Health Care Polls

2011-11-14T15:22:00.001-08:00

Via Talking Points Memo, a new CNN/ORC poll (November 11-13) shows 52% of Americans supporting the individual-mandate component of the 2010 health-care-reform law. The requirement that all Americans purchase health insurance (with subsidies for some) has been one of the least -- if not the least -- popular elements of the reform law. The wording of the survey item (from Polling Report) is as follows:

"As you may know, the health care bill passed in 2010 includes a provision that will require all Americans who do not have health insurance to get it. Do you favor or oppose that provision?"

That seems to me like pretty clear wording. In June (apparently the last time CNN/ORC polled on this issue), 44% favored the individual mandate (the June wording, which is also shown on Polling Report, is very similar to that used in the recent survey). There really may be some shifting taking place in public opinion or this could be a one-time "blip." Future polls will help indicate which.

2011-10-28T17:36:00.000-07:00

In the Kaiser Family Foundation monthly health care polls, the percentage of Americans expressing a favorable opinion toward the Affordable Care Act (the new law enacted in March 2010) has been in the low 40s nearly every month from August 2010 to September 2011. In the new October 2011 poll, however, favorability is down to 34%, compared with 51% who express an unfavorable attitude. We'll keep an eye on the Kaiser polls over the next few months to see if this month's drop in approval is a one-time blip or the start of a sustained trend.

2011-08-19T10:58:00.000-07:00

Via Political Wire, I came across this article in which Charlie Cook appraises the current state of the 2012 presidential election. Though not really the focus of the piece, it claims that President Obama's "signature legislative accomplishment of health care reform remains very unpopular."

Now, I'm not saying the health care reform policy (either when it was working its way through the Congress or as an actually enacted law) has ever been wildly popular. However, "very unpopular" doesn't strike me as an accurate characterization, either. Just to make sure I wasn't missing any new polling data that would support Cook's view, I visited Polling Report's compilation on health policy. Here is what I found...

In the Kaiser Family Foundation's latest Health Tracking Poll (in the field during roughly the past week, July 13-18), 42% of Americans rated the health care reform law favorably and 43% unfavorably (with the rest unsure or refusing to say). This finding confirms the impression I (and other observers) have had, that public opinion is divided or mixed on the policy.

Another poll listed in the repository is that by Ann Selzer for Bloomberg. It is somewhat dated by now (June 17-20), but it used a question wording that seems unique:

"Turning to the health care law passed last year, what is your opinion of the law? It should be repealed. It may need small modifications, but we should see how it works. It should be left alone."

A majority of respondents (51%) went with the "see how it works" option, suggesting patience and possible receptivity of the American people to the law. The poll found 35% support for repeal and 11% for leaving the law as is. (Here's a link to the Bloomberg News article on the poll).

Scrolling further down the Polling Report archive, we see some additional June polls (primarily from early in the month), when a larger number of survey outfits were measuring public opinion on the health law. These tended to show the unfavorable response outdrawing the favorable one more substantially (by 10 percentage points in the AP-GfK poll; by 11 in the CBS News poll, and by a hefty 17 in the CNN/ORC poll).

However, CNN/ORC has been one of the few polls to probe an issue that was discussed extensively in the past on this blog: opposition from the left. CNN/ORC uses this follow-up probe with respondents who said they opposed the law, "Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?" The June 2011 results then break down as follows:

39% favoring the law in the first place
36% opposing the law for being too liberal
14% opposing it for not being liberal enough

Now, again, I am not expecting health care reform to be an asset for Obama as he seeks re-election next year. If I can play amateur political consultant, I think he'd be better off emphasizing whatever amount of job growth takes place in the next year and the capture of Osama Bin Laden. However, I believe the evidence shows public opinion on health care reform to be more mixed and nuanced than Cook's apparent dismissal of it as "very unpopular."

2011-06-23T11:53:00.000-07:00

As many readers of this blog are probably aware, management consulting firm McKinsey & Co. recently released a poll of employers who provide health-insurance coverage to employees. The findings, which suggested that a substantial number of companies might terminate such coverage, has created a firestorm in policy circles and the political blogosphere. Here are two recent articles, defending and criticizing the McKinsey survey's methodology.

2011-06-19T16:09:00.000-07:00

Gallup reports trend lines in its polling of Americans' reported sources of health insurance (or lack of insurance). The percentage of Americans reporting they have employer-based health insurance has declined gradually over the last few years from approximately 49% to 45%. Insurance via government program (e.g., Medicaid, Medicare) has been edging up and now slightly exceeds one-quarter of the population.

The percentage of Americans who report being uninsured has held steady at slightly over 16% from 2009-2011. Some elements of the 2010 Affordable Care Act (health care reform) have already gone into effect. However, as noted in the above-linked Gallup article, the country's persistent economic difficulties have presumably dampened any gains in health-insurance coverage thus far from the 2010 law.

ACA provisions that are most likely to reduce the ranks of the uninsured -- new mechanisms to purchase health insurance (known as "exchanges"), tax credits for many purchasers, and expansion of Medicaid -- don't go into effect until 2014 (implementation timeline).

2011-06-16T22:34:00.000-07:00

John Sides examines research on how perceptions of fairness and inequity, partisan attitudes, and personal health status appear to predict (or not predict) attitudes toward government health care reform plans (via Pollster).

2011-05-04T21:50:00.000-07:00

The Rasmussen poll, which tends to have a Republican-leaning "house effect," is now showing "support for repeal of [health care reform] has fallen below 50%" for the first time since enactment of the legislation on March 23, 2010 (via Daily Kos). Rasmussen has been using the following question wording:

A proposal has been made to repeal the health care bill and stop it from going into effect. Do you strongly favor, somewhat favor, somewhat oppose or strongly oppose a proposal to repeal the health care bill?

I've always thought the measure to be vague; for example, does "somewhat favor" mean that someone would like parts of the legislation to be repealed, but not others? For what it's worth, though, here is a trend graph I made from percentages listed on Rasmussen's site and a little artistic flourish on my part (you may click on the graph to enlarge it):

There obviously have been fluctuations, and likely will into the future (indeed, support for repeal is back up in the first two May Rasmussen polls; follow Rasmussen's trends here). However, from mid-March to late April, there appears to have been a downward trend in support for repeal.

[Updated May 18, 2011.]

2011-03-22T17:50:00.001-07:00

Mark Blumenthal reviews current polling on health care reform, now roughly a year after the landmark legislation passed.

2011-03-12T15:07:00.000-08:00

Canadian blogger Oleh Iwanyshyn takes a critical look at polling during the U.S. health care reform debate.

2011-02-16T22:43:00.000-08:00

The New York Times offers this report-card-type synopsis on how successfully the health care reform law is being implemented throughout the nation and how major constituencies (i.e., insurers, doctors, the public) are reacting. The synopsis touches upon public opinion in only limited ways, but how successfully the law gets put into place in the next few years is likely to affect future public opinion.

2011-01-23T17:39:00.000-08:00

Recently, a number of columnists have remarked upon the lack of consistency (and in some cases, lack of precision) in how various pollsters have attempted to assess public opinion on repealing the health care reform (HCR) law enacted last March (see Jon Terbush, Greg Sargent, and Frank Newport).

My aim in this posting is to distill these writers' comments into a graphical format, depicting polling results obtained this month. First, though, I classify different polling outfits' question-wording formats into different categories (links to reports of a particular poll's results are given only if they're not available on Polling Report's HCR compendium).

QUESTION FORMATS

Only a dichotomous repeal/uphold item.

CNN/Opinion Research Corporation

NBC News/Wall Street Journal (respondents could choose whether they "strongly" or "not so strongly" held their views toward repealing or upholding HCR law; I combined the two pro-repeal and two pro-retention options in the graph)

Quinnipiac

Rasmussen (respondents could choose whether they "strongly" or "somewhat" held their views toward repealing or upholding HCR law; I combined the two pro-repeal and two pro-retention options in the graph)

Dichotomous repeal/uphold item, followed by item(s) to probe in greater detail (e.g., repeal all or only part of HCR law)

ABC News/Washington Post

CBS News/New York Times

Item directly asks respondents to choose between four main options: repeal all, repeal parts (i.e., make law do less), keep law as is, or expand law.

AP/GfK ("What would you prefer Congress do with the new health care law? Leave it as is. Change it so that it does MORE to change the health care system. Change it so that it does LESS to change the health care system. Repeal it completely.")

McClatchy/Marist ("Which one of the following comes closest to your opinion about what Congress should do with the 2010 health care law? Let it stand. Change it so it does more. Change it so it does less. Repeal it completely.")

GRAPH OF RESULTS

Each segment along the horizontal axis at the bottom of the graph represents a different poll (identified by sponsor/pollster and dates in the field). Above each entry, you can find the percentages of respondents endorsing a particular option signified by the color of a given dot. (You can also click on the graph to enlarge it.)

Let's look first at the blue and orange dots, which represent, respectively, percentages favoring repeal and retention in polls that examine the issue dichotomously (either with only a dichotomous item, or a dichotomous item followed by a probe for further detail). In other words, these items do not permit distinctions between full or partial repeal, or keeping the law as is or perhaps expanding it.

As Sargent says, "When pollsters offer respondents a straight choice between full repeal and leaving the law as is, more end up supporting repeal." Actually, this trend is more apparent for polls taken earlier in the month than later, although on the available information, we cannot separate the effects of polls' timing vs. those of the outfits conducting the poll.

The polls that use what I think is the best format -- AP/GfK and McClatchey/Marist -- both show expanding the scope of the HCR law (green) to be more popular than full repeal (red), status quo (brown), or partial repeal (lavender). In the polls shown in the graph, full repeal -- which is what passed the Republican-controlled House on January 19 -- tended to draw between 20-30 percent support.

In his January 19 column, Newport alluded thusly to an additional survey: "A USA Today/Gallup poll question we asked over this past weekend found that if given a number of options about what to do with the bill, 13% of Americans would keep the bill just as it is, and 32% would repeal in entirely. The rest, 53%, would opt to make minor or major changes in the bill." I overlooked this poll when I was creating my graph. The 32% support for full repeal is at the high end of the aformentioned range; also, the phraseology regarding preferences for major/minor changes is different from other polls' wordings.

[This entry replaces and expands upon my January 21, 2011 posting.]

2011-01-07T22:17:00.000-08:00

With the just-sworn-in Republican majority in the U.S. House poised to pass a repeal of last year's health care reform legislation (such repeal being extremely unlikely to go any further, as the Democrats still control the Senate), Mark Blumenthal of Huffington Post/Pollster.com looks at recent months' polling on the topic of repeal.

Some of the issues addressed by Blumenthal seem inherently difficult to resolve, regardless of how people might have answered the survey questions. If, for example, respondents report favoring repeal of only part -- but not all -- of the reform law, what degree of endorsement does that convey for the total repeal the House GOP is apparently planning to offer. Polls whose questions do not distinguish full from partial repeal are even less informative.

More intriguing, in my view, were some seemingly unusual response patterns reviewed by Blumenthal, which were not necessarily inevitable. Based on cross-tabulations Blumenthal obtained from Gallup, "more than a quarter (26%) of those who said it was a 'good thing' that Congress passed health reform also said they 'favored' repeal. A smaller number (20%) of those who said they considered the passage of reform a 'bad thing' opposed a repeal."

For all of these reasons and others, Blumenthal concludes that "Attitudes about repealing the health reform law do not easily reduce to a single number. And support for an explicit repeal of all aspects of the law falls far short of a majority."

Fall 2010 Attitudes Toward Health Care Reform and its Possible Repeal

2010-11-09T18:00:00.000-08:00

With the Republicans having regained a majority in the U.S. House and narrowed the Democrats' majority in the Senate last Tuesday, there is a very real possibility the GOP will try to repeal all or parts of the landmark health care reform (HCR) bill enacted earlier this year. What does recent polling tell us about the public's attitudes toward repeal?

The Kaiser Family Foundation issued an October report, summarizing the findings of eight national polls taken from September 9-October 10. Bruce Drake of Politics Daily characterized the Kaiser report in the following terms: "roughly, five of the eight polls looked at by Kaiser fall in the column of pro-repeal sentiment (some by small margins) while three do not."

Kaiser also has just released its November Tracking Poll, the findings of which are reported in greater detail here. The survey was conducted in the four days immediately following Election Day, and many of the results are reported separately for the overall sample and for people who say they voted. The findings of this poll are similar to those of many other HCR polls. The overall legislation is not all that popular, with 49% of the general-public sample favoring repeal of some sort (25% favoring repeal in part and 24%, in whole). Forty percent seem favorable to the new law, divided nearly evenly between favoring expansion of its provisions and keeping them as is. The voter subsample comes down more negatively toward HCR, 56% favoring some type of repeal and 36% expressing favorable sentiments.

As with virtually all HCR polls, however, the Kaiser survey shows specific provisions to be far more popular than the overall package. Among partial-repeal advocates in the general-public sample, 75-85% still favor small-business tax credits to help fund insurance, prohibiting coverage denial due to pre-existing conditions, filling in the "doughnut hole" in prescription drug coverage that seniors must pay out of their own pockets, and financial assistance to low-moderate income individuals to help them purchase coverage. The partial-repealers are lukewarm (55% support) on upper-income tax increases and downright hostile to the individual mandate that persons be covered (19% support). Even among persons endorsing full repeal, the tax-credit and pre-existing condition provisions of HCR each enjoy roughly 50% support.

Similarly, an October poll for Bloomberg News found most specific HCR provisions to enjoy support. According to this article on the Bloomberg poll, "Among eight of the law’s provisions on which the poll sought opinions, repeal was backed by a majority of likely voters for just two: requiring everyone to have health insurance and taxing companies that offer especially generous coverage."

Gallup Will Track Impact of HCR Provisions Now in Effect

2010-07-21T15:13:00.000-07:00

Gallup has announced that it will use its existing polling on health care utilization to track the effectiveness of provisions of the health care reform law that have now gone into effect (via Pollster.com's "Outliers"). For example, "Gallup asks Americans each day if there have been times in the past 12 months when they did not have enough money to pay for healthcare or medicine that they or their family needed." Should there now be a drop in the percentage of seniors responding affirmatively to this question, it can be taken as a sign of effectiveness of government checks being sent out under the new law to close the "donut hole" in seniors' Medicare prescription-drug payments.

The Big Day

2010-03-23T13:53:00.000-07:00

With today's signing of the main health care reform bill by President Obama (photo above from WhiteHouse.gov), I now officially put this blog into semi-retirement status. Legislative action on the bill is not complete, and the bill may well perpetually be a work-in-progress. In addition to the upcoming Senate corrections on the bill, there may be serious attempts in the coming months and years to change or even repeal the bill, in whole or in part. Even if there's not a lot of new legislative action in this area, I expect there to be considerable polling on consumer satisfaction with the new provisions, once they go into effect. If/when new polling on health care reform comes out, I'll be here to write about it.

If I had to pick one lesson about public opinion polling that I've learned from operating this blog, it is that pollsters should go beyond simple favor/oppose questions about a given policy and probe further the nature of the opposition. As we learned through the health care reform debate, opposition to the bill was not homogeneous. Most who opposed the legislation did so from the political right (claiming the bill would be too costly, create too much government entanglement, etc.), but an appreciable minority did so from the left (because of no single-payer structure, no public option, etc.). This distinction is important because, for example, conservative opponents will presumably be much more likely to want to vote out Democratic incumbents this November than will liberal opponents, who may come to accept the enacted legislation as exemplifying "the art of the possible."

I probably won't post very often with the blog in semi-retirement. However, the blog will always be here as one observer's historical record of the polling that was done on health care reform in the United States from August 2009 to the day the bill was signed in March 2010.

Comparing the IWF/Polling Company and Anzalone-Liszt Polls of Swing Districts

2010-03-17T12:59:00.000-07:00

Just a day after the release of the Independent Women's Forum/Polling Company survey of swing congressional districts (see Monday's entry below), Anzalone-Liszt Research released a swing-district poll of its own, as described in this news release. Anzalone-Liszt polls for Democratic candidates and liberal interest groups, putting them at the other end of the political spectrum from IWF and the Polling Company. I have thus gone ahead and written a "compare and contrast" piece on the two polls (my thanks to Anzalone-Liszt for sending me a detailed topline report). To begin, I made the following chart (on which you can click to enlarge).

The IWF/Polling Company survey was conducted more recently than Anzalone-Liszt's, but the latter was in the field longer, thus potentially allowing for greater call-backs to initial non-respondents. Of perhaps greater significance, Anzalone-Liszt surveyed respondents in nearly three times as many congressional districts as did IWF/Polling Company. Only in Anzalone-Liszt's poll did residents of Republican-held districts appear to be included (see here for a description of the kinds of districts polled by Anzalone-Liszt, particularly one's held by members of the Rural Caucus).

The upshot of the above sampling and procedural differences is that Anzalone-Liszt's sample was somewhat less conservative and somewhat more moderate than IWF/Polling Company's. Perhaps not surprisingly, therefore, the Anzalone-Liszt survey showed higher support for health care reform than did IWF/Polling Company's. Anzalone-Liszt's figure of 42% support, in fact, is just slightly below the latest national average of 44%, as compiled by Pollster.com. The notion of a swing district -- which I would define as one where the electoral competition between Democrats and Republicans is tight --is not necessarily synonymous with mirroring the average in national polls; however, it is not shocking that the two would coincide in some cases.

Although I found Anzalone-Liszt's question-wordings on the whole to have a more neutral tone than IWF/Polling Company's, there were some Anzalone-Liszt items that appeared to be colored by the firm's ideological leanings:

1. Among a set of provisions said to be in the bill, which were read to respondents to see if they would make them more likely to support the bill, was the following:

Cuts waste, fraud and abuse in Medicare and Medicaid and helps ensure that Medicare funds go to improving care instead of to insurance company profits.

I would consider this a glowing, too-good-to-be-true description.

2. A phrase in another item refers to how insurance companies "will be required to invest more in improving care instead of inflating their profits."

I'm not saying that insurance companies don't take unfair actions, but in a survey context, the phrase "inflating their profits" is pretty inflammatory.

March 2010 Independent Women's Forum Poll

2010-03-15T17:52:00.001-07:00

A new poll was released today, purporting to show that voters in swing congressional districts are heavily opposed to the health care reform legislation working its way toward a final vote in the U.S. House. The poll was sponsored by the conservative-leaning Independent Women's Forum, with surveying by conservative Kellyanne Conway's Polling Company. To get a flavor of positions taken by IWF, one of its directors recently delivered a presentation entitled "Saving Freedom From ObamaCare." Not surprisingly, the IWF poll was picked up by Doug Schoen, an increasingly vocal opponent of the present health care reform efforts.

A poll's association with an explicitly political group -- at either end of the spectrum -- does not automatically vitiate the poll. However, pollsters sometimes show "house effects" in the direction of the pollster's or sponsoring organization's partisan-ideological bent (e.g., Rasmussen's polls, cited often on FOX News and in other conservative circles, tend to have a pro-Republican house effect, whereas Research 2000, which conducts polls for the left-leaning website Daily Kos, tends to have a pro-Democratic house effect). At the very least, readers should take the pollster and sponsoring organization into account when evaluating the results of a poll (for further discussion, see M.W. Traugott and P.J. Lavrakas, The Voter's Guide to Election Polls, 4th ed., 2008, p. 43, under the heading "Are There Problems with Some Polls Conducted by Special Interest Groups?").

IWF released a detailed report of the findings, for which I commend the group. In examining the poll, I focused on two matters, the sample and question-wordings.

IWF/Polling Company listed 35 "swing" districts in which the poll was conducted, 15 in which a Democratic member had voted "no" on initial passage of the House bill last November, and 20 in which a Democratic member had voted "yes." Thirty-nine Democrats voted "no" in November, so it was not initially clear if the 15 "no" districts surveyed were representative of all districts represented by a Democrat who voted "no."

For the most part, Democrats who voted "no" came from districts ranging from a slight Democratic lean at the presidential level (i.e., districts won by Obama by a few percentage points) to a strong Republican lean (won by McCain by 20, 30, or even 35 percentage points). If IWF/Polling Company had polled disproportionately from strong Republican districts (that happened to elect Democrats to Congress), that could have systematically lowered support levels for health care reform in their poll.

Using this New York Times list of Democrats who voted "no" on initial House passage (and the accompanying statistics), I found IWF/Polling Company to have done a fair job of selecting Democratic "no" districts. Of the 15 such districts polled, most were ones won by McCain or Obama by single digits. There were some exceptions (e.g. Texas's 17th Congressional District, won by McCain by 35%; Tennessee's 6th CD, won by McCain by 25%); however, several of the Democratic "no" districts left out of the survey also had similarly large McCain margins. I give IWF/Polling Company good marks on district selection.

I was not as satisfied with the survey's question-wording, though. Many items had what I would consider an anti-health care reform tone. Examples include the following agree-disagree items, shown in green italics:

It is the responsibility of the federal government to mandate that everyone have government-approved health insurance and to be penalized if they do not.

Terms such as "mandate," "government-approved," and "penalized" seem slanted to evoke negative responses. Plus, the fact that most individuals would continue to receive health insurance through their jobs might well be obscured by the part of the item suggesting people would have to go out and get "government approved" insurance.

It would be an unprecedented violation of individual rights for the federal government to mandate that everyone have government-approved health insurance and to be penalized if they do not.

The phrase "unprecedented violation of individual rights" might just be a tad inflammatory?

Americans have the right to spend their own money to have access to legal health care services, treatments, and tests.

That would be a hard one to disagree with.

According to the nonpartisan Congressional Budget Office, the cost of health insurance premiums in the individual market will increase on average by $2,100 in the year 2016. This means that if the bill passes, families will pay $15,200 per year, but $13,100 per year if it did not pass.

This statement, read to participants who then said whether it would make them more or less likely to support the legislation, gives only part of the story. According to Talking Points Memo, "According to CBO, average premiums in the individual market would increase 10 to 13 percent because of provisions in the Senate health care bill, but, crucially, most people (about 57 percent) would actually find themselves paying significantly less money for insurance, thanks to federal subsidies for low- and middle-class consumers, than they would under current law."

Interestingly, even amidst these arguably tendentious survey items, one testing support for the proposition that "Health reform should focus on making sure everyone has insurance" found 53% in favor. Universality is, of course, a key goal of the Democrats, although roughly 6% of Americans are expected to be left uncovered under the proposed legislation.

I, too, have my own values and viewpoints, and perhaps am evaluating the poll too harshly. I encourage everyone to read the original IWF/Polling Company report for themselves and reach their own opinion.

HC Reform Polling a Bit Better in Early March

2010-03-13T20:44:00.000-08:00

As health care reform approaches crunch time in the U.S. House, recent national polling seems to suggest more favorable public attitudes toward reform than in prior weeks. On generic questions -- asking whether respondents favor or oppose health care reform without reference to specific provisions -- support levels seem to be creeping upward and opposition, downward.

One of the most detailed analyses of these trends comes from Pollster.com's Mark Blumenthal, whose March 10 essay reports support for health care reform (averaged over multiple polls) rising from roughly 40% to 44%, and opposition falling from the low 50s to 48%. For maximum rigor, Blumenthal also plots within-pollster trends over time (i.e., comparing all Rasmussen polls to each other; all Gallup polls to each other, etc.). I had thought about examining pollster-specific trends, but Mark beat me to it. When polls are examined in this manner, declining opposition appears to be a more powerful trend than does rising support.

Blumenthal cites another detailed report, from Democracy Corps (an outfit headed by pollsters and political operatives long associated with the Democratic Party). The Democracy Corps analysis covers some of the same terrain, but also delves into other matters, such as the popularity of individual components of health care reform legislation. (D-Corps' Footnote 2 states that Rasmussen polls were excluded for being "extreme outliers;" some analysts have excluded Economist/YouGov polls, as well, for being outliers in the opposite direction, which Democracy Corps does not do. Hence, the group's claim of increasing momentum for health care reform might be considered somewhat overstated, although movement in a pro-reform direction is clearly there.)

Despite the trends described above, there are still contrarians. Pat Caddell and Doug Schoen, who in the past have worked as pollsters for Democratic presidents, recently argued in the Washington Post that "the battle for public opinion has been lost. Comprehensive health care has been lost." I found the piece to be a lot heavier on conjecture ("If [reform legislation] fails, as appears possible, Democrats will face the brunt of the electorate's reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls") than on hard empirical data.

Moreover, some of Caddell and Schoen's empirical claims (e.g., "a solid majority of Americans opposes the massive health-reform plan" and "the American public is overwhelmingly against this bill in its totality") seem inconsistent with recent polling data (the aforementioned Pollster.com averages of 44% support and 48% opposition). I guess it depends on how one defines a "solid majority" and "overwhelmingly."

Caddell and Schoen cite polling to the effect that a higher proportion of health care reform opponents than of proponents report feeling strongly in their position. In this instance, I think their characterization is generally valid. Two points in response are warranted. First, many supporters may be less than ardent due to their belief that the final legislative proposals have been watered down too much (see the discussion of opposition from the left, in earlier postings on this blog). Second, as Public Policy Polling's Tom Jensen contends, "The vast majority of opposition to health care and allowing gays to serve openly in the military is coming from people who already say there's no chance they'll vote Democratic this fall. That's an indication of minimal fallout for Congressional Democrats by acting on these issues."

2010-03-06T21:27:00.000-08:00

This item is not so much about actual polls, but rather about an event that may have helped shape health care-related public opinion to some extent in recent weeks. The event in question is the attempt by Anthem Blue Cross to raise premiums on its individual policyholders (as opposed to persons who receive health insurance through group plans at work) by as much as 39%. Today's Los Angeles Times has an article about how the proposed rate hike -- and the Obama Administration's alacrity in publicizing it -- seemingly has given Democrats a concrete way to connect with the public on the health care reform issue.

2010-03-04T18:14:00.000-08:00

The latest installment of Pollster.com's "Outliers" includes not one, not two, not three, but four items on health care polling.

Guest Contribution by Jan Werner

2010-02-28T14:39:00.001-08:00

By Jan Werner

(With Jan's permission, I am reprinting a commentary originally distributed to the American Association for Public Opinion Research's listserv discussion group.)

Today's NY Times Week In Review section fills some unsold space with yet another rehash about poll results differing because of question wording, this time in the context of opinions on health care reform.

At the same time, the front page of that same section has an article on the expected costs of failure to enact some kind of health care reform.

This brings up the issue of why the media polls keep asking the same questions with slight variations of wording, instead of doing serious digging into just what people know about health care reform and what they want, or fear, from it.

Even the Kaiser Family Foundation tracking polls, while far superior on health care topics to anything one gets from the usual media suspects (NYT, ABC, Pew, etc.), mainly focus on the political affiliation of respondents rather than whether they have health care coverage and, if so, where it comes from and what it costs them.

Why don't we see questions about the source of respondents' health care coverage, the percentage of their income it consumes, how that amount has changed over time and how they expect it to change in the future, how much they know about rising health care costs and why they are rising? And why don't we see crosstabs by that kind of information rather than just by the same Dem/Ind/Rep political breakdowns?

One answer comes from Bob Blendon of the Harvard School of Public Health, via Trudy Lieberman, who writes on health care reporting in the Columbia Journalism Review.

Obviously, if only insurance companies are willing to sponsor serious research into what drives opinions on health care reform, then they are going to be the main beneficiaries of what that research reveals.

[Editor's Note: Quinnipiac has sporadically used respondents' type of health insurance -- none, Medicare/Medicaid, or private -- as a grouping factor in crosstabs, as seen here. Other pollsters may have done similarly, but I can't locate other examples right off the top of my head.]

2010-02-23T10:08:00.000-08:00

Jon Cohen and Frank Newport offer synopses of where public opinion currently stands on health care reform (via Pollster.com).

UPDATE: And so does Ezra Klein.

Pre-Summit Round-Up

2010-02-21T13:20:00.000-08:00

With President Obama preparing to release a new version of the health care reform plan in advance of Thursday's bipartisan summit on the matter, and Senate Majority Leader Harry Reid (D-NV) getting on board with the idea to use budget reconciliation to make changes to the Senate's December-passed bill, here are some recent developments in public opinion.

Newsweek revisits the issue of support for health care reform, as a general proposition, versus support for specific provisions (via Political Wire).

In terms of political calculus for this November's congressional elections, Public Policy Polling notes that a great deal of the opposition to the Democrats' health care reform legislation comes from people who would never vote Democratic anyway. Hence, any attempt by the Dems to trim back the legislation to attract these voters would be futile.

Comprehensiveness and Complexity (ABC/Post Poll)

2010-02-10T22:33:00.000-08:00

In the aftermath of Republican Scott Brown's win in the Massachusetts special election for U.S. Senate and with support in national public-opinion polls for health care reform (as a general proposition) clocking in around 40%, there have been calls for the Democrats to scale back their aspirations for reform. In particular, many Republicans (and some, shall we say, "cautious" Democrats) have suggested the Congress move away from comprehensive health care legislation such as what passed the U.S. House last November (including various mechanisms to cover roughly 30 million uninsured Americans and regulate the insurance industry) and instead aim for something more limited.

As one example, Republican Representative Bill Cassidy advocates a number of narrow provisions that seem unlikely to increase the number of insured persons by anything near the extent proposed by the Democrats. House Speaker Nancy Pelosi (D-CA), in constrast, has argued that health policy changes cannot be effective in isolation, thus necessitating a more comprehensive approach.

A new ABC/Washington Post poll (in the field February 4-8) contained the following item, which has received considerable publicity:

Do you think lawmakers in Washington should (keep trying to pass) a comprehensive health care reform plan, or should (give up on) comprehensive health care reform?

Keep trying to pass 63%
Give up on 34
No opinion 4

The public, knowlingly or not, thus appears to side with Pelosi on this matter. Another item, which appears to have received much less attention, to some extent gets at Pelosi's idea that effective reform requires the coordination of many "moving parts." It reads:

Do you think the proposed changes to the health care system are too complicated, or do you think the changes have to be this complex to accomplish what they're trying to do?

Too complicated 60
Have to be this complex 35
No opinion 5

Whether the 35% who claimed the Democratic plans' complexity is unavoidable truly were exhibiting systems-oriented thinking or were just rationalizing in defense of a plan they support, we don't know. Peter Muhlberger, a colleague of mine at Texas Tech, has written about political-science theories claiming "that many people have simplistic understandings of human agency. These understandings result in an inability to conceptualize complex
systems of governance and an inability to take alternative political perspectives" (p. 54).

Whatever else one can say about the pending health care reform legislation, it certainly exemplifies the operation of "complex systems of governance."

UPDATE: A Zogby poll that was in the field from January 29-February 1 obtained findings opposite to the ABC/Post poll summarized above, regarding the public's desire for comprehensive legislation.

2010-02-02T09:58:00.000-08:00

Nate Silver takes a look at open-ended responses from a Gallup survey to assess the degree to which opposition to health care reform might be based on faulty information. As Silver discusses, much of the information is ambiguous. Take, for example, respondents' statements that they oppose reform because it would hurt the elderly (with no further elaboration). If a respondent were referring to "death panels," that would be an erroneous reason. However, if someone were referring to Medicare Advantage cuts, that would be grounded in reality.

2010-02-01T11:01:00.000-08:00

PolitiFact reviews polling data to gauge the accuracy of U.S. House Minority Leader John Boehner's (R-OH) claim that a "majority" of Americans oppose the health care legislation before Congress (via Pollster.com). I think the PolitiFact piece is sound, as far as it goes. However, it does not delve into opposition from the left (a topic covered extensively here in the November and December 2009 archives). To the extent people would interpret Boehner's comments as implying that a majority oppose the bill because it's too liberal -- which Boehner never actually says -- I think it helps contextualize things to know that some of the opposition is because the bill is perceived by some as not liberal enough. Also, Pollster's Mark Blumenthal offers his assessment on where things currently stand with the health care reform legislation.

2010-01-24T14:28:00.000-08:00

At this stage, the U.S. House (last November) and Senate (last December) have each passed their own (different) health care reform bills. Normally, the two bodies would reach a unified compromise bill via a conference committee, and then pass the conference bill through each chamber and on to the President's desk. The win by Republican Scott Brown in last Tuesday's special U.S. Senate election in Massachusetts knocks the Democrats back down to 59 seats in the Senate, however, thus depriving them of the 60 votes needed to shut down a Republican filibuster (which a conference bill would certainly have drawn).

One possible way to salvage a bill along the lines of what's already been passed is for the House to pass the Senate-approved bill exactly as is. Because both bodies would then have passed the same exact legislation, it could go to the President without a conference process. Many House liberals apparently don't want to vote for the Senate-passed bill, though, feeling that it doesn't accomplish enough. Apparently as a result, Speaker Pelosi has said the votes aren't there in the House for the Senate bill.

Another option would be for the Senate to pass some additional provisions -- which many House liberals would like -- through budget reconciliation. Reconciliation requires only 51 votes to pass the Senate, but can only be applied to budget-relevant provisions (i.e., something that's a pure policy change with no relation to government spending cannot go through reconciliation). Nate Silver refers to potential changes through reconciliation to adjust the December-passed Senate bill as the "Senate sidecar." The House could then pass a new bill (or bills) that encompasses both the December-passed Senate bill and the Senate sidecar. Still other liberals appear to favor "blowing up" the already-passed House and Senate bills, having the Senate pass new bills through reconciliation, and having the House pass corresponding bills.

The aforementioned Nate Silver has attempted to make sense of the situation. He has a neat chart displaying a long list of specific health care provisions, how much popular support each enjoys (based on this month's Kaiser poll), whether the provision is already in the December-passed Senate bill, and Nate's guess as to whether the provision could be passed through reconciliation (due to budget relevance).

2010-01-22T14:44:00.000-08:00

Margie Omero examines polling data to get an idea of what message(s) voters in the Massachusetts U.S. Senate special election were sending about health care reform.

2010-01-12T10:58:00.000-08:00

At this stage, with the U.S. House and Senate each having passed its respective version of health care reform in late 2009, we're waiting to see what kind of merged, compromise bill emerges so the House and Senate can vote on final passage. We're also waiting on a January 19 special U.S. Senate election in Massachusetts to fill the late Ted Kennedy's seat, which will determine whether the Democrats still have 60 seats (including two Independents who caucus with the Democrats) to ward off Republican filibusters.

With the House-passed public option seemingly dead due to Senate resistance and relatively few major issues still being negotiated between the two chambers, most of the current polling appears to be on general preferences.

Gallup, which for several months has been asking respondents if they would advise their members of Congress to vote for or against health care reform, now (Jan. 8-10) shows "for" edging ahead of "against," 49 to 46 percent, the first time the "for" side has led since last October.

A more pessimistic tone comes from a new CBS poll (Jan. 6-10), however, as "Just 36 percent of Americans approve of Mr. Obama's handling of health care... In December of last year, 42 percent of Americans approved of the president’s handling of health care, and 47 percent approved in October."

The CBS poll asked its questions in a way that, in my view, provides greater context than most polls about what seems to be going on. First, the poll asked about three main objectives of reform: expanding health-insurance coverage, cost-control, and regulation of the insurance industry. Second, the poll asked respondents whether they felt congressional proposals went too far, got it about right, or did not go far enough, with regard to each of the three aforementioned objectives.

Questions that ask respondents if they think health care reform in general does or doesn't go too far are open to multiple interpretations. To liberals, "not going far enough" could mean not expanding coverage to enough people, whereas to conservatives it could mean not doing enough to roll back government involvement in health care. By asking respondents whether they think the current legislative proposals go too far or not far enough, specifically and separately with regard to coverage, cost-control, and regulation, CBS appears to have removed much of the ambiguity in interpreting the results.

On the question, "Do you think the changes to the health care system under consideration in Congress go too far in trying to provide health insurance to as many Americans as possible, don't go far enough, or are the changes about right?," the 35% saying not far enough would seem to be responding in a liberal direction, with another 22% saying about right (detailed results).

On the question, "Do you think the changes to the health care system under consideration in Congress go too far in trying to control costs, don't go far enough, or are the changes about right?," 39% say not far enough. I'd argue there is some ambiguity here, as liberals could be referring to cost control by reining in the industry whereas conservatives might mean cutting government spending.

The third question -- "Do you think the changes to the health care system under consideration in Congress go too far in trying to regulate the health insurance industry, don't go far enough, or are the changes about right?" -- seems to go a long way in clarifying things. Here, a "not far enough" response would seem to be liberal. Indeed, self-identified Democrats (50%) were more likely to say the plan didn't go far enough than Republicans (26%); Independents said not enough at a 48% rate. For the total sample, 43% said the plan didn't go far enough.

2009-12-25T12:31:00.000-08:00

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!

2009-12-22T17:16:00.000-08:00

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).

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

2009-12-17T12:47:00.001-08:00

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.

Breaking Down Nov-Dec Decline in Support for HC Reform

2009-12-12T18:01:00.000-08:00

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.

2009-12-10T15:05:00.000-08:00

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.

2009-12-09T18:06:00.000-08:00

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.

Ipsos Polling Executives Discuss Health Care Surveying

2009-11-30T16:25:00.000-08:00

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.

Happy Thanksgiving!

2009-11-26T12:18:00.000-08:00

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.

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

2009-11-17T16:22:00.001-08:00

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.

2009-11-10T18:11:00.001-08:00

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.

2009-11-01T16:47:00.000-08:00

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

How Closely Have People Been Following the Debate?

2009-10-26T06:05:00.000-07:00

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.

2009-10-24T20:33:00.000-07:00

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

2009-10-23T07:48:00.000-07:00

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

2009-10-22T12:26:00.000-07:00

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!

Sen. Landrieu, the Public Option, and Free Lunches

2009-10-16T12:15:00.000-07:00

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.

2009-10-14T18:23:00.000-07:00

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."

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

2009-10-09T08:07:00.000-07:00

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%.

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

2009-10-07T11:14:00.000-07:00

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%).

2009-10-05T19:29:00.000-07:00

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

Comments on Resurgent Republic Analysis (10/4)

2009-10-04T13:47:00.000-07:00

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.

Washington Post Revisits Its Own Data (9/30)

2009-09-30T17:00:00.000-07:00

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.

Kaiser Foundation's September Poll (9/29)

2009-09-29T14:29:00.000-07:00

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.

2009-09-28T13:09:00.000-07:00

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

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

2009-09-25T13:09:00.000-07:00

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.

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

2009-09-23T09:38:00.000-07:00

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.

2009-09-21T15:10:00.001-07:00

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

One Week Post Obama Speech (9/18)

2009-09-18T06:43:00.000-07:00

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.

2009-09-15T16:09:00.000-07:00

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.

2009-09-14T10:18:00.001-07:00

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.

CBS News Poll (9/11)

2009-09-11T11:24:00.001-07:00

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.

Post-Speech Tidbits (9/10)

2009-09-10T10:33:00.000-07:00

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.

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

2009-09-09T08:03:00.000-07:00

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.

2009-09-06T22:46:00.000-07:00

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.

2009-09-05T12:30:00.001-07:00

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.

Support for Public Option in the States

2009-09-04T17:14:00.000-07:00

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?"

Satisfaction with Publicly Provided Health Care (9/3)

2009-09-03T10:08:00.001-07:00

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).

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

2009-09-02T11:08:00.000-07:00

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.

Miscellaneous (9/1)

2009-09-01T12:26:00.000-07:00

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.

Age-Group Comparisons (8/27)

2009-08-27T07:34:00.000-07:00

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.

Miscellaneous (8/25)

2009-08-25T09:13:00.000-07:00

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.

More Polling on the Public Option (8/24)

2009-08-24T07:32:00.000-07:00

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.

Weekly Wrap-Up (8/21)

2009-08-21T06:48:00.000-07:00

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.

Avalanche of New HC Polls (8/20)

2009-08-20T14:45:00.000-07:00

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!

Misconceptions About Reform Bills (8/19)

2009-08-19T09:40:00.000-07:00

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.

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

2009-08-18T15:32:00.000-07:00

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.

Urgency to Pass a Health Care Reform Bill (8/17)

2009-08-17T06:49:00.001-07:00

Given the seeming volatility in what can happen in the health care reform debate -- such as the recent flap over "death panels" -- it's not surprising that President Obama wanted House and Senate floor votes before the August recess. That's impossible now, but presumably the President and Democratic congressional leaders will push for votes as quickly as possible when legislators return to Washington in September. House and Senate members will presumably be more inclined to proceed swiftly, to the extent voters express a strong sense of urgency that health care reform be enacted. How urgent do voters think health care reform is?

In the following diagram (which you can click to enlarge), I've plotted different polls' answers to this question. A couple of things should be noted. First, I've grouped together survey items that, on the surface, seem to be asking about different things; I would argue, however, that all of them get at the urgency question in one way or another. Second, the percentages listed in the headings for respondents who consider passage of health care reform a high priority are conservative (in the sense of being cautious). For example, I say that 46% of respondents in the TIME magazine poll assign a high priority to passage of health care reform. Those are only the people who said it was "very important." Arguably, however, we should add in the 23% who said it was "somewhat important," which would bring the total to 69% attaching some importance to passage of a bill.

The poll implying the least urgency for passage of a health care reform bill is Rasmussen's. I know I pick on Rasmussen fairly often, but two points seem worth making. First, across a variety of issues, Rasmussen's recent polls seem to skew Republican a bit. Second, of the 54% favoring no action this year, perhaps some of these respondents (and by extension some of the larger population) would favor a health care reform bill being passed next year, after more negotiation and compromise.

As with all the other issues for which I've been summarizing poll results, it will be interesting to see what polls coming out in the coming weeks say about the matter of urgency.

Weekly Wrap-Up (8/14)

2009-08-14T09:17:00.000-07:00

My thanks to all who have visited this blog during its inaugural week! Thus far, I have been summarizing Americans' views on specific issues, based almost exclusively on polling done during July. I expect many, if not most, of the same media and polling outfits to come out with new results in the coming weeks. At least I'm hoping that's the case, as the best way to examine trends is by looking at the same pollster, using the same questions, over time.

One outlet that had a July poll (July 21-22) and now has an August poll (August 11-12) is FOX News/Opinion Dynamics. Self-identified Republicans are a little over-represented in this poll (D 39, R 35) compared to Pollster.com's national average (D 38.3, R 32.5), which should be taken into account in looking at FOX's overall national results. Also, many of the health-related items in the FOX poll are, one might say, a bit more "quirky" than those asked by other outfits. For example, one of the FOX items asks:

"Which one of the following [emotions] best describes how you feel about the government being more involved in your health care?"

Self-identified Democrats fall primarily into two categories: reassured (37% of Democrats) and indifferent (35%). Republicans, on the other hand, fall predominantly into frightened (51%) and angry (27%).

The question-wording iself is questionable, in my view, as most Americans' current health plans will likely remain unchanged and, for these people, the government presumably would not be "more involved in your health care." Critics have argued that Obama's claim of, "If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period..." might be somewhat misleading. The reason is that, even though nothing in the legislation would explicitly throw people out of their existing plans, the government plan might induce businesses to change or drop their employees' current plans, which could be considered a by-product of government involvement. However, approximately 90% of Americans in employer-based plans would apparently stay in them, according to a Congressional Budget Office analysis of one of the plans under consideration by the U.S. Senate:

"[By 2017] about 147 million people would be covered by an employment-based health plan, 15 million fewer than under current law."

This Yahoo News/AP "Fact Check" article also does a nice job of examining this area of contention, as well as others.

Just a couple more brief notes:

*The August 11 installment of Pollster.com's "Outliers" feature (links to various polling developments) has a number of health-care relevant links.

*The Marist Poll (which was in the field August 3-6) has now entered the fray on health care reform.

Anticipated Effect on Quality of Care (8/13)

2009-08-13T11:40:00.000-07:00

How do Americans think health care reform will affect the quality of health care? Pollsters have addressed this question from two frames of reference, how people think health care will be affected for the nation as a whole, and for oneself and one's family. As shown in the diagram below (which you can click to enlarge), the polling is clear. Americans appear far more sanguine that reform will improve health care at the national level (darker-shaded boxes) than in their own personal lives (lighter-shaded boxes). Regarding anticipated impact on health care for the nation at large, two recent polls (Kaiser and Gallup) show sizable pluralities in a positive direction -- in other words, more people think health care nationally will be improved than degraded. A third recent poll, Quinnipiac, has it essentially even. (A Rasmussen poll from back in January produced more pessimistic results.)

When it comes to perceived personal impact, however, there's near-unanimity in the polls that reform will damage the care individuals and their families receive (the one exception is the poll by Kaiser, where a slight plurality thinks its own care will get better).

The above pattern -- where Americans have responded relatively favorably regarding how they think reform will affect health care nationally -- may be a good sign for President Obama and the Democrats as they seek to enact (and potentially at a later time, implement) health care reform legislation.

While I was studying for my Ph.D. in social psychology at the University of Michigan in the 1980s, I took a course on public opinion from political scientist/social psychologist Donald Kinder. One of Prof. Kinder's ideas at the time, as I understood it, was that support for an incumbent president is driven more by individual voters' collective ("we") perception of how well the economy is doing for the nation as a whole, than by an individualistic ("me") perception of how that particular voter is doing. I just found an online document that summarizes this research more formally:

Early studies assumed [support for an incumbent president] was indicative of pocketbook voting −- citizens rewarding and punishing incumbents based on their own economic circumstances (Key 1968; Kramer 1971). But subsequent studies established that the effect of personal economic circumstances was small in magnitude relative to perceptions of the state of the national economy (Kinder and Kiewiet 1979; Markus 1988, 1992). This phenomena of evaluating the president based on national rather than personal economic circumstances, known as “sociotropic” voting, has become one of the main ways in the political science literature that voters systematically hold presidents accountable for their performance in office (Fiorina 1981; Achen and Bartels 2004).

A couple of cautionary notes are in order before folks at the White House begin popping the champagne corks. First, will the sociotropism phenomenon hold as well for health care as for the state of the economy (especially given the current recession/depression)? Second, the above poltical-science excerpt makes clear that it's actual -- not merely anticipated -- results that voters are looking at. On the whole, though, these poll findings would seem to provide reasonably good news for the Democrats.

Taxes to Pay for Expanded Coverage? (8/12)

2009-08-12T09:58:00.001-07:00

With President Obama pledging that health care reform must be deficit-neutral, new revenue sources will be necessary so that the extension of health insurance to the millions of uninsured will not add to annual federal budget deficits (and, cumulatively, the national debt).

Among the proposals to add revenue, two of them are tax increases on upper-income Americans and treating the health-insurance benefits many Americans receive from their employers as taxable income (generally, the latter proposal has been restricted to employees with particularly generous "gold-plated" health plans). The diagram below (which you can click to enlarge) focuses on the four polling firms that asked about both an upper-income and employee-benefits tax.

Upper-income tax increases have clear majority support, from 56-68 percent. According to an article from earlier this summer, "House Democrats are considering a $544 billion tax on families that earn more than $350,000 a year, but [Speaker Nancy] Pelosi wants to raise the income threshold to $1 million for joint filers." The NBC/Wall St. Journal poll asked about both of these income levels and Pelosi's proposal indeed draws additional support; the NBC/WSJ item on setting the threshold for new taxes at a million dollars also draws higher support than other firms' items on higher-income taxes.

Treating employee health-insurance benefits as taxable income, on the other hand, is not very popular. Even when the survey item alludes to only health-insurance plans above a certain monetary value being taxed (Pew), support is very low. The NBC/WSJ item draws 41% support, but it refers only to insurance companies being subjected to higher taxes (presumably companies' added tax liabilities would be passed on to beneficiaries).

Just to mention a couple other polls that didn't ask both the high-income and employee-benefits questions, in late July the CBS/New York Times poll found 65% support for the item, "In order to help pay for health care reform, would you favor or oppose increasing taxes on Americans with high incomes?" Also, back in May, Rasmussen polled on various tax options, including the employee-benefits one.

The "Public Option" (8/11)

2009-08-11T09:31:00.000-07:00

Perhaps the most contentious issue among congressional negotiators and interest groups in Washington, DC (and elsewhere) is the so-called public option. The idea is that the government would create a new health-insurance program (modeled to one degree or another on Medicare, the government insurance program for seniors) that people could join. Proponents argue that, by having it compete with private insurers, the public option would help control costs. Opponents, on the other hand, see the public option as yet another government intrusion into an area they feel should be left to the private market.

Where does the public seem to stand? Not surprisingly, the public option has been widely polled, and we shall focus exclusively on it today. As seen in the diagram below (which you can click on to enlarge), levels of support for the public option vary widely according to different polls, despite the relative consistency of question wording (all the survey items refer in some fashion to the public option being a government health-insurance program that would compete with private insurance companies). The predominant trend, I would say, is that a majority of respondents supports a public option, with five of the eight polls showing between 52-66 percent in favor.

Still, though, two other polls show support in the mid-40s and one poll (Rasmussen) has support way down at 35%. What to make of this? Let's start with Rasmussen. Whereas Rasmussen's presidential-election polling has tended to be highly accurate (relative to the actual results), other types of polls from this outfit appear to have had a Republican slant. Here are some examples:

*Whereas most polls tended to have George W. Bush's job-approval ratings during the waning months of his administration in the low-30s or even the 20s, Rasmussen consistently had it around 35%.

*Whereas virtually every pollster other than Rasmussen has shown a majority of voters to prefer the Democrats (at this early point) in next year's U.S. House elections, Rasmussen has been showing the Republicans in the lead (albeit with large percentages undecided).

Polling analysts refer to systematic differences in the results (on the same basic issue) between different survey firms (or survey "houses") as house effects. These may stem from different firms' practices regarding question-wording, sample weighting, etc. On health care reform and other issues, it looks to me as though Rasmussen has a substantial house effect.

There's one other aspect of the public-option polling I'd like to point out. As can be seen in the diagram above, I have highlighted in red the words "option" and "offering" in the wording of some of the survey items. It appears that wordings stressing the voluntariness of the public option (i.e., that it is an "option," or something "offered" to the consumer) tend to elicit higher support than wordings that don't highlight voluntariness as much. This is just a hunch. If anyone has other explanations for the large variation in support between the polls, please share them in the comments section.

Universality, Individual and Employer Mandates (8/10)

2009-08-10T08:41:00.000-07:00

Today, we look at three specific issues in the health care debate. The first is universality (i.e., belief that any new policy should work toward or guarantee health insurance to all). The other two issues involve possible mechanisms for achieving universality, an individual mandate (i.e., requiring all individuals to obtain health insurance) and an employer mandate (requiring companies to provide health insurance to their employees -- as many of them do now -- perhaps with some assistance to the smallest businesses to help them fulfill the mandate).

We see first that, via a variety of different question wordings, universality consistently receives majority support (you may click on the graphics to enlarge them)...

The polling on personal/individual mandates reveals a huge disjunction, with two polls showing robust support and another two showing weak support. The distinguishing factor appears to be how the situation is characterized for people who would have trouble adhering to the mandate. When the survey item emphasizes "help" being available for these people, the policy is supported, whereas when punitive consequences for noncompliance are mentioned, support plummets.

Lastly, support for the employer mandate tends to be around 50% and above, except for one poll that refers to a "penalty" being imposed on companies that do not participate.

Most of the underlying data for these graphs can be found in Polling Report's health policy page, except for the FOX data, which are available here.

Welcome Statement

2009-08-09T12:20:00.000-07:00

If you're following the debate in Washington, DC over health care/insurance reform as closely as I am, you're probably interested in what the public opinion polling has to say. One thing that I find particularly frustrating is when a media report cites only one poll to make a claim about the public's support or opposition toward some issue or another, without contextualizing the matter (i.e., is the one poll consistent with others taken around the same time or is it possibly an outlier?). My aim, therefore, is to compile all the relevant polling in one place, just like Stuart Thiel's old "Professor Pollkatz" site used to do with George W. Bush's approval ratings.

There already are at least two poll-compilation sites where you can see what's going on related to health care, but each is limited in some way. Pollster.com presents beautiful graphics compiling poll results on a given topic, but thus far at least, it is covering only two questions related to health care: President Obama's handling of the issue, and general support for the Democrats' health care reform efforts (as led by Obama or congressional Democrats). Polling Report, on the other hand, provides a lot more raw information, but (a) it's not in graphical form, and (b) it doesn't group the data together by specific issues (e.g., support for universal coverage, a public option, an employer mandate, etc.). The relevant Pollster and Polling Report pages can be accessed via the links section to the right. I will aim, however, to create additional graphic depictions on the specific components of the larger health care debate.

The next few months will be "crunch time" for health care reform. If you want to see where the public stands on all the particulars of the debate, this is the place!