuous.

Put another way, we have no "true value" to measure against- no concrete bill exists (or at least did not exist until recently). You can't measure what doesn't exist!


Young and Amic note the distinction between general items (e.g., "Do you support or oppose the health care plan...") and specific ones (pertaining to a public option, employer mandates, etc.). However, they appear to see both as reflecting primarily broad underlying values rather than truly crystallized opinions. Again, some passages:

Are... generic questions valid at all? We think they are but with caveats.

Indeed, before the final bill, such questions seem to be nothing more than a measure of optimism about the reform process, much like "right track, wrong track" questions. Looking forward to a final bill, we do expect that such generic questions will become relevant. Only then will they have a "true value" to be measured against.

...questions which reference specifics like the "public option" are hypothetical and have to be understood as such. Indeed, without a final bill, they should be used more for sensitivity analysis than anything predictive-which policy measures garner more support, which ones less so...

To this end, we have tracked specific items for most of the healthcare debate. Here we understood that healthcare reform would be fundamentally a debate about the role of government (or lack thereof). All of our items fall along a government intervention continuum. In our experience, polling on "fuzzy" issues places a premium on understanding the underlying value cleavages related to the policy debate at hand. At its essence, healthcare reform is a debate about the proper role of government.


(The reference to "sensitivity analysis" implies to me that items are used only to see if they make broader trends move upward or downward, and not because of any substantive message they convey; see here for further description.)

Notice, however, that Young and Amic seem to be saying that with emergence of the final bill, the responses to both general and specific items will now take on greater substantive clarity, like responses to whether someone in 2008 was going to vote for Obama or McCain.

Color me skeptical. Given the vast number of provisions likely to be in the final health care reform bill, the complexity of many concepts, and the partisan spin we're likely to hear from politicians on both sides of the ideological divide, I would still expect citizens' impressions of the final bill to convey broad values rather than fine-tuned judgments.

Thursday, November 26, 2009

Happy Thanksgiving!

Via Pollster.com's "Thanksgiving Outliers," here are three articles on health care reform.

Ruy Teixeira argues that a lot of the polling we see on health care reform "tends to be duplicative and doesn’t really tell us anything new." One exception, Teixeira claims, is polling on Americans' support for promotion of preventive behaviorsto reduce the incidence of illnesses such as diabetes, cancer and heart disease.

John Sides conducts a re-analysis of Quinnipiac polling data (with cross-tabs provided to him by the poll's directors that were not in publicly released reports), focusing on whether respondents support a full, undiluted public option, oppose direct enactment of a public opinion but support a trigger, etc. His main conclusions:

...about one-third of the sample supports the “pure” public option [with no state opt-out or trigger]. A slightly smaller group, roughly 30%, supports a “qualified” public option that features either an opt-out provision or a trigger. About 20% of the public oppose the option, but would support it with an opt-out provision. Thirteen percent oppose it but would support it with a trigger. Finally, there is a “diehard” group of public option opponents, who are about 20-25% of the population.

Finally, Jonathan Chait looks at the possible strategic angles behind Republican/conservative politicians' and commentators' interpretations of health care polls.

Tuesday, November 17, 2009

Opposition to Health Care Reform from the Left (11/17)

As shown in this Pollster.com graphic, public support for President Obama and the Democrats' health care reform plans has consistently been around 45% (plus or minus a few percent) for several months, whereas opposition has consistently approached 50% for the past few months.

That nearly all recent polls show opposition exceeding support -- albeit often by small margins -- may lend some credence to Republican Senate floor leader Mitch McConnell's claim over the weekend that the country does not want the pending legislation and that Democratic efforts to pass it are at their own peril.

In a technical sense, McConnell may be right. However, the implication that conservative opposition to the Democrats' bills is carrying the day does not appear to be correct.

A new CNN/Opinion Research Corporation poll (in the field November 13-15) obtained a typical finding, namely that 46% favored the U.S. House's recently passed "bill that would make major changes in the country’s health care system," whereas 49% expressed opposition. However, CNN asked this follow-up question to respondents in the opposition camp: "Do you oppose that bill because you think its approach toward health care is too liberal, or because you think its approach toward health care is not liberal enough?"

Responses broke down as follows: 34% opposed the bill because they considered it too liberal; 10% opposed it because they felt it was not liberal enough; 3% opposed it for other reasons; and the remaining couple of percent apparently did not endorse a reason. One can thus conclude (within the usual confines of the margin of error) that 56% of Americans favor either the House-passed version of health care reform or something further to the left. (Thanks to Pollster.com discussant "Wong" for pointing out this finding.)

I just did some Google searching on the CNN/ORC question wording for the item that asked opponents why they didn't favor the bill, and I could not find any previous instances of this question being asked. Without such a question, we would not know whether opposition to the Democrats' health call bills was monolithic or diversified. Now, we have a pretty good idea.

Tuesday, November 10, 2009

October trends in support for health care reform are examined by Mark Blumenthal and by the team of Robert Blendon and John Benson, the latter also featuring comparisons to 1994.

Sunday, November 1, 2009

Gallup distills its polling on health care reform into five major themes (hat tip).

Monday, October 26, 2009

How Closely Have People Been Following the Debate?

The Kaiser Family Foundation survey has been asking a question this year that attempts to gauge how closely people have been following the debate over health care reform. There is always the possibility that some respondents will overstate how closely they are following the debate, in order to present themselves as well-informed, civically engaged citizens. For that reason, it is helpful to obtain independent confirmation of a survey's general findings, from sources external to the survey itself.

It recently occurred to me that an independent source of information on people's interest level in a particular news story is the amount of web-searching they do on the story. Google Trends is one site that provides data on how much searching has taken place on an issue. Accordingly, I typed in "health care" to Google Trends and then did a screen capture of the results, shown below (see blue trendlines). I also manually superimposed the trendline (in red) for the percent of respondents who said they were following the health care debate "very closely" in the Kaiser polls.


The two trends -- web-searching and poll responses -- are on different absolute scales, but I don't think that matters. What's important, to my mind, are the arcs of the two trends. For the most part, they seem consistent with each other; both trends rose from July to August, and fell from September to October. One discrepancy is that, whereas the Kaiser poll showed a slight increase in interest from August to September, web-searching suggested a decrease from the August to the September peak. I also did a screen capture of Kaiser's summary table, for those interested in greater detail (note that, whereas the graphic trendlines go chronologically from left to right, Kaiser's data table goes chronologically from right to left). You can click on the graphic to enlarge it.

Saturday, October 24, 2009

CBS News polling director Sarah Dutton examines trends in support for a public option, including the effects of question-wording (hat tip).

Friday, October 23, 2009

Pollster.com's Mark Blumenthal examines conservatives' criticism of question wording on the public option in a recent poll.

Thursday, October 22, 2009

Andrew Gelman uses 2000 and 2004 polling data (2008 are not available) to examine support for federal spending to expand health-insurance coverage, along various respondent demographic dimensions (primarily income, age, and state of residence). If you think some of my graphics are funky, take a look at Andrew's!

Friday, October 16, 2009

Sen. Landrieu, the Public Option, and Free Lunches

Sen. Mary Landrieu, a relatively conservative Democratic U.S. senator from Louisiana, apparently is not on board for direct implementation of a public option, but would support a trigger to implement one automatically if certain conditions were not met (e.g., if health insurance prices exceeded a certain level after some amount of time had passed).

Within this context, Landrieu was asked in an MSNBC television interview why she opposed a public option when it enjoyed high support in public-opinion polls. Here is her answer (as transcribed by a Daily Kos discussant):

"I think that when people hear 'public option,' they hear 'free health care.' Everybody wants free health care. Everybody wants health care they don't have to pay for. The problem is that we as government and business have to pick up the tab, and as individuals. So I'm not at all surprised that the public option has been sold as free health care. But there is no free lunch."

(Here is a link to where the video is available.)

Landrieu makes a fair point. In fact, it's a point that can be examined empirically by comparing polls whose question-wordings do or do not explicitly mention that consumers would have to pay for (or purchase, etc.) a health-insurance policy under the public option, if they wanted to join such a program. If the polls whose wordings do not mention the pay aspect (i.e., that possibly imply the public option is a "free lunch") tended to be the only ones that generated majority (or at least plurality) support, then perhaps Landrieu would have a point.

One batch of polls that quickly shoots down the Landrieu thesis is the set of state-specific surveys commissioned by Daily Kos and conducted by Research 2000. The DK/R2K polls have consistently included the phrase "...that anyone can purchase," and even in moderate-to-conservative states such as Arkansas, Kentucky, and Montana, higher percentages of respondents have expressed support for a public option than opposition toward one.

One national poll that has used the "purchase" terminology when assessing support for the public option is that by The Economist/YouGov ("Do you favor or oppose having a 'public option' which would allow individuals to purchase health insurance coverage from the government?"). Although this poll comes out weekly, it does not always ask about the public option. I have plotted support levels for the last five Economist/YouGov polls, below (original reports: July 26-28, Aug. 16-18, Aug. 23-25, Sept. 13-15, Oct. 11-13).


Again, support for a public option seems pretty solid, even when the polling item makes clear that a public option is not a "free lunch" and instead would have to be purchased by interested individuals.

There is one area where I think Sen. Landrieu's claim may have some merit, however. It is true that polling results showing "super-high" (59-77%) support for the public option have not used question-wordings that make clear the program would entail a cost.

Wednesday, October 14, 2009

Pollster.com's Mark Blumenthal examines the polling -- and there isn't a lot of it -- on the American public's knowledge of what, specifically, is the "public option."

Friday, October 9, 2009

Economist Poll (But Not Others) Confirms Recent Surge (10/9)

Following up on my previous post, the just-released Economist/YouGov poll (in the field October 4-6) shows 52% support for President Obama's and the Democrats' health care reform plans, up from 49% in the same poll a week before. This finding is consistent with a recent upward trend from three other polling outfits.

Not all new polls show such high support, however. Pew Research Center (September 30-October 4) shows a stunningly low 34% of respondents favoring reform, whereas Quinnipiac University (September 29-October 5) pegs support at 40%.

Wednesday, October 7, 2009

Support for Reform May Be Rising, Following Mid-September Swoon (10/7)

Over at Pollster.com, Brendan Nyhan has reviewed trends in support for health care reform in the weeks following President Obama's speech to Congress. Nyhan acknowledges some short-term upticks in support, but concludes that in the long run, support has not changed all that much.

I decided to pursue this question too, but by breaking out the support levels from particular polls individually. The following chart (which you may click on to enlarge) is a bit busy! A couple of things to note are that the widths of the color-coded rectangles correspond to the days a given poll was in the field, and that the vertical gray bar represents the day of Obama's speech.


The trends in support appear similar to those in Nyhan's analysis. As can be seen in the above graph, polls from the Economist/YouGov (here and here), Rasmussen, and FOX News all show mid-September slides, probably a fall-off after the post-speech bounce.

However, Rasmussen, Gallup, and AP-GfK all appear to show early-October resurgences (a little less clear in the case of AP-GfK, as it doesn't have a mid-September data point). The Economist/YouGov poll from late September shows stabilization (although not gain) after its earlier polls showed a drop in support. The next Economist/YouGov poll, which should be out shortly, potentially could corroborate other polls showing an October rise in support.

Whereas Nyhan identified a trend of rising opposition to Obama's and the Democrats' reform plans, some of the newer polls (not graphed here) appear to suggest otherwise. Gallup showed opposition (i.e., the percent of respondents who would advise their members of Congress to vote against) falling from 40% in mid-September to 36% in early October, while AP-GfK found less disapproval of Obama's handling of health care in October (47%) than in September (52%).

Monday, October 5, 2009

Nate Silver suggests that unusually low levels of support for health care reform in FOX News polls may stem from question-order effects.

Sunday, October 4, 2009

Comments on Resurgent Republic Analysis (10/4)

The right-leaning political-analysis group Resurgent Republic recently issued a brief synopsis of national polls, arguing that a trio of issues -- consumer costs, increases to the federal deficit, and reduced quality -- are responsible for holding down support for President Obama's and the Democrats' proposed health care reform legislation (hat tip). I, too, have examined similar issues (here and here), and there are many ways to look at them.

Survey items about cost and quality generally offer respondents three choices: will reform plans under consideration make things better (i.e., reduce costs, raise quality), make things worse, or leave things unchanged? The thrust of my argument today is that the "leave unchanged" category offers useful information and should be incorporated into any analysis of poll results. Here are some examples of what I'm getting at:

Resurgent Republic (RR) says: “The CBS/[New York] Times September poll also found that only 19% believe the proposed changes will affect the cost of health care for the better.”

That figure is absolutely correct. But, if one looks at the full CBS/NYT report, one sees that in addition to the 19% who are optimists, 27% of respondents say costs will get worse, 22% say it will stay the same, and 28% claim not to know enough about the issue to comment. Among those offering an opinion, 60% thus feel health care costs will either get better or stay the same:

(19 + 22)/(19 + 27 + 22)

RR: “Only 14% believe the proposed health care changes will increase the quality of their own health care (CBS/Times 9/19-23).”

Percentages for the other answer choices were 30% worse, 32% same, and 21% don’t know enough. Thus, by the same calculation method as shown above, 61% of those offering an opinion say the quality of their own care will either get better or stay the same.

RR: “In the ABC/[Washington]Post surveys in August and September, 2x the number of voters believe health care costs will worsen instead of improve should health care reform pass (ABC/Post 9/10-12 and 8/13-17).”

Indeed, as documented at Polling Report's compendium of health care surveys (go to page 2 of PR's health care page), RR's statement is spot-on. For the September ABC/WP poll, 20% believe their health care costs will change for the better, 40% for the worse, and 38% feel these costs will stay about the same. Because there are so few "don't knows" in this polls, I won't bother to subtract them out. What we get is that 58% of respondents feel their costs will either come down or stay the same.

Just a few more. In the September 11-13 CNN/Opinion Research Corp. poll (results of which I found at Polling Report), the findings were as follows:

"From what you know of the health care reforms which the Administration is working on, do you think the amount you pay for medical care would increase, decrease, or remain the same?" Fifty-one percent replied that these costs would either decrease (16%) or remain the same (35%), whereas 47% thought they would increase.

"From what you know of those health care reforms, do you think you and your family would, in general, be better off, worse off or about the same?" Sixty-four percent said they'd either be better off (21%) or about the same (43%), whereas 35% said they'd be worse off.

In fairness to RR, they do on occasion frame their statements in a way that suggests a large percentage of respondents either think things will get better or stay the same: “NBC/WSJ surveys find that a plurality of voters (36%) believe their health care quality will worsen as a result of the President’s plan.”

There we have it. Consistent majorities -- oftentimes around 60% -- feel health care costs and quality will either get better or stay the same. Admittedly, the "stay the same" category is driving much of these results. Still, even if many American consumers feel their health care costs and quality will only stay the same (and not improve), that arguably is a good deal for a program that will provide health insurance for all or most of the 47 million Americans who currently lack it.

Wednesday, September 30, 2009

Washington Post Revisits Its Own Data (9/30)

In the aftermath of yesterday's two main votes in the U.S. Senate Finance Committee against including various types of public option in the reform bill working its way through Congress, the Washington Post today went back and conducted new analyses on its own poll (with ABC News) that initially gathered data from September 10-12.

Of the Finance Committee's 23 members, 13 voted against both public-option amendments, eight voted for both amendments, and two split their votes (against one amendment and for the other). In their new analyses, the Post focused on the states represented by the first two groups of senators.

As part of a national survey, the pollster may ask respondents what state they live in (which the Post/ABC apparently did). With total sample sizes typically around 1,000 (it was 1,007 for the September ABC/Post poll), the number of respondents in any one particular state would almost certainly be too small for statistical analysis.

However, in a burst of creative thinking, the Post realized that aggregating the residents of states represented by the 13 strong-opposition senators, and doing the same with residents of states represented by the eight strong-proponent senators, could yield two fairly sizable subgroups in the data (although these exact subsample sizes did not appear to be reported).

I have created the following table to summarize how the residents of the two sets of states (those represented by opponent and proponent senators) came down on two key questions discussed by the Post (you make click on the table to enlarge it).


The Post's conclusion, which I think is consistent with the support percentages shown in the table, is as follows (extraneous symbols edited out):

Among those living in states represented by the 13 Senate Finance Committee members opposing both amendments, a majority... gave a thumbs down to the health reform proposals being developed by the Congress and Obama administration. But when asked about a package that excluded a public option, the results flipped and most stood in favor of the reform effort.

The opposite was true among those living in states represented by the 8 members of the committee who voted for both amendments, as support in those states held steady regardless of the inclusion of a public option.


The Post's re-analysis speaks both to the idea of ("small d") democratic representation and the seeming power of the public option's inclusion or exclusion in a final bill to turn around opinion in the "opponent-senator" states. As much as I admire the creativity of the approach, however, I feel it has at least one potential flaw.

While it may be true that in the aggregate the residents of the 13 "opponent-senator" states are negatively inclined toward a public option (although this is an inference from the rise in support for a hypothetical bill with the public option removed), it does not follow that each and every opponent-senator state opposes a public option. (I'm not saying that the Post asserted the latter, just that some readers could draw that conclusion on their own.)

In fact, as I summarize here, when many of the opponent-senator states are looked at individually, their residents actually support the public option by majority or plurality.

Tuesday, September 29, 2009

Kaiser Foundation's September Poll (9/29)

The Kaiser Family Foundation is out with its September poll, which I think is interesting to look at for a few reasons. First, Kaiser has been polling every month from June 2009 forward and also conducted surveys in February and April of this year (six polls total during 2009), providing useful benchmarks for current trends. Second, this latest poll was in the field from September 11-18, making it a good gauge of the public's short-term reaction to President Obama's big health care speech on September 9.

As seen in the following chart (which you can click to enlarge) in which I attempted to distill the key findings of this year's Kaiser polling, pro-reform sentiment currently appears to be at -- or near -- peak levels for the year, depending on which items one looks at.


For example, the percentage of respondents currently saying "the quality of your own health care" would be better under a reformed system was the highest it has been all year, whereas belief that the health care of "you and your family" would be better off was only one point shy of an annual high.

On the one hand, a skeptic might contend that support levels would be artificially high in roughly the week following the Obama speech (and South Carolina Republican Joe Wilson's "You Lie" outburst). On the other hand, however, some of the figures to which the current ones are being compared were obtained in February and March, during the initial "honeymoon" months of Obama's administration.

Some items still draw low support, such as the two pertaining to waiting times (one asking about personal situations and the other focused on the country at large), where only around 20% of respondents say things will change for the better. On these items, however, there are large percentages (31-38%) expecting things "would [...] stay about the same."

One last thing to point out is that Kaiser did some split-sample experiments to test the effect of certain wordings. As I highlighted in the above chart, inclusion or exclusion of the phrase "similar to Medicare" did not have much effect on support for a public option.

Monday, September 28, 2009

The Politico takes a look at difficulties (real or apparent) in interpreting public opinion polls on health care reform.

Friday, September 25, 2009

Poll of (D-Leaning) Swing Districts (9/25)

A new survey of 1,200 respondents total "in ninety-one swing [congressional] districts (Blue Dog, Frontline, and Rural Caucus House districts)," taken from September 11-17, has now been released. The poll was sponsored by the organization Health Care for America Now (HCAN) and conducted by the firm of Anzalone-Liszt, which works for Democratic candidates (hat tip: Daily Kos). In general, the poll contains results that seem favorable toward President Obama's and the Democrats' health care reform proposals. Some details of the poll warrant particular scrutiny, however.

As a first step in analyzing a poll, one should know the larger population to whom the sample is meant to generalize. The term "Blue Dog" refers to relatively conservative Democrats, so I initially wondered if the sample consisted heavily of persons represented by Democrats in Congress. The term "Frontline," as I just learned via some web searching, also applies exclusively to Democrats. However, the Rural Caucus appears to include both Democratic and Republican members of the House. Thus, it appears safe to say that the sample in the HCAN/Anzalone-Liszt survey consists substantially of individuals who vote Democratic, albeit in many cases for candidates in the party's center-right ideological location.

Second, the poll appears to contain two types of items: ones that directly ask respondents if they approve or not of a given policy proposal, and others that preface the approval-disapproval question with a paragraph-length description of what's covered under the policy. Responses to all types of survey items can be affected by question wording, but some critics seem to really have a problem with the preface/description type of item.

Some of the key results are described in the official poll summary, as follows:

Although initial support for Obama’s healthcare reform plan is under 50% (44% Support / 49% Oppose), voters express strong support for its individual components and a majority favors it after hearing a detailed description (53% Favor / 41% Oppose)...

To say that this poll's overall support for the Democratic plan seems lukewarm, at best, may be missing the point, however. Some conservative Democrats have been threatening to vote against a reform bill that contains a public option. What the poll might convey to the Blue Dogs therefore is that, while bill is not necessarily wildly popular among their constituents, neither is it wildly unpopular.

Wednesday, September 23, 2009

U.S. Regional Differences in Health Care Reform Attitudes (9/23)

The political fortunes of the Republican party have been heading south in recent years, both literally and figuratively. A Daily Kos/Research 2000 national poll (September 14-17) found that, whereas 50% of respondents from the South gave the GOP a favorable rating, the percentages doing so from the Northeast, Midwest, and West regions were minuscule, ranging from 7-14%. These findings have sparked some commentaries from the blogosphere (here and here; hat tip).

One of the commentators, Joshua Tucker, offered the following analogy: "Quite seriously, if I saw this type of regional distribution of support for a political party in a country like Slovakia, I would assume the party represented an ethnic minority."

Tucker concluded with this suggestion: "...I wonder if we’ve hit the point where the mainstream media ought to be reporting support for the president, congress, political parties, etc. not in terms of the country as a whole, but rather by providing two numbers: support in the South and support in the rest of the country excluding the South?"

In today's entry, I provide such a breakdown for support of President Obama's and the Democrats' health care reform proposals. Before presenting the results, I want to warn that the information is limited, due to many pollsters' either not providing cross-tabulated percentages (i.e., demographics by support) at all in their free online documentation, or not doing so by region.

Thus, some of the polls are older than I'd like them to be, plus the question gauging support is not the same from poll to poll (i.e., sometimes regional breakdowns were available for general support, sometimes for public-option support, etc.). I encountered similar difficulties when I reported on age and gender breakdowns in support. Here are the numbers on region (as always, you may click on the graphic to enlarge it)...


Despite the different areas of focus in the questions used in this analysis (i.e., general support for reform, the public option, Obama's handling of the issue), the trends were pretty similar across polling outfits. As seen further in the graphs, Southerners were pretty consistently the least likely regional group to respond favorably to Obama and the Democrats' reform plans. However, the dip in support from the South (relative to other regions) is not always that large, particularly compared to the Midwest and the West. Thus, the South does not appear to be as different from the rest of the country on health care attitudes as it was on favorability toward the Republican party. The nature of the questions and dates in the field for these polls are as follows.

Economist/YouGov (September 13-15). “Overall, given what you know about them, do you support or oppose the proposed changes to the health care system being developed by Congress and the Obama administration?”

Daily Kos/Research 2000 (August 31-September 3). “Do you favor or oppose creating a government-administered health insurance option that anyone can purchase to compete with private insurance plans?”

Marist (August 3-6). “Do you approve or disapprove of how President Barack Obama is handling health care?”

Gallup (August 31-September 2). “Would you advise your member of Congress to vote for or against a healthcare reform bill when they return to Washington in September, or do you not have an opinion?”

I am also monitoring state-specific polling numbers.

Monday, September 21, 2009

Jay Cost at Real Clear Politics analyzes how public opinion on health care reform might translate into U.S. House and Senate members' votes.

Friday, September 18, 2009

One Week Post Obama Speech (9/18)

Observers of political survey research are no doubt familiar with the concept of a "bounce," the lift in polling numbers a presidential nominee tends to get immediately after his (or someday her) party's national convention. As seen in the two postings immediately below the present one, poll analysts have been examining the immediate "bounce" from President Obama's health care speech on September 9 with regard to support for his and congressional Democrats' reform plans.

Bounces tend to dissipate, however, so it's a good idea to look at polling numbers after additional days have gone by and the "buzz" over a speech has begun to die down. A week post-speech may not seem like sufficient time for assessing the persistence of any gains in support following Obama's address to Congress. However, with the hour-to-hour news cycles in the political blogosphere and on cable news channels, a week arguably is pretty long.

Another issue is whether any observed shift in aggregate opinion is broad-based, as opposed to being confined to partisans of one type or another. The graph below (which you can click on to enlarge) thus examines these two elements of post-speech public opinion on health care reform: what do things look like with a week's passage of time, and how do the trends break down by party? The traditional "red/blue" color scheme for self-identified Republicans and Democrats, respectively, is used, with Independents in purple, and overall (full-sample) trends in black. Each poll (Economist/YouGov [pre, post], FOX News, Pew Research Center) is identified by its initial letter. Finally, each dot placement represents that poll's final day in the field (e.g., the FOX "post" poll was taken September 15-16).


Two trends are apparent in the above graphs. First, there appears to be a small, but consistent upward bump in support for Obama and the Democrats' reform plans. Second, contrary to some media commentary, small increases in support were observed all partisan subgroups, not just the President's Democratic base.

A few qualifiers are in order:

1. Just because measured support for the Obama/Democratic reform plans appears to be higher after the speech than before, this doesn't mean that we can definitively say the speech caused the rise. Other news developments or social/political dynamics potentially could have caused the shift, although I can't think of any other, more salient explanation than the speech itself.

2. The polls depicted in the graph above are, of course, not the only ones available. For example, Rasmussen's daily tracking polls (based on two-day rolling averages) have shown support for the Obama/Democratic reform plans rising from 44% immediately before the speech to 51% roughly three days afterwards, but then falling back down to around 44% in the following days.

Tuesday, September 15, 2009

Pollster.com's Mark Blumenthal weighs in on what the post-speech polls are telling us about whether -- and to what degree -- there's been an upturn in support for President Obama and his health care reform plans.

Monday, September 14, 2009

Nate Silver at Five-Thirty-Eight has two new postings on recent health care surveys. One examines trendlines in support for President Obama and the Democrats' reform plans in the days since his speech, and the other focuses on some subleties in a set of items from the new Washington Post/ABC poll.

Friday, September 11, 2009

CBS News Poll (9/11)

CBS News released a poll this morning, which seeks to gauge the effects of President Obama's Wednesday night speech on health care reform. The poll used a panel design, in which the same respondents are followed-up over time; in this case the same people were surveyed before the speech (August 27-31) and after (Thursday, September 10). Also, the above-linked report provides results for many items separately for those who said they watched and did not watch the speech. In general, Obama's speech seems to have been successful.

ADDENDUM: AARP commissioned an overnight poll of Americans 45 years and older, following the speech. The focus was on how well, in respondents' eyes, Obama addressed their concerns about pending reform legislation.

Thursday, September 10, 2009

Post-Speech Tidbits (9/10)

Daily Kos contributor DemFromCT provides an overview of initial polling after President Obama's health care speech last night (note that Daily Kos is a left-leaning website).

Rasmussen, whose polls I've suggested lean right, reports 44% support for the Obama/Democratic reform plan from a poll in which "the overwhelmingly majority of interviews... were conducted before the president’s speech to Congress Wednesday night." Rasmussen adds that it "will be tracking support for the proposals on a daily basis over the next several days to measure what impact the speech has on public opinion."

Gallup's daily poll has Obama's overall job-approval rating at 51%. Given the salience of health care reform at the moment, one might infer that any upcoming changes in his job-approval numbers could be attributed to the speech.

Wednesday, September 9, 2009

Another Skeptical Audience for Obama Tonight: Men (9/9)

Many political analysts have been framing tonight's health care reform speech by President Obama in terms of his need to appeal to different audiences. Perhaps the most frequently cited audience is people who already have health insurance, to allay any fears they have that a reform bill will harm their quality of care and/or raise their costs. Another oft-cited audience is older Americans, who want to make sure their Medicare coverage is not diminished. NBC's Chuck Todd suggests three additional audiences: ordinary Americans, progressives, and Maine's Republican senator Olympia Snowe.

I would like to suggest yet another audience, one that has proven resistant to Obama and the Democrats' proposals for reform: men. As shown in the figure below (which you can click to enlarge), men have consistently shown lower levels of support for reform than have women. As I've discussed previously, relatively few polls publicly disclose demographic cross-tabulations on health care attitudes, and I applaud the pollsters who do. Where possible, I've plotted men's and women's support levels on polls' basic favor/oppose question; however, in some cases, I've had to use other items (see wordings beneath the figure).


Public Policy Polling (Aug. 14-17). Do you support or oppose President Obama’s health care plan, or do you not have an opinion?

Gallup (Aug. 31-Sept. 2). Would you advise your member of Congress to vote for or against a healthcare reform bill when they return to Washington in September, or do you not have an opinion?

Survey USA (Aug. 19). Now I am going to tell you more about the health care plan that President Obama supports and please tell me whether you would favor or oppose it. The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans. Do you favor or oppose this plan?

Quinnipiac (July 27-Aug. 3). Do you think President Obama's health care plan would improve the quality of health care in the nation, hurt the quality of health care in the nation, or not make a difference?

The differences could not be more clear. Within any given poll (i.e., green vs. green boxes, purple vs. purple boxes, etc.), support for health care reform is greater among women than among men. Various reports discuss women's greater involvement than men's in family health issues. A 2003 report from the Kaiser Family Foundation noted that, "A majority (58%) of all mothers report they are primarily responsible for decisions about their family’s health insurance..."

Another online document, which compiled health care-related polls from around 2005-2006, claimed the following (although I could not locate the specific poll on which the statement was based):

Four in 10 (40%) adult women in the U.S. say that they are "very worried" about not being able to afford the health care services they need, compared with fewer than three in 10 (27%) men... The gender gap may be due, in part, to the facts that women are often the primary health care decision-makers in the home, that they generally have more significant health care needs than men, and that they are disproportionately lower income.

Whether Obama will attempt in his speech to close this gender gap (by raising men's support rather than lowering women's!), I don't know. I suspect he'll be focusing on the other target audiences identified by the pundits.

Sunday, September 6, 2009

Robert Blendon and John Benson of the Harvard School of Public Health have attempted to summarize 22 recent polls on health care reform within one relatively brief essay (New England Journal of Medicine, August 27). I learned about Blendon and Benson's effort from this New York Times article.

Saturday, September 5, 2009

Greg Dworkin (who posts as DemFromCT at Daily Kos) was kind enough to send me an e-mail, notifying me that he mentioned the Health Care Polls blog during a panel on polling at the recent Netroots Nation conference and providing a link to a video of the session. The panel consisted of a real all-star line-up of survey experts from the academic, polling, statistical, and political-writing fields. I watched the video last night and found all the speakers to be lively and informative.

In particular, I would recommend the presentation by Pollster.com's Mark Blumenthal late in the 88-minute session. Regular visitors to Health Care Polls know that I sometimes dwell on how Rasmussen Reports sometimes generates findings that are out of step with those of most other pollsters. Using the methodologically "old school" CBS/New York Times poll as a comparison, Blumenthal reviews Rasmussen's procedures at several key steps of the polling process.

From the information Blumenthal presents, a reader might draw the conclusion that Rasmussen's polling methods are aimed at quickness and expediency (e.g., the CBS/NYT poll makes up to four call-back attempts to reach a household where no one answers the phone, whereas Rasmussen makes none). Rasmussen, it should be acknowledged, does not let sources of potential unrepresentativeness in his samples (as from the no call-back policy missing highly mobile individuals) go completely unaddressed; he weights his samples at the end to bring them into sync with known demographic parameters (e.g., from the U.S. Census). Other pollsters weight (or post-stratify) at the end, as well, but it appears that they take more direct action during the stages of data collection to maintain population representativeness than does Rasmussen.

Friday, September 4, 2009

Support for Public Option in the States

NOTE: This page is being continually updated beyond its original posting on 9/4, whenever I become aware of new state-specific polls.

Whereas there have been many national polls gauging support for a public option, what likely is more important to individual lawmakers is the reception to such a plan in their home state or district. The electorates before whom members of Congress must stand for re-election, after all, are state or local, not national. All members of the U.S. Senate and some members of the U.S. House (from low-population states such as Alaska, Delaware, and North Dakota) represent a full statewide constituency.

The left-leaning Daily Kos website, using independent pollster Research 2000, has been surveying support in various states for the public option (as part of potential federal legislation). DK/R2K's standard question-wording and support levels in the states surveyed are as follows:

Do you favor or oppose creating a government-administered health insurance option that anyone can purchase to compete with private insurance plans?

Arkansas... Favor 55%, Oppose 38% (Added 9/14)

[A University of Arkansas poll, in the field October 14-28, found 39% support and 48% opposition to a public option (Added 11/22)]

Connecticut Favor 68%, Oppose 21% (Added 9/15)

Kentucky... Favor 46%, Oppose 45%

Maine....Favor 58%, Oppose 29% (Added 9/18)

.....[Democracy Corps also recently polled Maine, including a number of questions pertaining to health care policy (added 9/30)]

Montana*.. Favor 47%, Oppose 43% (added 9/30; this poll was taken August 17-19 -- my apologies for missing it)

Nebraska*.. Favor 39%, Oppose 47%

Nevada..... Favor 52%, Oppose 40%

[Ohio (from Quinnipiac poll)... Favor 57%, Oppose 35% (added 10/1)]

*Worded "Do you favor or oppose creating a new public health insurance plan that anyone can purchase?"

Thursday, September 3, 2009

Satisfaction with Publicly Provided Health Care (9/3)

I recently saw two articles pop up, independently of each other, that address the question of consumers' satisfaction with health care provided as part of public/government programs.

Gallup aggregated data it had collected from 2006-2008 on consumers' satisfaction with their health care, dividing respondents into whether they had private or government (Medicare, Medicaid) health insurance coverage. Results revealed "only a slight difference in how Americans with Medicaid or Medicare versus those with private insurance plans rate the quality of care they receive, and no difference in how the two groups rate their coverage." In terms of quality of care, 87% of those with private coverage rated their care excellent or good, whereas 82% of those on one of the government programs did so.

Gallup noted an age difference, however, "...suggest[ing] that the private-government gap may be so small because senior citizens -- the vast majority of whom are covered by Medicare -- give very positive ratings to their healthcare coverage and quality. Among non-seniors, private plans tend to get better ratings than the traditional government plans on both coverage and quality." Gallup concludes the following from its findings:

It is not clear what the results discussed here might mean for satisfaction with a public healthcare option if it came to pass. The fact that Americans' ratings of their healthcare differ little, whether they have a private or a government plan, suggests that a properly constructed government health plan may not necessarily lead to perceptions of reduced quality or poor coverage from its beneficiaries. However, the fact that a public-private gap in quality ratings appears to exist for non-seniors (who presumably would be most likely to use a new public option) suggests that views about government-sponsored healthcare may differ by demographic group, possibly depending on one's likelihood of being affected.

The second survey pertains to a local program, Healthy San Francisco, which I frankly had not heard of (my thanks to a Daily Kos diarist for publicizing it). According to a February article from the San Francisco Chronicle, the program continues to succeed at covering city residents who had been uninsured. An article by New America Media provides these details of the program:

Healthy San Francisco is not health insurance but direct care provided on a sliding scale to the uninsured at city and private health clinics. The program began in July 2007 providing care to the city’s uninsured, who number over 60,000. It has now covered about 75 percent of them at a cost of roughly $120 million a year, including city money, state grants, employer contributions and participants’ fees. The average monthly cost per person is $280.

The Kaiser Family Foundation recently released a survey of HSF participants, the most salient finding being the high satisfaction with the program: 94% overall satisfaction (63% very satisfied, 31% somewhat satisfied).

Table 3 on health care utilization is also interesting, with the report concluding, "...while it is difficult to make direct comparisons, using the most recent available data, Healthy San Francisco participants report significantly greater numbers of doctor visits than the general population, both in San Francisco and nationally, perhaps a reflection of their greater health needs."

The apparent success of HSF arguably could be used to bolster support for a government-administered public option at the federal level, as is being currently considered by Congress. On the other hand, HSF could perhaps offer ammunition to lawmakers who support more localized mechanisms for expanding health care, such as statewide or regional co-ops (here and here).

Wednesday, September 2, 2009

August's "Raucus Caucuses" Seem to Have Had Little Effect on Public Opinion (9/2)

Two newly released polls suggest that the vigorous (some would say "over the top") protests at congressional lawmakers' August town hall meetings have done little to change public opinion.

The Pew Center's poll report, in fact, contains a section entitled "Health Care Opinions Largely Unchanged." Regarding the health care reforms being considered in Congress (as a general proposition), the numbers from the August 20-27 polling (39% favor, 46% opposed) are virtually identical to those obtained from July 22-26 (38% favor, 44% opposed). Not all the news is negative for the Democrats, however, as more people (39%) now think reform would be better for the country than worse (33%).

Among the many items in the Ipsos-McClatchy poll, the following one on the public option, for example, shows very similar support from July 9-13 (52% support) to August 27-31 (49% support):

It is necessary to create a public health insurance plan to make sure that all Americans have access to quality healthcare.

Tuesday, September 1, 2009

Miscellaneous (9/1)

CBS News has released a new health care poll (in the field August 27-31), focusing on respondents' self-perceived understanding of the reform plans being discussed in Washington.

A piece yesterday from The Hill on divisions among Democratic lawmakers on the public option alluded to polling on this issue:

There is strong support among House Democrats for a government-run health insurance plan that would compete with private insurers. House leaders have also distributed polling data to the Caucus showing strong voter support for it.

Pollster.com's Mark Blumenthal weighs in on the wording of survey items designed to measure support for a public option, joining Nate Silver and Gary Langer.

Thursday, August 27, 2009

Age-Group Comparisons (8/27)

There's been a lot of discussion of how seniors, who already are on Medicare, appear to be the least supportive age group of President Obama and the Democrats' plans for enacting health care reform. Seemingly at the center of seniors' concerns is the idea of cutting federal support for a program called Medicare Advantage. According to a Los Angeles Times article:

Although scaling back payments would have no effect on a sizable majority of Medicare users, it would create an opening for opponents to make the blanket allegation that the president wants to cut back on Medicare benefits -- as some Republicans are already starting to say.

Also, of course, seniors were more likely to vote for John McCain in last year's presidential election than were younger voters, who went overwhelmingly for Obama.

The diagram below (which you may click on to enlarge) compares different age groups' attitudes toward health care reform in four recent polls. Compiling these percentages was not as easy as I thought it might be, for a variety of reasons. First, only some pollsters make a public release of cross-tabulations between demographic characteristics and health care-related attitudes (other pollsters reserve such cross-tabs for paid subscribers). Second, age cross-tabs on a common attitude item were not always available. My plan was to use general favor/oppose items toward Obama and the Democrats' reform plan, but such an item was not always available so I had to substitute other types of items, as described below. Third, different pollsters use different cut-points to create their age groups. There's always a youngest age group, for example, but some pollsters bracket it from 18-29 whereas others use 18-34; similar discrepancies exist for other age groups, as well.


Having said all this, the pattern of seniors showing the least support for Obama/Democratic reform plans is clear and well replicated. For any given color of bar (purple, light blue, green, or orange; each representing a different pollster and question), the shortest height is with the seniors.

One other thing to notice is that two polls, ABC/Washington Post and The Economist/YouGuv, only reported on a 30-64 broad middle-age group rather than having two groups like other pollsters; whether groups in the lower and upper halves of the 30-64 age range were combined because they did not differ much in their responses, or the pollsters never broke 30-64 year-olds into smaller subsets, I don't know. For these two polls, I have taken the percentage on the respective attitude measures attributed to 30-64 year-olds and plotted them twice (linked by a light-blue or green horizontal line), where a 30s-40s group and a 50s-60s group would ordinarily go. Now that these "housekeeping" matters are out of the way, here are the question wordings used:

Survey USA (Aug. 19): “Now I am going to tell you more about the health care plan that President Obama supports and please tell me whether you would favor or oppose it. The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans. Do you favor or oppose this plan?”

ABC/Washington Post (Aug. 13-17): “Reform’s supported by 58 percent of adults under age 30, but 44 percent of 30- to 64-year-olds and just 34 percent of seniors, apparently concerned about its potential impact on Medicare” (this quote comes from an article and does not depict the actual survey item).

Economist-You Gov (Aug. 16-18): “If President Obama and Congress pass a health care reform plan, do you think you personally would receive better or worse care than you receive now?" (% Saying Better).

Kaiser Family Foundation (Aug. 4-11): “Do you think you and your family would be better off or worse off if the president and Congress passed health care reform, or don’t you think it would make much difference?” (% Saying Better).

The four polls above were not the only ones that made some type of age-related comparison. Others did, as well, but their age groupings and/or survey items appeared non-comparable in some way to the four polls whose results I plotted. Two additional polls are as follows:

A Harris Interactive poll used what I think are the most interesting age-group descriptors (shown in Table 2 of the linked document): "Echo Boomers (18-32), Gen. X (33-44), Baby Boomers (45-63), Matures (64+)." Harris plotted the percentage of respondents in each age group who rated Obama's job performance in various issue domains as "fair" or "poor." On health care, higher percentages of Matures (71%) and Gen. X (69%) gave Obama these unflattering ratings than did Echo and Baby Boomers (each 62%). Along with some of the figures from other polls plotted above, this finding from Harris shows a non-linear trend (i.e., support does not decline in perfect progression from the youngest to the oldest voters).

Finally, a Penn, Schoen, & Berland poll released in conjunction with AARP reported only comparisons between respondents younger than 50 and 50-plus. A section of this poll's report entitled "Specific Policy Proposals" (on pages 6-7) is perhaps the most worthy of attention. On most of the items, the younger respondents are more favorably inclined, but on others, there is little or no difference.

Tuesday, August 25, 2009

Miscellaneous (8/25)

A couple of brief notes today...

Nate Silver gives his criteria for how poll questions on a public option should be worded. To see my earlier postings on how various survey outfits have worded their public-option items, click for July and for August.

Rasmussen has surveyed Massachusetts residents on their support for health care reform plans being advanced in Washington, DC by President Obama and the Democrats. Fifty-three percent of Bay Staters support the Democratic plan for the nation. This finding is potentially important, as Massachusetts has nearly achieved universal coverage (97.4%), albeit with some growing pains. One component of the Massachusetts policy is an individual mandate to purchase health insurance, some variation of which may appear in the developing federal legislation. Granted, Massachusetts is a liberal state, but for its residents to have seen first-hand a universal-coverage program in place for a few years -- warts and all -- and still show majority support for enacting similar legislation nationally says something.

Monday, August 24, 2009

More Polling on the Public Option (8/24)

Following up on our previous charting of support for a public option, which almost exclusively covered July polling, we now look at surveys from the first three weeks of August. Support levels for the public option are depicted in the following diagram, which you can click to enlarge. Links to detailed reports of these individual polls can be found below in my entries from recent days.


The public option continues to hold its own pretty well, especially when the "choice" aspect of it is made clear in the wording of the question. Even in the Economist/You Gov poll, which as shown above registers the lowest level of support for the public option, it would take only one-third of the undecided switching to a position in favor to give the public option majority support.

From the perspective of any given Senator or Representative, however, the national numbers may not be as important as those in his or her own state or congresssional district. The latter, after all, are where the office-holder must seek re-election. Daily Kos, in association with the independent polling firm Research 2000, has been conducting surveys in the states and districts of Democrats who, in the eyes of many liberals, are not doing enough to achieve passage of a public option. Two such polls that have come out recently are for the state of Montana (whose Democratic Senator Max Baucus chairs the Finance Committee) and the Tennessee district of Representative Jim Cooper who now, as in 1994, appears lukewarm at best to the health care reform efforts of a Democratic president. Whereas a narrow plurality favors a public option in Montana, a large majority does so in Cooper's Tennessee district.

Friday, August 21, 2009

Weekly Wrap-Up (8/21)

An ABC News/Washington Post poll has been released today, adding to the bunch released yesterday.

Nate Silver of "Five Thirty Eight" (a reference to the total number of electoral votes in presidential elections) comments on the discrepancy in a recent NBC/Wall Street Journal poll between the 36% support for "Barack Obama's health care plan" in the abstract and the 53% support when a more detailed description of Obama's plan is provided:

The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans.

The Kaiser Family Foundation's report of its August poll, released yesterday, provides extensive trend data, comparing responses to the same item in August, July, June, April, and February of this year, and December and October of last year (not all items have all these data points). Despite the extensive media coverage of the August town meetings being held by members of Congress in their home states/districts, the percentage of Americans following these developments "very closely" has risen only modestly, to 33% from percentages in the mid-20s in previous months.

ADDENDUM (8/22): Pollster.com's "Outliers" feature links to several articles pertaining to health care polling.

Thursday, August 20, 2009

Avalanche of New HC Polls (8/20)

Today we've seen the release of several polls, each of which is either devoted to health care or contains substantial coverage in that area:

Survey USA (previously publicized by Jed Lewison at Daily Kos)

Economist/YouGov

Kaiser Family Foundation

That should give us a lot to chew on in the coming days!

Wednesday, August 19, 2009

Misconceptions About Reform Bills (8/19)

A common theme in recent health care polling -- presumably stemming from the heated rhetoric at townhall meetings and elsewhere -- is the degree to which various claims have sunk in with the American people. These claims either refer to policies that are not in any of the bills working their way through Congress or appear to represent gross exaggerations of provisions that are in bills.

Three polls probing for the acceptance of misconceptions have been released in the last two days, from NBC News, Daily Kos, and Public Policy Polling (PPP). Daily Kos is a well-known left-leaning blog, but it uses the established, independent pollster Research 2000 to conduct its surveys.

NBC and Kos asked about a couple of the same areas, as shown in the chart below (which you can click to enlarge). Interestingly, the two polls appear to differ substantially in how much acceptance of misconceptions exists in the U.S. public (percentages indicative of misconceptions are shown in maroon). Whereas the NBC poll shows roughly half of the public endorsing misconceptions, Kos shows only 10-25% acceptance of them.


One possible reason for the NBC poll's higher endorsement level has been suggested by Brendan Nyhan:

The problem is that NBC asked respondents if various results were "likely to happen" under the proposed health care plan, a vague phrase that allows for implausible but increasingly popular fallback position that the provisions in question are not in the plan but will somehow result from it in practice.

A focus of the Kos poll was comparing the responses of self-identified Democrats, Republicans, and Independents. For example, on the question of whether the proposed legislation "creates 'death panels' which have the authority to subjectively determine whether or not a gravely ill or injured person should receive health care based on their 'level of productivity in society'," high percentages of Democrats (88%) and Independents (76%) correctly say "no," whereas only 43% of Republicans do so.

Two polls looked at the public's understanding that Medicare is a government program. According to PPP:

One poll question indicative of how difficult it is to gain public understanding on a complicated issue asked if respondents thought the government should ‘stay out of Medicare,’ something inherently impossible. 39% said yes.

Kos simply asked: "Is Medicare a government program or not?" Respondents of all three partisan groups overwhelmingly gave the correct response of "yes," but the percentage of Republicans who did so (76%) was somewhat lower than the corresponding figures for Democrats (89%) and Independents (83%).

ADDENDUM (8/21): A new national poll by Indiana University also addresses partisan differences in respondents' beliefs about whether certain provisions are or are not included in congressional bills.

Tuesday, August 18, 2009

Comparing Polls over Time (New NBC Poll; 8/18)

An NBC News poll (in the field August 15-17) has just appeared, focusing on health care issues (findings for select items were released during the day, but a comprehensive article was not available until 6:30 Eastern). One finding that was reported during the day is as follows:

...43 percent say they favor a public option, versus 47 percent who oppose it. That's a shift from last month's NBC/Journal poll, when 46 percent said they backed it and 44 percent were opposed.

Most readers of this blog are probably familiar with the concept of margin-of-error (MoE), the idea that because a poll interviews only a small (albeit scientifically selected) fraction of a large population, there's likely going to be some fluctuation in a sample's result from what the true value in the full population is.

In the present example, one probably doesn't need a lot of statistical firepower to argue that this month's 43% support for a public option (with its attendant margin of error in either direction) and last month's 46% support (with its MoE) may not really represent much of a "shift." For future reference, though, I thought I'd provide the formula for conducting a rigorous comparison of the sort implied by the NBC poll. This document from the University of Minnesota is very helpful. I've summarized some of the key ideas from the Minnesota page in the following graphic (which you can click on to enlarge).


The formula leads us to a 95% Confidence Interval (CI) for what the true difference between the proportions is. In other words, the difference between the two Jones approval ratings is highly likely to be something greater than zero, but not necessarily much different from zero. (One would typically multiply the standard error by 1.96 to get the "plus/minus" term for a 95% confidence interval, but perhaps the Minnesota writer was trying to simplify things by using 2.)

Applying the above formula to the two NBC polls' public-option support levels, one gets:


Because the CI is inclusive of zero (i.e., bounded by a negative value at one end and a positive value at the other), it is thus within the realm of possibility that the difference is indeed zero, as I implied above.