Poll on Individual Mandate

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.

Dip in ACA Favorability

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.

Is Cook Right About ACA Being "Very Unpopular"?

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."

McKinsey Poll on Employers' Likely Moves

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.

How Americans Obtain Health Insurance (If They Have It)

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).

What Predicts Attitudes Toward Health Care Reform?

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).

Rasmussen on Support for Repeal

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.]

Blumenthal Has One-Year Follow-Up After ACA Passage

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

A View from Canada

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

NY Times Summarizes ACA Implementation

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.

Parsing Question-Wordings Used in Surveying on ACA Repeal

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.]

Blumenthal Analyzes ACA Opinion As GOP Assumes Power in U.S. House

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."