Sunday, November 23, 2014

Thursday, October 9, 2014

Greenberg-Ayres Battleground Poll Probes ACA "Opposition From the Left" with Novel Question-Wording

I've just finished listening to a Political Wire podcast, posted yesterday, in which Democratic pollster Stan Greenberg discusses a recent poll he conducted with Republican pollster Whit Ayres in states with "battleground" U.S. Senate races (almost certainly a more GOP-friendly electorate than is the case nationally) and the implications of the poll findings for the upcoming November elections.

Roughly between the 15:00-20:00 minute points of the interview, Greenberg discusses the portion of the poll pertaining to the Affordable Care Act (ACA), particularly regarding opposition to the law from the political left. Opposition from the left is not a new issue, as I (and other observers, such as Mark Blumenthal) have discussed it frequently in the past (herehere, here, and here).

Pollsters' attempts to assess reasons for opposition to the ACA have taken various forms. CNN/Opinion Research Corporation (ORC) has used the wording "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?" Other pollsters have asked whether respondents who oppose the ACA do so because it goes "too far" or "doesn't go far enough" (Ipsos-McClatchy) or because it involves too much or too little government entanglement with health care (Public Policy Polling).

Back in 2009, Blumenthal quoted Megan McArdle to the effect that the too-far/not-far-enough wording was susceptible to multiple interpretations. The phrase "not going far enough," McArdle argued, could have either a liberal, pro-government health care interpretation (i.e., the ACA didn't go far enough in expanding Medicare or creating a government single-payer system), or a conservative/libertarian interpretation (i.e., the ACA didn't go far enough in cutting back government subsidies of health care or means-testing programs).

This is where Greenberg and Ayres come in. To overcome the inherent lack of clarity in previously used terms such as "too far," these pollsters adopted the following wording (which Greenberg says was developed by Ayres) in their recent survey, to ask respondents who opposed the ACA why they did so. Opponents of the law were given the following two choices:

I'm opposed because it's a big government solution that we cannot afford. 

I'm opposed because you still have to buy private insurance and I'd prefer a single-payer, government-run system like Canada.

In response to the initial ACA question on the Greenberg-Ayres poll ("Do you support or oppose the health care reform law that passed in 2010, also known as the Affordable Care Act or Obamacare?"), more respondents expressed opposition (54%) than supported it (42%). However, among the ACA opponents, 36% chose the anti-insurance company, pro-single payer option (about evenly divided between "strongly" and "somewhat" advocating that view).

(In the interview, Greenberg states that "one-fifth of the opponents are opposed because it's not a government-run, Canadian system." Perhaps he was referring only to the respondents who strongly endorsed the single-payer option.)

Greenberg discusses additional interesting issues in the interview besides the ACA, but naturally given the focus on this blog, the ACA question-wording was what I seized upon.

Thursday, July 24, 2014

Summary of ACA Public Opinion Webinar

I participated yesterday in the Affordable Care Act public opinion webinar, which I previewed in my July 2 post (below). The presenter, Mollyann Brodie, Ph.D., of the Kaiser Family Foundation, first led participants through an overview of the ACA itself, before moving on to the public opinion aspects. Two of her main themes were how heavily attitudes toward the ACA appeared to be colored by general partisanship, and how public awareness of many ACA provisions remains rather low. As an example of the latter, Brodie talked about how, under the ACA's preventative health section, women cannot be charged a co-pay for a mammogram. Yet, many women may not associate the new policy with Obamacare. On the survey-research side, the main thing I learned was that, later in 2014 and into 2015, large government surveys such as the National Health Interview Survey will begin tracking the rate of health-insurance coverage in the nation. Thus far, organizations such as Gallup and RAND have been providing such estimates. Click here for information on purchasing a recording of the webinar.


Brodie's evidence of partisan polarization in views toward the ACA was pretty compelling, in my view. One apparent exception to the trend, however, comes from responses in a recent Commonwealth Fund survey, among those individuals with newly acquired health insurance. Seventy-four percent of self-identified Republicans expressed satisfaction with their new health plans, only somewhat below the percentages of Independents (82%) and Democrats (85%) reporting satisfaction (see Exhibit 12 of the linked document).

Wednesday, July 2, 2014

Upcoming Webinar on ACA Public Opinion

The American Association for Public Opinion Research (AAPOR) will be putting on a webinar entitled "Public Opinion on the Affordable Care Act (a.k.a Obamacare) and Measuring Early Views and Experiences During Its Implementation." The webinar, to be led by Mollyann Brodie, PhD, of the Kaiser Family Foundation, will be held on Wednesday, July 23, 2014, from 12:00-1:30 p.m. CDT. There is a sliding fee scale to register for the webinar based on professional/student status and AAPOR membership. A recording of the webinar will be available for purchase afterwards.

Monday, March 31, 2014

Two Summations of Public Opinion on Obamacare

With today being the deadline date for uninsured people to sign up for health insurance under the Affordable Care Act, two sources have sought to summarize the state of public opinion toward the law at this point in time (via HuffPost/Pollster).
  • The Glover Park Group, a PR firm whose consultants include Democratic-affiliated spokespersons and operatives such as Carter Eskew, Joe Lockhart, and Dee Dee Myers, has put out this slideshow.
  • Meanwhile, Paul Steinhauser offers his synopsis in an article entitled "Five Things Polling Tells Us About Obamacare."

Wednesday, March 12, 2014

POS Looks Beyond Support/Oppose Dichotomy

Elizabeth Harrington and Bill McInturff of the Republican-affiliated polling firm Public Opinion Strategies have written a piece that seeks to probe Americans' attitudes toward the Affordable Care Act, beyond the support/oppose dichotomy (via HuffPost/Pollster). The report notes that there is broad support for trying to repair problems with the ACA (as opposed to repealing it entirely) and that many Americans are hopeful the law will work in the long run.

Thursday, February 27, 2014

Newly Released Kaiser and CBS/NY Times Polls

Two polls -- Kaiser Foundation and CBS/New York Times -- dealing (in whole or in part) with health-insurance issues were released in recent days. Two points grabbed my attention.

First, the two polls showed virtually identical numbers on Americans' preferences for retaining, retooling, or repealing the Affordable Care Act. In the Kaiser poll, 8% want Congress to "Keep the law as it is," whereas another 48% want it to "Keep the law in place and work to improve it." Combined, these two categories suggest that 56% of Americans want the essential features of the ACA retained. Twelve percent want the law repealed and replaced "with a Republican-sponsored alternative" and another 19% want Congress to "repeal the law and not replace it." 

The CBS/NYT poll asked respondents: "Which comes closest to your view about the 2010 health care law? The law is working well and should be kept in place as is. There are some good things in the law, but some changes are needed to make it work better. OR, The law has so much wrong with it that it needs to be repealed entirely." Again, a combined 56% of respondents fell into one of the two categories favorable to retention of the ACA, although the component percentages were slightly different (6% keep as is, 50% make changes to improve). Forty-two percent called for repeal.


Second, although the retention numbers seem pretty good for Obamacare, basic "favorable/unfavorable" numbers do not. They were 35% and 47%, respectively, in the February Kaiser poll. Opposition seems to have really exploded among the uninsured, who might be expected to embrace the law. As shown in this Kaiser trend diagram, favorable responses to the ACA tended to exceed or match unfavorable ones among the uninsured for nearly four years of monthly polling. In the most recent Kaiser poll, however, unfavorable dominates favorable 56% to 22%.

As acknowledged by Kaiser (and highlighted by HuffPost/Pollster), it may not be opinions shifting so much as the composition of the uninsured. Those who were uninsured before the October 1, 2013 launching of the online exchanges presumably fell into at least two groups: those who were embracing the opportunity to sign-up for free or reduced-cost health insurance (and ultimately did so); and those who, for ideological (or other) reasons, were opposed to participating in Obamacare (and who decided not to).

As roughly 10 million Americans have now signed up for coverage, philosophical opponents of the ACA will comprise an ever-growing share of the uninsured. (As I discussed in another context, the uninsured include some well-off people who choose to pay directly for their medical treatment.) Kaiser summarizes the situation thusly: "As more Americans gain coverage under the law, we can expect the group who remain uninsured to change over time, and some changes in opinion may be attributable to changes in who remains uninsured, rather than a shift in opinion among individuals."

Also, because the uninsured comprise a relatively small share of the U.S. population (around 16%, according to Gallup research), their numbers among Kaiser's overall 1501-person sample would likely be small, thus increasing the margin of error for the uninsured-specific findings. In fact, Kaiser provides a nice methodology report, which states that 137 uninsured individuals were present in the "unweighted" sample (i.e., before statistical adjustments for any under- or over-representation of demographic subgroups to match their percentages of the nation's population). Associated with this subsample size, the margin of error for analyses focusing on the uninsured is plus/minus 9 percentage points (much larger than the typical +/- 3 for samples of around 1,000).

Wednesday, February 12, 2014

Gallup Shows Decline in % of Uninsured Americans

HuffPost/Pollster provides a round-up of expert opinion on Gallup's latest finding of a reduction in the percent of Americans reporting themselves to lack health insurance.

Sunday, February 9, 2014

Hurt by Health Care Reform?

Some of the major polling outfits ask questions in their health care surveys on whether respondents feel the Affordable Care Act has helped or hurt them personally. Variations on this question might ask about the respondent and his/her family collectively, or even whether respondents feel the ACA has hurt Americans at large. There are some interesting things to notice in Gallup's most recent poll (which uses the "you and your family" wording).

As Greg Sargent discusses, of the 19% of Gallup respondents claiming they or their family have been harmed by Obamacare, "Sixty percent of those who say the law has hurt them or their families are Republicans or GOP-leaning independents. Only 23 percent are Dems or Dem-leaning independents, and another 15 percent are non-leaning independents."

Sargent adds that, "It’s always possible Republicans and conservatives are disproportionately impacted by the law, but it’s also possible that some who already dislike Obamacare are more likely to tell pollsters they’ve been negatively impacted by it, perhaps because they’re inclined to blame problems they’re experiencing with the health system in general on the law. Of course, this could work the other way around: Dems and Dem-leaners could be less inclined to say they are being hurt by it."

Another aspect of this issue that jumps out at me is how stable the trend lines for "help" and "hurt" appear to be in Gallup's historical polling on the matter. In February 2012, when relatively few Obamacare provisions had gone into effect, 16% said they or their family had been hurt by the law and 12% said they or their family had been helped. Unfortunately, Gallup went a long time without polling on this question, but its three most recent percentages for "hurt" have been 19, 19, and 19 (from polls taken November 23-24, 2013; January 3-4, 2014; and January 31-February 1, 2014). The respective percentages for "helped" were 9, 10, and 13 in these polls.

Considering the turmoil with the malfunctioning federal-exchange website from its debut on October 1 until the re-launch on December 1, and the controversy over many individual-market plans being cancelled (which was heavily in the news from late October into November), it seems remarkable that the percentages of respondents claiming harm to themselves or their families rose only modestly from the 16% in Feb. 2012 to 19% in late 2013 and early 2014.

Two hypotheses come to mind (although additional plausible ones could probably be generated). One is that a fairly sizable share (greater than the 3% aggregate increment) of Americans who had not felt harm in Feb. 2012 did so in late 2013/early 2014, but that others who were claiming harm in Feb. 2012 (or would have, had they been polled) were no longer feeling this way by late 2013, thus limiting the net increase in felt harm to the aforementioned 3%. The other hypothesis (a la Sargent) is that the help/harm survey questions are being answered heavily through an ideological lens, with little basis in how people really are tangibly affected. This latter explanation is cynical, to be sure, but would seem to explain the consistency of the results from early 2012 to late 2013 and beyond.

Tuesday, January 14, 2014

Health Status of ACA Enrollees by Sign-Up Month

Using their daily-tracking surveys since October 1, 2013, the operators of the Reuters/Ipsos Poll have been able to characterize trends in health status of people who have been signing up for insurance through the Affordable Care Act/Obamacare exchanges (hat tip to HuffPollster). In October, 69% of ACA enrollees who participated in the Reuters/Ipsos surveys claimed to have some significant health issue, whereas 31% reported none. The trend began shifting in November, however, with 55% of that month's enrollees claiming a health issue and 45% not. For January (which is less than half over), the numbers have reversed: 60% of this month's enrollees now report no major health issue, and 40% do. This development is important because, in order for insurance companies to cover the treatment of the sickest of its policyholders, they need a large volume of healthy subscribers to pay into the system without needing as much treatment.

Wednesday, January 8, 2014

Two Brief Items

The Republican-associated polling firm Public Opinion Strategies offers "Five Observations from Four Years of Polling Data on Obamacare" (via HuffPollster).  

The Washington Post's "Wonk Blog" notes that public interest in Obamacare seems to be declining, for the moment at least, as indicated by less Google activity and press coverage lately than during the fall (via Daily Kos). One possibly discussed by Wonk Blog is that enrollment under the Affordable Care Act is going relatively smoothly and good news is considered less newsworthy than bad news.