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