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.