Public Support for Health Reform Increases in September, Reversing Summer Declines as Congress Takes Up Legislation

Survey Finds Support for New Proposals for Fees and Taxes on Insurance Companies to Help Pay for Overhaul

Public support for health reform ended its summer slide, reversed course and moved modestly upwards in September, according to the latest Kaiser Health Tracking Poll.

Fifty-seven percent of Americans now believe that tackling health care reform is more important than ever - up from 53 percent in August. The proportion of Americans who think their families would be better off if health reform passes is up six percentage points (42% versus 36% in August), and the percentage who think that the country would be better off is up eight points (to 53% from 45% in August).

Despite the uptick, a substantial share of the public (47%) favors taking longer to work out a bipartisan approach to health reform, compared to 42 percent who would prefer to see Democrats move faster on their own. Meanwhile, the public continues to view the action in Washington with mixed feelings: The largest share (68%) said they were "hopeful" about reform, but 50% are "anxious" and 31% "angry."

"Opinion in the coming months is hard to predict, but as the focus shifted from the town halls and hot button issues to the President, the Congress and the core issues in the legislation that affect people the most, the summer downturn in support was largely erased," said Kaiser President and CEO Drew Altman.

Upswing in Support Driven by Changes Among Republicans and Independents

Republicans and political independents became markedly more pessimistic about health reform in August, but those viewpoints softened in September. While 49 percent of Republicans say their family would be worse off if health reform passes, this is down from 61 percent in August. The percentage of independents saying they would be worse off fell from 36 percent in August to 26 percent this month.

Democrats remain overwhelmingly in favor of tackling health care now (77%), while most Republicans say we cannot afford to do so (63%) and independents are more evenly divided (51% in favor and 44% opposed).

Fifty-seven percent of the public - including 56% of independents - say the GOP is opposing reform plans more for political reasons than because they think reform will be bad for the country.

Majority Backing Seen for Taxing Expensive Health Plans and Imposing Fees on Insurers to Pay for Reform

Substantial majorities of Americans continue to say they back individual reform components designed to expand coverage, including an individual mandate (68%), an employer mandate (67%) and an expansion of state programs such as Medicaid and the Children's Health Insurance Program (82%).

The component that draws among the strongest support across the political spectrum is requiring that health insurance companies cover anyone who applies, even if they are sick or have a pre-existing condition. Overall, 8 in 10 people support that idea, including 67 percent of Republicans, 80 percent of independents and 88 percent of Democrats.

When it comes to paying for reform, two ideas now under discussion among policymakers garner initial majority support. Fifty-seven percent of the public say they would support "having health insurance companies pay a fee based on how much business they have" and 59 percent would support "having health insurance companies pay a tax for offering very expensive policies." In both cases, Republicans are evenly divided while Democrats and political independents tilt in favor. The poll did not test arguments for and against the policies.

Messages Matter

People say they would be more likely to support a new reform proposal if they heard it would:

    --  Improve health care for our children and grandchildren (77%);
    --  Provide financial help to buy health insurance to those who need it
        (74%);
    --  Help ensure the long-term financial health of Medicare (69%);
    --  Fulfill a moral obligation by ensuring that people don't have to go
        without needed health care just because they can't afford it (68%); and

    --  Mean that people with a history of illness would not be denied coverage
        and could get it at the same price as healthier people (65%).

Conversely, people say they would be less likely to support a new reform proposal if they heard that it would:

    --  Limit choice of doctors (65%);
    --  Reduce the quality of care provided to seniors under Medicare (63%);
    --  Result in payment cuts that might make doctors less willing to take
        Medicare patients (62%);
    --  Get the government too involved in your personal health care decisions
        (59%); and

    --  Increase people's insurance premiums or other out-of-pocket costs (57%).

Seniors Are Still Less Convinced Reform Will Benefit Them

Seniors are still less convinced than others that health reform will benefit them, but they too have become less pessimistic since August. The share of seniors who think their family would be better off if reform passes climbed 8 percentage points from August, from 23 percent to 31 percent. Twenty-eight percent thought they would be worse off, and 33 percent said it wouldn't make a difference. Fifty-five percent of seniors said they were "confused."

Some commentators believe that proposals to obtain savings in the Medicare program are driving opposition among seniors. The survey finds that a plurality of seniors (49%) opposed the idea of limiting future increases in Medicare provider payments as a way to help pay for health care reform. But a solid majority (59%) would back the same limits if they were framed as helping to "keep Medicare financially sound in the future."

"Some Medicare changes being discussed in the health reform debate can be seen as strengthening Medicare for the long-term or as harming it. Which of these messages breaks through could ultimately shape seniors' reactions," said Mollyann Brodie, vice president for Public Opinion and Survey Research at the Kaiser Family Foundation.

Many Say News Coverage Has Focused on Politics and Controversy

Health reform is the top story out of Washington, with news organizations ramping up coverage in recent months. In assessing the job of the media, 50 percent of the public says news coverage of health reform "has been mostly about politics and controversies," while eight percent say it has been mostly about "how policy reforms might affect your own family." Thirty-seven percent view the coverage as a balance of the two.

Fifty-four percent of the public report that they had seen an ad in the last seven days that had to do with proposed changes in the health care system, up from 45 percent in August and 21 percent in June. The public says that these ads have come fairly evenly from proponents and opponents of reform.

Americans Continue to Struggle with Unaffordable Health Care

While policymakers debate solutions, the problem of high health care costs remains. One third of Americans (33%) say they or someone in their household has had problems paying medical bills over the past year. That is up nine percentage points from August and represents the highest level this measure has reached in nearly a year.

A majority of Americans (56%) also say they have put off care over the last 12 months because of cost reasons, with many saying that they had relied on home remedies or over the counter drugs instead of seeing a doctor (44%), skipped dental care or other checkups (35%), or skipped a recommended medical test or treatment (28%).

Methodology

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.

The full question wording, results, charts and a brief on the poll can be viewed online at http://www.kff.org/kaiserpolls/posr092909pkg.cfm.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information, research and analysis on health issues.