Americans’ Views of the
Uninsured Issue
Surveys developed in collaboration with the
Robert Wood Johnson Foundation and
Kaiser Family Foundation
Robert J. Blendon, Sc.D.
Kennedy School of Government
Harvard School of Public Health
The Insurance Status of the
Public vs. Voters
The Public1
85%
Insured
15%
Uninsured
Voters (2000 election)2
92%
Insured
Uninsured
Sources: 1 U.S.
8%
Census Bureau, CPS (2003); 2 Kaiser Family Foundation/Harvard School of Public Health, post-election
survey (Nov-Dec 2000).
Key Points
1)
Dissatisfaction with health system growing,
including concerns over uninsured
2)
Rising costs, Medicare, and uninsured top issues
3)
Driven by future fears/stories of uninsured
4)
Support for wide range of uninsured proposals
5)
However, support subject to challenges
– Public lacks knowledge
– Satisfied with own health care
– Divided over taxes
6)
When challenged, hybrid proposals do best
Dissatisfaction with Overall Health
Care in the Country Today
Health system (Fair or poor)1
58%
2003
1998
49%
Uninsured problem getting worse (last 2 years)2
2003
56%
Quality health care (dissatisfied)3
54%
2003
2000
44%
Source: 1 Employee Benefit Research Institute polls (1998, 2003); 2 Harvard School of Public Health/Robert Wood
Johnson Foundation/ICR poll (2003); 3 Washington Post/ABC News polls (2000, 2003).
Dissatisfaction with the Availability and
Affordability of Health Care
% saying not at all satisfied
100%
80%
60%
40%
30%
22%
20%
0%
December 2001
December 2003
Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR polls (December 2001, December
2003).
Most Important Issues for
Government to Address
Percent saying issue is one of two most important:
1.
Economy/Jobs
40%
2.
War/Defense
32%
3.
Health Care
16%
4(t).
Terrorism
11%
4(t).
Education
11%
6.
Foreign policy (general)
7%
7.
Medicare
6%
Note: May sum to more than 100% because each respondent was asked to give up to two
different answers.
Source: Harris Interactive poll (December 2003)
Most Important Health Care Issues for
Government to Address
Percent of Americans saying issue is one of the two most important for government
to address:
Cost
36%
Prescription drug
costs
General costs
21%
15%
Medicare
Uninsured or
inadequate
insurance/coverage
26%
21%
Note: Does not sum to 100% because many Americans mentioned other issues or said they
didn’t know.
Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003).
Public Worries about the Future
Worried might lose health insurance (among
insured)1
36%
Worried will not be able to afford health
care/health insurance2
58%
Think there will be rationing3
64%
Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (December 2003); 2 Harvard School of Public
Health/Robert Wood Johnson foundation/ICR poll (December 2003); 3 Washington Post/ABC News poll (October 2003).
The Uninsured in Media Polling
Put off Treatment for Serious Illness Last Year
38%
Uninsured
Insured
12%
Dissatisfied with quality of care received
Uninsured
Insured
33%
11%
Dissatisfied with ability to get latest treatments
Uninsured
Insured
41%
15%
Source: Washington Post/ABC News poll (October 2003).
Public Support for Ways to Guarantee Health
Insurance for More Americans
Expand
Medicaid/SCHIP
80%
22%
Employers required
to offer plan
Tax credit plan
Individual coverage
mandate plan
Universal Medicare
plan
Single national
government plan
76%
21%
71%
14%
54%
10%
55%
14%
47%
11%
General support
Top pick
Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003).
How negative arguments affect support for proposals to
cover the uninsured (1)
Expanding existing state programs
What if you heard that expanding
these programs would require
raising taxes to pay for the cost?
82%
55%
Employer mandate
What if you heard that it would be
so expensive that employers would
be forced to lay off workers?
76%
35%
Tax credits and deductions
for the uninsured
What if you heard that the amount
of tax relief would not be enough to
cover the cost of a private plan?
70%
36%
Initially favors
Favors after challenge
Note: Responses of Massachusetts adults
Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).
How negative arguments affect support for proposals to
cover the uninsured (2)
Legally requiring all residents
to have health insurance
56%
What if you heard that even with
the government’s help, people
won’t be able to afford insurance
and the law will cause financial
hardship?
22%
Single payer government plan
50%
What if you heard that you would
have to wait longer for some
hospital and specialty care?
30%
Initially favors
Favors after challenge
Note: Responses of Massachusetts adults
Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).
Public Preference:
Current System or Universal Coverage?
62%
38%
33%
Current system
Universal
coverage
Source: Washington Post/ABC News Poll (October 2003).
Universal
coverage, with
waiting lists for
non-emergency
treatment
35%
Universal
coverage, with
limited choice of
doctors
The Public’s Perception of How Well Various
Health Plans Are Run
46%
Private employer
plans1
30%
40%
Medicare2
31%
35%
Federal employees
plan1
52%
Health plan of the
Congress1
34%
51%
Well run
Don't know
Source:1 Harvard School of Public Health/ICR poll (2003); 2 Kaiser Family Foundation/Harvard School of Public Health poll
(2003).
Insured Americans’ Satisfaction with Their
Own Health Care
% satisfied
Health plan
performance (A or B
rating)1
72%
Quality of health
care received2
88%
Ability to get most
sophisticated treatment2
Out-of-pocket costs2
81%
64%
Source: 1Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2Washington
Post/ABC News poll (October 2003).
Americans’ Views About What Government
Should Do About the Uninsured
Percent saying the government should. . .
47%
37%
13%
3%
Keep things the
way they are
Make limited effort
to provide
insurance to some
of the uninsured,
would mean more
govt spending
Make a major
effort to provide
insurance, may
require a tax
increase to pay
for it
Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (June 2003).
Don’t know/
Refused
Conclusions/The Uninsured
•
Broad support for larger vision
•
Implementation over years
•
Hybrid plans best
•
Financing issues/toughest issue