Washington Post Revisits Its Own Data (9/30)

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

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

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

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

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


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

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

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

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

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

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

Kaiser Foundation's September Poll (9/29)

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

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


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

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

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

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

Politico on Interpretive Difficulties

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)

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)

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.

Cost on Linkage of Public Opinion to Senators' and Representatives' Votes

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)

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.

Blumenthal on Aftermath of Obama Speech

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.

Silver with Two Recent Postings on Polling and Health Care

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)

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)

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)

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.

Blendon and Benson Summarize 22 Recent Polls

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.

Health-Care Polling Session at Netroots Nation

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

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)

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)

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)

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.