The Public’s Health Care Agenda for the 112th Congress

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Though the public remains divided on health reform overall, opposition to the new law ticked upward in January as Republicans ramped up efforts to repeal it, according to a new survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.

The survey also showed that there is no groundswell of public support for overturning the law, that many individual components of the legislation remain popular across the political spectrum and that a majority of Americans oppose the idea of lawmakers using the appropriations process to defund or slow down implementation of the law.

The survey, fielded in the weeks prior to the House repeal vote, was conducted at a time of substantial change in the political landscape in Washington, as Republicans take control of the House and politicians of both major parties attempt to respond to public concerns over the rising federal budget deficit. While most Americans in the survey say they prefer spending cuts over new taxes as the main way to reduce the deficit, there is little public consensus about where to achieve meaningful savings and a majority opposes any spending reductions in two of the nation’s largest entitlement programs, Medicare and Social Security. Nearly half of Americans oppose any cuts in another major entitlement program, Medicaid. Large majorities oppose major reductions in all three programs.

"Budget experts say that the budget deficit cannot be tackled without taking on Social Security, Medicare and Medicaid spending, or by raising taxes," said Kaiser President and CEO Drew Altman. "But the American people do not believe this at all. There is a huge gap in basic beliefs and understandings of the problem and what it takes to solve it."

Mixed Views on Repeal, While A Majority Opposes Cutting Off Funding

The share of Americans with unfavorable views of the health reform law rose to 50 percent this month, up from 41 percent in December, while the share holding favorable views remained largely unchanged at 41 percent. Increasing opposition among independents drove much of the change. Fifty-seven percent of independents had an unfavorable view of the law in January, up sharply from 41 percent in December, suggesting that GOP messages about the need to repeal the law resonated with independents during this time period.

The public also is divided on what should happen next.  About as many people want to expand the law or keep it as it is (28% and 19%, respectively) as want to repeal and replace the law or simply just repeal it (23% and 20%).  Now that the repeal vote in the House is over, Republicans are expected to turn to efforts to defund and slow down implementation of the law through the appropriations process and other means. Yet the survey finds that most Americans (62%) disapprove of such a strategy.  Most Republicans (57%) favor defunding health reform in the absence of repeal, but most independents are opposed (62%) along with a large majority Democrats (84%).  Even among those who don’t like the law and want to see it repealed, about four in ten say they disapprove of cutting off funding.

"The public is frustrated with politics as usual, and may be saying that defunding a law is not how government should work," said Mollyann Brodie, senior vice president and director of the Foundation’s Public Opinion and Survey Research group.


The public’s concerns about the law are varied, and tend to vary by party affiliation.  More than half of Americans, including 81 percent of Republicans and 57 percent of independents, believe it will entail too much government involvement in the health care system.  Yet most Democrats, 58 percent, think it will lead to about the right amount of government involvement.  Also, despite the Congressional Budget Office’s findings to the contrary, 60 percent of Americans think the law will boost the deficit over the next decade -- a view common even among supporters of the law.

Component Parts of Health Reform Remain Popular
Despite such concerns, many of the law’s component parts remain popular.  Substantial majorities of Americans say they favor many of its provisions such as gradually closing the coverage gap known as the Medicare doughnut hole (85%), providing subsidies for low- and moderate-income Americans to buy health insurance (79%), establishing a voluntary insurance program known as the CLASS Act to help pay for long-term care services (76%) and expanding the Medicaid program (67%). Some provisions are less popular, including requirements that all but the smallest employers offer health insurance to their workers or pay a penalty (51% oppose this) and, most controversially, that nearly all Americans obtain health coverage or face a fine (76% oppose).

The survey shows, however, that public opinion about this last provision is somewhat malleable.  Told that without the requirement, insurance companies would still be allowed to deny coverage to people who are sick, unfavorable views fall from 76 percent to 47 percent.  On the other side, opposition rises to 85 percent when Americans are told that the requirement could mean that some people would have to buy health insurance they find too expensive or don’t want.

Most Want To Reduce The Deficit But Not With Big Cuts in Medicare, Social Security or Medicaid
About two in three Americans say they are "very concerned" about the federal budget deficit, including more than seven in ten Republicans and independents and fewer than half of Democrats.  There is a similar partisan divide over when Congress should tackle the problem, with most independents (61%) and Republicans (70%) saying lawmakers should act
quickly to reduce the deficit and most Democrats (61%) preferring to wait until the economy gets better.

Most Americans -- including majorities of Republicans and independents (76% and 59%) and a plurality of Democrats (39%) -- prefer spending cuts over tax increases as the main way to reduce the deficit.  But finding spending cuts the public will accept will be difficult for lawmakers.  Of the 12 areas of spending cited in the poll, the only one in which a majority of Americans say they are willing to support "major reductions" is the relatively small amount devoted to foreign aid. In addition, about four in ten would back major reductions in funding for the war in Afghanistan and in salaries and benefits for federal workers.

In contrast, a majority of Americans said they would support no spending reductions in Social Security (64%) and Medicare (56%), two entitlement programs that together account for about a third of all federal spending.  Nor do they want to see any reduction in spending for public education (63%).  Nearly half say the same thing about Medicaid (47%). Very small percentages of Americans support the "major reductions" that some believe are necessary in programs such as Social Security (8%), Medicare(8%) and Medicaid (13%), the survey found. 

This is true even among Republicans, just 18 percent of whom support major reductions to
Medicaid and 10 percent of whom support major reductions to Medicare and Social Security.
"The upcoming battle lines are clear," said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health.  "One side will argue we need across the board cuts in domestic spending to quickly reduce the deficit, the other that popular health care programs should not be cut even if the deficit is not reduced.  Which side will win is not clear."



Even among Republicans, who are more likely than Democrats and independents to back spending cuts, majorities say they would not support any reductions in Social Security (59%) and public education (53%). Moreover, 52 percent of Republicans want no reductions in funding for national defense, another major area of federal spending and one in which independents and Democrats would support some cuts.  When it comes to funding for expanding insurance coverage under the health reform law, 44 percent of Republicans say they would support major reductions while almost as many Democrats (38%) want to see no reductions.

The public’s reluctance to touch Medicare, Social Security and, when it comes to big cuts, also Medicaid may stem from the benefits, direct and otherwise, that people believe they confer on their families.  More than three-quarters of Americans rated Medicare as either "very important" (55%) or "somewhat important" (22%) to their families, while nearly six in ten said the same thing about Medicaid (39% "very important," 20% "somewhat important").  Sixty-eight percent of Americans say the country’s budgetary problems can be addressed without trimming Medicare spending at all.

Methodology
This Kaiser Family Foundation/Harvard School of Public Health survey,The Public’s Health Care Agenda for the 112th Congress, was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., including Claudia Deane, Liz Hamel, Sarah Cho, Bianca DiJulio, and Theresa Boston and by Professor Robert Blendon, Sc.D. and John Benson at the Harvard School of Public Health.  The survey was conducted January 4 through January 14, 2011, among a nationally representative random sample of 1,502 adults ages 18 and older.  Telephone interviews conducted by landline (1,000) and cell phone (502, including 203 who had no landline telephone) were carried out in English and Spanish by Social Science Research Solutions. The margin of sampling error is plus or minus 3 percentage points.  For results based on other subgroups, the margin of sampling error may be higher.

The full question wording, results, charts and a brief on the poll can be viewed online.

via kff.org