July 30, 2009

Obama’s Ratings Slide Across the Board

Section 4: Health Care Overhaul

Public Generally Opposes Health Care Proposals

Public attention to the health care overhaul debate in Congress continues to grow. This week’s Pew Research Center News Interest Index survey finds that, for the first time, the health care debate in Washington is the public’s top news story. When asked specifically about the bills in Congress to overhaul the health care system, 41% say they have heard a lot about the bills, 47% a little, and only 10% have heard nothing at all.

The public’s current impression of the health care legislation before Congress is more negative than positive. By a slim margin, more Americans say they “generally oppose” (44%) the health care proposals being discussed in Congress right now than “generally favor” them (38%); 18% offer no opinion.

Americans who say they have heard a lot about the health care bills in Congress oppose them by a wide margin (56% to 36% margin. Those who have heard little or nothing about the bills are divided about evenly (40% favor, 35% oppose) with 24% offering no opinion.

Not surprisingly, there is a huge partisan divide on the issue of health care reform. Republicans oppose the health proposals being discussed in Congress by a 76% to 12% margin; Democrats favor them by a 61% to 20% margin. There is currently more opposition (49%) than support (34%) among independents.

These partisan divisions are magnified among Americans who are tracking the issue closely. Republicans who have heard a lot about the health care proposals more universally oppose them than those who have heard a little or nothing at all (87% vs. 65%). And nearly three-quarters (72%) of the Democrats who have heard a lot about the proposals favor them compared with 55% of the Democrats who have heard little or nothing.

But, critically, increased attention to the health care legislation among independents is associated with more opposition, not more support. Independents who have heard a lot about the bills oppose them by a 70% to 27% margin. Independents who have heard little or nothing are divided evenly (38% favor, 35% oppose). Overall, the more attentive independents have a lot more in common with Republicans than with Democrats when it comes to the current legislation in Congress, which tips the overall public balance of opinion in the direction of opposition.

Besides party, income level and whether respondents have health insurance are factors in opinions about the health care legislation being debated on Capitol Hill. More people with higher family incomes oppose the health care proposals than favor them (51% oppose, 35% favor), while those with family incomes less than $30,000 are more divided (44% favor, 36% oppose). Nearly half (48%) of those with health insurance oppose the proposals, compared with only 30% of those who don’t have insurance, a plurality (44%) of whom favor the health care proposals being discussed in Congress. There are also some differences in opinion by race and age but no significant differences by gender or education.

In general, groups that, on balance, oppose the health care legislation tend to do so by substantially larger margins than groups that favor such legislation. For example, Republicans oppose the legislation by a 64-point margin (76% oppose, 12% favor) while Democrats favor the legislation by a 41-point margin (61% favor vs. 20% oppose). The same is true along income lines, with those earning $75,000 or more opposing the bills before Congress by a 16-point margin (51% oppose vs. 35% favor) and those earning less than $30,000 favoring the proposals by a slim 8-point margin (44% favor, 36% oppose). Even when it comes to age, people age 65 and older oppose the reforms before Congress by a 19-point margin (48% oppose vs. 29% favor), while Americans under age 30 are almost evenly divided (44% favor, 39% oppose).

Costs and Government Involvement Biggest Concerns

Two concerns are offered most frequently by people who say they oppose the health care legislation before Congress: the cost and the extent of government involvement. About a quarter (26%) of those who oppose the current reform bills cite the cost and impact on the budget and taxes as the main reason they are against the legislation. Another 18% say the changes would lead to too much government involvement and bureaucracy. A smaller number oppose the current proposals because they believe they would reduce health care quality and access, while restricting people’s choices. There are also expressions of skepticism about the political process: 8% say the bills are too complex and haven’t been explained clearly and 4% express distrust of Congress, Obama and the political decision makers involved.

Of those who favor the health care proposals being discussed in Congress, 42% cite the prospect of providing universal health coverage or covering more people as the reason for their opinion. Another 14% say controlling costs and affordability are the main reasons they back a health care overhaul, while 13% refer more generally to the need for some kind of change.

Public Supports Addressing Many Health Care Reform Goals

While there is more skepticism than support when it comes to the overall proposals before Congress, many of the specific elements being discussed are broadly favored. More than three-quarters (79%) favor requiring insurance companies to sell health coverage to people, even if they have pre-existing medical conditions, and 65% favor requiring that all Americans have health insurance with the government providing financial help for those who can’t afford it. A slim majority (52%) also favors a government health insurance plan to compete with private health insurance plans, while 37% oppose a government option.

The public is more divided in opinion about the various ways to pay for changes to the health care system. A majority (63%) favors raising taxes on families with incomes of more than $350,000 and individuals earning more than $280,000. A similar number (61%) favors requiring employers to pay into a government health care fund if they do not provide health insurance coverage to their employees.

However, 62% oppose taxing employees whose health insurance benefits are above a certain value. A majority (58%) also opposes tighter restrictions on what medical procedures Medicare and Medicaid will cover.

Partisan Division on Health Care

On virtually every proposal tested, Democrats are substantially more supportive of change than Republicans. The widest gap is over the proposal to mandate insurance with government assistance to those who can’t afford it – something 87% of Democrats favor compared with 41% of Republicans. Independents fall between, with 60% supporting this idea.

Developing a government health care option is also divisive, with 66% of Democrats, 50% of independents and only 36% of Republicans favoring the idea. There are similarly wide divisions over the proposal to tax higher income households as a means to pay for changes to the health care system and requiring employers to pay into a government health fund if they don’t provide insurance for their employees.

There are only a few areas of relative agreement across party lines. Most Democrats (87%) Republicans (72%) and independents (76%) favor requiring insurance companies to cover those with pre-existing conditions. And there is virtually no partisan difference on tightening what medical procedures are covered by Medicare and Medicaid, something which few Democrats (37%) Republicans (31%) or independents (29%) support.

The less affluent are more supportive of three of the key proposals than wealthier Americans. Nearly three-fourths (74%) of those earning less than $30,000 favor requiring Americans to have health insurance if the government provides financial help for those who can’t afford it, compared with 60% of those earning $75,000 or more. There is a similar difference on the issue of raising taxes on individuals and families with high incomes (70% with family incomes of $30,000 or less favor this compared with 57% of those earning $75,000 or more). There is a slightly smaller difference on the issue of requiring employers to pay into a government health care fund; 66% of those earning $30,000 or less favor this proposal, compared with 58% of those earning $75,000 or more.

Attentive Independents Skeptical of Most Reform Proposals

How much people have heard about the bills before Congress is a factor in how they evaluate the various proposals. This is especially true for Republicans and independents; and in both cases those who are hearing the most about the reform proposals express more opposition to the proposals now before Congress. This is not surprising when it comes to Republicans – as more attentive partisans often track with their party’s positions more strongly. But the fact that independents who are hearing more tend to agree with the Republicans is a notable pattern.

For example, independents who have heard a lot about the health care proposals are divided in their opinions about requiring Americans to have health insurance (47% favor and 47% oppose). But among independents who have heard little or nothing overall, 68% favor this idea while only 26% oppose it. A similar pattern is evident on the issue of a government health insurance plan; 57% of independents who have heard a lot oppose this proposal while 58% of those who have heard less favor it.

Independents who have heard a lot are also more likely to oppose various ways of paying for health care reform. At least half of independents who have heard a lot about the proposals oppose raising taxes on the wealthy (53%) and requiring employers who don’t offer health insurance coverage to pay into a government fund (50%), while majorities who have heard a little or nothing favor these ways of paying for health care reform.

Reps Trust Private Insurance Companies; Dems Trust the Government

By a slim margin, the public trusts private insurance companies more than the government when it comes to deciding what kinds of medical procedures should be covered by health insurance (38% vs. 32%). Nearly one-in-five (19%) say they trust neither, another 2% volunteer another response and 8% are unsure.

About six-in-ten Republicans (61%) trust private insurance companies compared with only 14% who trust the government when it comes to deciding what medical procedures health insurance should cover. Conservative Republicans are even more likely to trust private insurance companies (67%) than moderate to liberal Republicans (51%).

By comparison, nearly half (49%) of Democrats trust the government, including 43% of conservative to moderate Democrats and 61% of liberal democrats. About a quarter (27%) of Democrats says they trust private insurance companies more than government. Independents are more divided: 36% say they trust private insurance companies more and 30% say the government.