Fall 2010 Attitudes Toward Health Care Reform and its Possible Repeal

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

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

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

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

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

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."

Aftermath of Announced Premium Hike

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.

Cornucopia of Health Care Polling Reports

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

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.]

Cohen, Newport, and Klein on Health Care Public Opinion

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

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)

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.

Silver Analyzes Open-Ended Survey Data

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.

PolitiFact on Boehner's ACA Claim

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.

Update on Bills Post-Massachusetts Senate Special Election

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).

Omero on Massachusetts Special Election

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.

Where Things Stand Pre-Massachusetts Special Election

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.