Resurgent Republic Looks at Self-Insured Voters

The conservative-leaning group Resurgent Republic examines the demographic and attitudinal characteristics of self-insured voters, that is, those who purchased their own (pre-Obamacare) coverage on the individual market, rather than getting it from an employer. Though these individuals appear to have attributes favorable to the Republicans -- well-off economically, more likely to live in suburbs than cities -- they did not support the GOP in 2012 as strongly as they might have. The piece concludes that, "If Republicans can effectively speak to the anxiety caused by Obamacare, they’ll find an attentive audience, especially in battleground 2014 states."

I have a few quibbles and comments on the Resurgent Republic analysis. First, the article notes that, "Three-fourths (77 percent) of those self-insured are either very or somewhat satisfied with their plan." The "anxiety" alluded to above thus would stem from such highly satisfied customers having their policies cancelled. I would have liked to see the breakdown into the separate choices of "very" and "somewhat" satisfied. Second, by some estimates, roughly half of people who had their individual policies cancelled will pay less for replacement policies, which provide greater benefits. Assuming the glitches with the purchasing websites are rectified sometime soon, individual-market voters may not react as negatively to having to change insurance policies as the article suggests. Finally, Resurgent Republic cites "sticker shock" estimates from the Manhattan Institute. The Washington Post's Ezra Klein argues here that the Manhattan Institute figures are flawed.

Washington Post-ABC Poll Latest to Show Increasing Popularity of Obamacare

Continuing a trend that I began discussing here, the latest Washington Post-ABC News poll shows an uptick in support for the Affordable Care Act (aka Obamacare). Three times in 2013 has the Post-ABC asked the question, "Overall, do you support or oppose the federal law making changes to the health care system?" Here are the results...

Post-ABC	July	Sept	Oct
Support	42	42	46
Oppose	49	52	49
Difference	-7	-10	-3

According to this Post article accompanying the poll, "Support has rebounded since July among moderate and conservative Democrats, while Republican opposition has also softened."

The improvement may only seem like a few percentage points. However, the fact that two other recent polls -- NBC/Wall Street Journal and Democracy Corps -- have also shown an uptick in support for the ACA suggests the change is likely authentic (for now, at least).

The rise in support seems surprising in the context of difficulties with the federal website for people to sign up. However, some of the state websites (where such are available) seem to be working well.

The larger driver of public opinion toward Obamacare may be the unpopularity of the Republicans' actions during the recent federal-government shutdown. Paradoxically, in seeking to register their staunch opposition to the ACA, the GOP may actually have made it more popular! It is perhaps for this reason that former Florida Gov. Jeb Bush, a Republican, was calling on his party to exercise more "self-restraint."

Demographic Differences in Pew Poll

The Pew Research Center is out with a new poll (in the field October 9-13), gauging public reactions to the second week of the roll-out of the online Obamacare marketplaces. The overall sample views the roll-out unfavorably. To the question "How well are online health insurance exchanges working?," 46% answered not too well or not at all well, whereas only 29% said very or fairly well (the rest said "don't know"). Young adults (18-29), who are getting a lot of media attention on the health-care issue, are split at 37-37 between the relatively favorable and unfavorable responses.

Uninsured people with incomes too high to qualify for Medicaid need to consult the exchanges in order to fulfill the individual mandate to have health insurance. Some people with insurance may be interested in whether the exchanges offer a better deal that what they currently pay. The survey found that nearly two-thirds of the uninsured either have visited (22%) or plan to visit (42%) the exchanges; however, with the subsample of uninsured people numbering only 181, the margin of error is around +/- 7, a wider-than-usual interval. Among those with insurance, around one-third either have visited (12%) or plan to visit (19%). An interesting, even paradoxical finding is that:

Among those who have visited an exchange website, more say the exchanges overall are not working well by a 56%-37% margin. Yet when asked about their own experience on an exchange website, a 56% majority say they personally found the site to be very or fairly easy to use, while 40% say it was difficult to use.

Democracy Corps Poll Shows Good News for ACA Supporters

Democracy Corps, a polling/advising group headed by Democratic Party stalwarts Stan Greenberg and James Carville, has released a new health care survey in conjunction with the organization Women's Voices, Women's Vote (hat tip to Political Wire). Although clearly party-aligned, Democracy Corps has a good record for accuracy, nailing President Obama's four percentage-point victory margin last year over Mitt Romney. The newly released health care poll was in the field October 6-8, coinciding with the early stages of both the roll-out of the Obamacare online exchanges and the government shutdown. To see the full set of poll results, go here first. You'll then be able to click on links for results in the form of memos, the questionnaire, and graphs.

The report is entitled "38 Percent," referring to the estimated proportion of American voters who "clearly oppose the Affordable Care Act." Democracy Corps presents results for both its total sample (which appears to be comprised of registered voters) and a likely-voter sample. The results are very similar for the two samples, so I'll just cite figures for the total sample.

On the initial item assessing attitudes toward "the health care reform law that passed in 2010," support and opposition each drew 45% of respondents. However, subtracting respondents who answered on a subsequent question that they opposed the ACA because it "doesn't go far enough," one ends up with the aforementioned figure of 38% assumed to dislike Obamacare for conservative reasons.

Several other findings are worth noting:

• Despite the tendency of some to jump to quick conclusions, the American public seems in large part to hold a wait-and-see attitude toward the ACA. Among four possible answer choices on current perceptions of the law, 46% of respondents said it was "too early to tell" how things would turn out, 20% saw it as making things "harder for me," 17% said they could not yet see any ways in which the law was helping, and 14% were "beginning to see benefits."


• Positive shifts in attitude toward the ACA were seen in several subgroups from 2010 to the latest poll. For example, White voters without a college education, who have been generally hostile to Obama, have gone from hating the law in 2010 (opponents outnumbering supporters by 31 percentage points) to merely being in sizable opposition (opponents being more numerous by 18 percentage points). White older women have gone from -23 to only -4. And groups that were moderately supportive have become wildly supportive, such as unmarried women, who shifted from +9 to +29.


• Good will toward the ACA appears premised to a large extent on the idea that the law can and will be refined and improved over time. That is how I read the results of a mini-experiment embedded within the Democracy Corps survey, at least. Some respondents were asked to choose between "We should implement and fix the health care reform law" and "We should repeal and replace the health care reform law." The clear winner was the "implement and fix" alternative, 58-38 percent. However, when the choice (given to a different set of respondents) was between "We should implement the health care reform law" (without reference to fixing the law) and "We should repeal the health care reform law," repeal was preferred 51-46.

This new Democracy Corps/Women's Voices, Women's Vote poll follows two other recent ones seemingly showing an upturn for the ACA: a late September survey by The Morning Consult/Survey Sampling International; and an NBC/Wall Street Journal poll showing that the amount by which the ACA was "underwater" (percentage saying it was a "bad idea" exceeding the percentage saying it was a "good idea") had shrunk from 13 percentage points in September to only 5 percentage points in October.

Whether people really are becoming more favorable toward the ACA/Obamacare is questionable, especially with the prolonged difficulties people are having using the websites to sign up. Another possibility is that the disrepute into which the Republicans have fallen over the government shutdown has transferred over into disdain for positions held by the GOP (such as opposition to Obamacare).

First Polling Results on Roll-Out of Exchanges

Based on news reports since the October 1 opening of the online health-insurance exchanges, two dominant -- and likely inter-related -- themes have been the high volume of response and the technical glitches plaguing the federal exchange site, healthcare.gov. Where governors opted to have their respective states create their own exchanges rather than having their citizens use the federal site as a fallback, there seems to be variation in how smoothly the websites are working (compare, for example, New York to Maryland).

Here at the Health Care Polls blog, we're interested in public opinion toward, and reaction to, the Affordable Care Act and its component parts, such as the exchanges (also known as marketplaces). And we now have what is, to my knowledge, the first major survey on the topic, from AP-GfK. The poll was conducted from October 3-7, thus gauging immediate reaction to the unveiling of the exchanges. A Huffington Post article on the poll is available here, whereas the AP-GfK technical report is here.

AP-GfK surveyed 1,227 adults, for which the margin of error (MoE) is said to be 3.4 percentage points for the 95% confidence level. According to the Huffington Post article:

Overall, the poll found, 40 percent of Americans said the launch of the insurance markets hasn't gone well, 20 percent said it's gone somewhat well and 30 percent didn't know what to say. Just 7 percent said the launch had gone "very well" or "[extremely] well."

(The article had a typo about the final 7 percent, which I corrected based on the technical report.)

Seventy-six individuals from the original 1,227 respondents, or 7%, reported that they or someone in their household had "tried to sign up for health insurance coverage through this market." With the stated 3.4% MoE around the 7% estimate, we could say (assuming accurate responses) that between 3.6 and 10.4 percent of the U.S. public as a whole had tried the exchanges.

However, the MoE varies slightly depending on whether the sample is relatively evenly divided on an issue (e.g., 50/50, 55/45) or relatively unanimous (e.g., 90/10), with the margin being smaller (more precise) the closer to unanimity. My impression is that pollsters usually report the MoE assuming a 50/50 breakdown on the survey items, so if AP-GfK did so, then the MoE around the 7% who claimed to have used the exchanges would be tighter than 3.6 to 10.4 percent.*

Those 76 exchange users were asked a variety of questions. Quoting from the above-linked Huffington Post article, "Among those who've actually tested out the system, three-quarters of those polled said they've experienced problems trying to sign up. Only about 1 in 10 succeeded in buying health insurance." As the same article notes, however, the MoE for responses of just these 76 people is a whopping +/- 13.5%. Now that AP-GfK has provided an initial estimate of the proportion of Americans using the exchanges, they and other pollsters might consider obtaining oversamples of exchange users in future surveys, so that estimates from this group can have greater precision.

One area in which the AP-GfK poll appears to be somewhat out-of-whack is the 37% job-approval rating for President Obama, compared to other polls from around the same time that peg the President's approval between 40-51%. Assuming that attitudes toward the Affordable Care Act and the exchanges are correlated with support for Obama, then evaluations of the ACA and exchanges may be biased somewhat in a negative direction by the AP-GfK poll.

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*The margin of error with 95% confidence is calculated from:

+/- 1.96 X square root (pq/n)

where p = the percentage of respondents who answered in one way (e.g., "yes" on a yes/no question), q = the percentage who answered with the other choice, and n = sample size. (Readers with some statistical training may recognize +/- 1.96 as the values that cut off the upper and lower 2.5% of the "bell curve" distribution, thus leaving 95% of the distribution.)

Using the AP-GfK's reported sample size of 1,227, a 50/50 division on a question (i.e., p and q each equal .50), would yield a margin of error of:

1.96 X square root (.25/1,227) = .028 or 2.8%

(I do not know why there is the slight discrepancy between AP-GfK's reported MoE of 3.4% and my calculation of 2.8%; if AP-GfK has a cluster-sampling component to its work, that would raise the MoE.)

Anyway, using the conventional MoE formula with a breakdown of .07 and .93 for usage vs. non-usage of the health-insurance exchanges, the calculation is...

1.96 X square root (.065/1,227) = .014 or 1.4%

An online margin-of-error calculator, which corrects for population size, is available here. You might enter 200,000,000 for the population size, which is roughly how many adults there are in the U.S. With any large population, the middle term in the larger equation tends toward 1, so has no effect when used to multiply the other elements of the equation.

Harry Enten Reviews Poll Findings on the ACA/Obamacare

Via HuffPost/Pollster, Harry Enten gives the latest health-insurance polling a good vetting.

New Poll from "The Morning Consult"

Via Political Wire, I learned of a new poll on attitudes toward the Affordable Care Act. The poll was released by a publication call The Morning Consult, with surveying done from September 25-28 by Survey Sampling International. I was not previously familiar with either of these entities. As best I can tell, the Consult is a business-oriented, center-right outlet. Its founder, Michael Ramlet, is described on this webpage as having done some work for Republican organizations and being affiliated with the bipartisan Purple Strategies group.

Regarding TMC/SSI's methodology, the poll's report claims that, "The interviews were conducted online... The data were post-stratified to match a target sample of registered voters based on age, race, gender, education and region." Post-stratification is a form of adjusting the amount of weight given to different demographic groups, to make the sample as a whole conform to known population parameters (e.g., from the U.S. Census).

According to the TMC/SSI report, 48% of respondents approve of "the health care legislation passed by Barack Obama and Congress in 2010" (21% strongly, 27% somewhat). The overall approval reported by TMC/SSI is thus about 10 percentage points higher than obtained by other recent polls. TMC/SSI provide extensive subgroup statistics, so we can look "under the hood" a bit at their recent poll. Partisan composition of the TMC/SSI poll certainly raises some questions:

519 Republican-leaning respondents (26.3% of sample, of whom 15% support ACA)
836 Democratic-leaning respondents (42.3% of sample, of whom 75% support it)
620 Independent respondents (31.4%, of sample, of whom 38% support it)

The TMC/SSI party-ID numbers are clearly out of whack with those of other survey firms. If one looks at HuffPost/Pollster's party ID averages (using the selection tool to limit the results to registered-voter samples, which is what TMC/SSI used), the percent of Americans identifying as Democrats is 37.9% and the percent identifying as Republicans is 33.7%, dramatically closer to each other than in TMC/SSI's partisan breakdown.

Relative party-ID proportions are not the only reason TMC/SSI reports higher approval for the ACA than do other polls. Even looking at self-identified party subgroups one at a time, TMC/SSI shows greater support for Obamacare in some instances than do other pollsters. Take, for example, a recent CNN/Opinion Research Corporation poll, which found 38% approval overall for the law. Approval from self-identified Democrats was virtually identical in the TMC/SSI (75%) and CNN/ORC (74%) polls. However, self-identified Republicans reported greater support to TMC/SSI (15%) than to CNN/ORC (7%). The same pattern occurred among self-described Independents: 38% approval in the TMC/SSI poll vs. 27% in the CNN/ORC survey.

Having said all of this, what first caught my eye about the TMC/SSI poll was response to the item, "What would you like to see Congress do when it comes to the health care law?" Response options were: "expand the law," "let the law take effect," "make changes to improve the law," "delay and defund the law," and "repeal the law." Among the full sample, a collective 67% endorsed the first three alternatives, all of which seem, at the least, accepting of the ACA (even the third category, though not representing a ringing endorsement, conveys a "mend it but don't end it" outlook). The two most anti-Obamacare categories -- delay/defund and outright repeal -- together comprised only 33% of the sample.

One way to put the apparent Democratic slant of the sample aside and escape the partisan lens is to focus directly on Independents. Among Independents, the combined percentage advocating delay/defund and repeal is only 37%. In contrast, 63% favored one of the supportive/accepting alternatives.

It would be interesting to see more pollsters offer the "make changes to improve the law" response option to their participants.