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Health-care reform polling poorly

Jon Cohn updates us on the state of health-care reform's polling:

The last few polls on health care reform have been discouraging. Public support for the Affordable Care Act does not seem to be rising. If anything, it seems to be falling, as a quick glance at Pollster.com will confirm.

The decline is relatively modest and you could plausibly explain it away as a reflection of views on other issues. (I.e., if people weren't so down on the economy, they wouldn't be so down on health care reform.) But you certainly can't argue that people are enthusiastic about reform these days, since the numbers were tepid even before the decline. In the latest CBS/New York Times poll, published on Wednesday, just 37 percent of respondents said they approved of the law, while 49 percent said they disapproved.

Still, if you dig deeper into the same poll, you'll find that public sentiment on health care reform is more complicated than those figures suggest. While 40 percent of respondents said they supported repealing the Affordable Care Act, more than half changed their minds (leaving just 19 percent in favor of repeal) when pollsters mentioned that it'd mean letting insurance companies exclude people with pre-existing conditions. ...

One other thing: When pollsters asked respondents if they'd be more or less likely to vote for a member of Congress that supported reform, 28 percent said more likely, 28 percent less likely, and 41 percent said it'd make no difference.

By Ezra Klein  |  September 16, 2010; 10:38 AM ET
Categories:  Polls  
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Comments

I think people remember what an ugly fight it was to pass health care reform. And yet, nothing has changed because most of the bill's provisions are delayed for several years.

Posted by: ideallydc | September 16, 2010 11:13 AM | Report abuse

I think the biggest problem is that, after a full year of debate and lots and lots of screaming, the public hasn't seen any results.

And mostly, what people want to see is their premiums/copays/prescription drugs cost less.

Frankly, people are egocentric. It's "nice" that 30 million more people have healthcare, but people are probably more concerned about how much their healthcare costs.

You want to influence coverage of healthcare? Have stories with Medicare recipients showing the $250 check to cover the "donut hole" in prescription drug coverage. How about stories (after 9/23) with people who no longer have to worry about pre-existing conditions for themselves or their children?

Posted by: msollot | September 16, 2010 11:15 AM | Report abuse

Then there are things like the 1099 provision that pop up and even the Democrats claim that they didn't mean to do that.

This plays right to the Republican narrative of a partisan bill that was rammed through by Pelosi, et. al.

Posted by: jnc4p | September 16, 2010 11:21 AM | Report abuse

The poll that I'd really like to see about health care reform is one that follows up on people's reasons for opposing it. Ask them what their main objection is, and then ask if they would support it if that objection were overcome. I suspect that a lot of the opposition is based on disinformation such as "death panels" and paying to cover illegal immigrants. It would be interesting to see where support would be if some of the lies about reform were removed from the equation.

Posted by: rashomon | September 16, 2010 11:35 AM | Report abuse

ACA must be explained as an integrated strategy. This has never been done. I have read through lots and lots of mainstream reportage on ACA, and it has never been explained. How many people do you meet who can tell you about how the state markets will work, and how they are likely to change things? This is the CENTERPIECE of the legislation, and you don't read anything about it. It will increase insurer competition and increase risk pools -- both cost-cutters. It starts out slow but eventually everyone will use them.

But all you read instead is banter (and a lot of phony arguments) over cost projections. If costs go up, but at a lesser rate, that is a cost savings -- but opponents have insisted costs must go down -- and any insurer who hikes costs now, is blaming it on Obama, and getting away with it. Just go read the comments under any Wall Street Journal article on healthcare -- it's an intellectual disaster zone. For example, they depend heavily upon the emotional theory that if there is a mistake or oversight (the 1099 thing for example), then this is an unalterable condition, and the whole law is fraught with uncertainty. This is what passes for "thinking" among citizens reading the mainstream media.

Note also that 12-13% of the population consistently opposes ACA because it isn't liberal enough, i.e. it doesn't have a public option to begin with. This is a lack that particularly rankles, because of the mandate. But 12-13% is larger than the spread against ACA in the Pollster chart here. These people may be staying home in the election, but if they come out, they won't be voting Republican.

It is remarkable that the Democrats have not paid any attention to this. It was foreseen months ago that explaining the law is a REQUIREMENT for approval of something which phases in very slowly. Democratic funders should get off their butts and do something. Here is an example of how it can be done:

http://www.youtube.com/leearnold#p/u/5/Tts2uTWt6e8

(If that doesn't show up as a hot link -- then highlight, copy, and paste it.)

Posted by: Lee_A_Arnold | September 16, 2010 11:40 AM | Report abuse

I'm not looking forwards to it as my dividend paying stocks are going to be taxed higher and that my insurance costs aren't actually going down.

Plus there is the whole consitutional debate over wether or not you can be forced to purchase something just be being alive. If that sets a precedent its not hard to imagine a slippery slope.

Posted by: abcd4 | September 16, 2010 12:16 PM | Report abuse

Hmmm, people don't like an unprecedented mandate to purchase a product from an unaccountable private monopoly. I'm as confused as Jon Cohn, I can't think of why that would be so.

Posted by: michaelh81 | September 16, 2010 12:28 PM | Report abuse

Ezra: you could do a considerable service if you would explain why Democrats used up all the (rather pathetic) fight they had in them to win something that is effectively not going to kick in until 2014.

No wonder it polls poorly. It doesn't exist if people can't see and feel it.

Posted by: janinsanfran | September 16, 2010 12:32 PM | Report abuse

@leeAArnold,


"How many people do you meet who can tell you about how the state markets will work, and how they are likely to change things? This is the CENTERPIECE of the legislation, and you don't read anything about it."

You know what it'll do. It'll do little for places like the Northeast. Our states already have all those requirements in place. My state of NJ already has unlimited lifetime maximum requirements, 100% coverage for preventative care etc.

What it'll do for those states that don't have that like say in the Midwest is it will increase their benefit levels, sure but it will then correspondingly increase costs (which liberals conveniently forget that there's no free lunch here when you've sold your lunch to the highest bidder (PHARMA).)

its nice that people won't have to stress about pre-ex anymore and that's a good thing. But then again people in MA have had that for several years and you know what they stress about now? the cost.

Posted by: visionbrkr | September 16, 2010 12:34 PM | Report abuse

There was a poll asking people if they would like to have a basket of fresh fruit from Harry and David delivered to their door every month, with a new fruit featured each month. Overwhelming numbers said, sure. Then they were asked if it was okay if their wages were garnished and their bank accounts connected directly to Harry and David, and they turned against the whole idea.

Posted by: truck1 | September 16, 2010 12:38 PM | Report abuse

Then there are things like the 1099 provision that pop up and even the Democrats claim that they didn't mean to do that.


Posted by: jnc4p | September 16, 2010 11:21 AM | Report abuse


jnc4p,

don't fool yourself. They meant to do it. They needed the revenues it brought in even if they never intend to collect them. Remember how many times last year they went back and forth with the CBO. I'd love to have been a fly on the wall in those conversations. And when its horribly over-budget they'll just blame Republicans. Its a nice little shell game.

Posted by: visionbrkr | September 16, 2010 12:40 PM | Report abuse

This morning I attended a benefits administrators conference in Fort Smith, AR put on by AR Blue Cross Blue Shield. Presumably it was to inform company HR folks how to handle the changes in health care reform.

In reality, the Blue Cross Blue Shield spokesman spent the first hour instructing us on how our companies could avoid compliance with HCR by "grandfathering" our BCBS health insurance policies -- by not making any changes to our existing policies or switching to another company. The powerpoint presentation included dozens of ways that we could get "in trouble" -- ie: threaten our "grandfathered" status and be forced to comply with the new law.

I believe I was the only one of about 50 attendees who understood that HCR is bad for medical insurance companies, and that the purpose of this conference was to transmit their belief to us, the company administrators and purchasers of AR Blue Cross, Blue Shield health insurance plans, in order to maintain the health insurance companies' status quo for as long as possible.

After listening to insurance company propaganda for 1 full hour, I walked out. I had expected to learn the benefits our employees would enjoy via the Patient Protection and Affordable Care Act. Instead, I learned about how to make BCBS of AR happy and profitable by rejecting "Obamacare."

Every day it's beginning to feel more like the United States of Corporate America. Very discouraging.

JP Ellen
jpel@cox.net

Copy to: whitehouse.gov

Posted by: jgau4 | September 16, 2010 1:48 PM | Report abuse

Visionbrker: "You know what it'll do. It'll do little for places like the Northeast."

Please direct us to the New Jersey website where the health insurers have listed their coverage in a standard format for easy price comparisons overall.

And, did the Massachusetts cost increases for individual coverage come in under the national average?

Or, are you repealing the laws of economics too? If there are state exchanges nation-wide, it immediately initiates a few things: (1) Based on a state insurance commissioner's okay, any insurer can enter provided they list their plans in a standard format. (2) Immediately introduces more competition, because any insurer providing the plans can enter any state. (3) Allows the building of much bigger risk pools, because any insurer providing the plans can enter. (4) Zero marketing cost, because you already know where to go to find all the information and eliminating a whole budget item for the healthcare insurers. (5) This savings in marketing costs gets passed on to consumers. (6) The uniformity of listing greatly reduces transaction-costs for consumers, who will find shopping and bargaining to be much easier.

In other words, it must reduce costs of several different kinds -- by definition -- and it may reduce costs even further than the analyses allow, because economists can't predict this sort of thing prior to having the consumer preferences actually acted upon in the new market. This is all basic market economics. YOu better believe the health insurers don't want this system. The wonder of it is that it was originally a Republican proposal.

You yourself don't have a realizable plan to deal with big pharma, so bringing it in as a cause to ditch Obamacare is disingenuous. What you fail to see is that once the country clears all the useless confusion over insurance out of the way, then the only things remaining for people to think about are the other cost drivers. Just collineating the state markets for health insurance is a step forward.

Posted by: Lee_A_Arnold | September 16, 2010 2:16 PM | Report abuse

The fear mongers are out in full force on this one. They have the ill informed believing all this pays for is black gangsters to have free health care while everyone else pays for insurance without any choice.
When anyone mentions "obamacare" to me, I ask them what provisions are going into affect first. No one can tell me. They don't know anything, except what they hear from certain talk shows.
I have worked in health care so I can go on the defensive very quickly.
I do bring up the pre-existing condition because that applies to my family, and if I lost my insurance no one else would insure me.
I believe if 2 things are addresses right now, the first 4 provisions at healthcare.org and the fear people have that they won't have access to what they need, it would go along way.
People are worried they won't have a choice to pick their DRS. If you you go to the hospital you see what ER doctor that is working, which hospitalist that is on duty, and what surgeon is available to do your surgery. There is not much choice when you really need help.
I recently saw a story about states that are bringing lawsuits against the act, applying funding from the act. Cafeteria politicians, picking and choosing what they like. It should not be allowed.

Posted by: bro2brady | September 16, 2010 2:29 PM | Report abuse

The poverty data released today also noted that the number of Americans without health insurance increased to 50.6 million in 2009, up from 46.3 million in 2008. Guess the pros of highlighting this stat and the need for and benefits of Pres. Obama's health insurance reform is overshadowed by cons of the negative poverty data.

The really scary part is that the data is for 2009. The data for 2010 (poverty and number of Americans without health insurance) may be even worse. Little wonder the blogosphere is still mulling over the release.

Posted by: tuber | September 16, 2010 3:15 PM | Report abuse

Democrat Gene Taylor has now signed onto H.R. 4972 (the Obamacare Repeal Act). He is the first Democrat to openly advocate total repeal of the PPACA.

Personally, I'm not certain repeal is necessary: simply ignoring the PPACA is probably sufficient. There really isn't a way the Obama Regime can "punish" the 60% of the population which doesn't want it.

Posted by: rmgregory | September 16, 2010 4:32 PM | Report abuse

My sense is that the reaction to health care reform is largely a proxy for feelings about the state of the economy.

As tuber points out many of the benefits of the reform haven't come online yet either.

On the other hand, I already know of one person whose life and family finances were likely saved by the ability of parents to keep kids on their plan into their mid-20s. (e.g. 24 year old diagnosed with cancer -- he will likely be OK, but he doesn't have insurance through an employer, and he would almost certainly be uninsurable between now and the time that the health care reform law comes on line).

Posted by: JPRS | September 16, 2010 6:43 PM | Report abuse

Stuck right in the middle of that CBS poll area number of questions, from 48 to 63, with a rat5her good bit of news for the democrats. With the exception of a question about which party would be more likely to reduce the deficit, and one on national Security, where the numbers say more about the voters themselves than the voters attitudes, each question finds that, "Regardless of whom you vote for which party would do a better job of..."

On the Economy, Jobs, and ten other subjects, the dems hold a non trivial to large edge over the Republicans. And the two questions that the Republicans WIN, Reduce the Deficit, and defeat terrorism, the numbers suggest a poll somewhat over representative of republicans that it should be, and somewhat underrepresentative of Democrats.

On the usual questions of approve/disapprove, the questions obviously have to add disappointed Democrats to angry Republicans, so don't properly predict voter behavior in November.

This poll is a real indicator that the Dems are in fact doing much better than the Pollsters want to report.

Posted by: ceflynline | September 16, 2010 6:59 PM | Report abuse

Lee,

NJ reform IN 1994 enacted five basic plans in the Individual and small employer markets (2-50 employees) (A, B, C, D and an HMO equivalent). They all have to have certain minimum benefit levels (kind of like the exchanges will have) but insurers can offer more than that if they choose to try to differntiate themselves.

Read the attached. i would expect many states have similar info on their own state depts of insurance websites.

http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcmain.htm

here also there are price comparisons and options for NJ Family care if you make under a certain income.

http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates.htm


And its not about bad mouthing Obamacare as you put it. PPACA should have told Pharma that you only get 5 years of brand name to generics. Instead they got 12 when Obama wanted 7. google the "eshoo amendment" and see what that Democrat did to raise the future cost of healthcare for biologics to price them out of the range of all but the ultra wealthy. Its not often I agree with Jane Hamsher, but here I do.

Posted by: visionbrkr | September 16, 2010 7:39 PM | Report abuse

JPRS,

again people don't understand the law. HIPAA (a law from 1996) would have helped that individual just as much as the dependent to age 26 provision. HIPAA allowed for coverage to continue in instances like that with no possibility of pre-ex if there less than a 62 day lapse in coverage. That individual would NOT have automatically been subject to pre-ex.

I don't blame you because you don't know that and I'm glad for that individual that they are going to be OK but again the lack of understanding of not only PPACA but HIPAA is a major problem that even the well educated can't seem to get past for some reason.

Posted by: visionbrkr | September 16, 2010 9:14 PM | Report abuse

Visionbrkr: You're right, the New Jersey page is a good example. A specimen page is here:

http://www.state.nj.us/dobi/division_insurance/ihcseh/ihcratepage_sp.pdf

Now, it doesn't allow everybody to get in, and neither I think does ACA, at first. But finally, when you have all companies listing in an identical format in all states, with free entry and exit of every firm and every consumer, then you are effectively on the way to one national efficient market, with every state commissioner's blessing.

Obviously it will take years. But we can only guess at the true price of healthcare until everybody is in the same market because we cannot have an efficient market until all the supply and all the demand is in the bidding.

Further, economics shows time and again that this maximum market will allow the largest economies of scale, such as risk pooling, lower marketing costs and so on, which will be larger than New Jersey can realize on its own. So the market part of ACA by itself will provide savings to the Northeast eventually, beside the other cost controls in ACA which are not in Massachusetts or New Jersey, such as computerization of records, cost effectiveness treatment reviews, and the like. Once we add it all together, if it's not everything necessary in cost control and it doesn't work, then obviously Pharma will be revisited sooner rather than later. I'm betting sooner for another reason, which is that we are finally at the correct mix of science and tools for medical productivity: biotech, nanotech, computation and genomics, and further innovation in this brew is going to be held back by the extended patent protections and undeserved rents to the patent holders. In the end, though, I feel that the only approach which has a political chance of succeeding is a piecemeal approach like this one.

Posted by: Lee_A_Arnold | September 17, 2010 12:45 AM | Report abuse

Lee,

that's all fine and good but NJ's rates are among the highest in the country. Do you know why? Because a whole lot of stuff is covered. From autism treatment to baby forumla. And you know what, that stuff costs MONEY. There are no free lunches. You can nip at the edges with some of this stuff but until you get to the true cost drivers which are doctors and to a much smaller extent now but a larger extent in the future Pharma then you're treading water.

oh and ezra used to talk about it a lot more but obesity is a HUGE cost driver (no pun intended).

oh and btw the exchanges are not national. They're regional at best which I honestly think is a good thing. Mississippi can't afford what NJ wants in its benefits and NJ doesn't want to reduce its benefits to what Mississippi can afford. How you like to be a parent of a child with autism that was getting it covered in NJ now because of a law that passed a few years back and then WHAM-O, national exchanges take effect and no coverage for autism. I wouldn't be too happy about that.

Posted by: visionbrkr | September 17, 2010 11:36 AM | Report abuse

Visionbrkr: "NJ's rates are among the highest in the country"

As far as I can tell, they are around $100-200 per month more than California rates on comparable coverage, but Californai is a far bigger market to amortize. NJ rates should be much higher.

Visionbrkr: "until you get to the true cost drivers"

As always, the next question is, what's your real plan. No impossible wishlists, please.

Visionbrkr: "oh and btw the exchanges are not national"

No, but the entry and exit of national insurers into each market appears to be much easier, while preserving the overview of state commissioners even if they don't choose the Wyden opt-out, as the case may be. And that is one big step closer to a rational market, and then we'll be closer to affording treatment to autistic kids in every state.

Posted by: Lee_A_Arnold | September 17, 2010 1:59 PM | Report abuse

Lee,

the only way to get the cost drivers down is to do what other countries that control costs do. Dr Smith, you get paid "x" for an office visit and "y" for colonoscopy, etc. Oh and good luck with getting that by the AMA. Once you've spoiled them rotten you can't just as easily take away.

The entry and exit will again be biting at the edges. In NJ we have about 5 insurance companies (years ago we had 10). It'll give more options but if they're still paying doctors 20% more every year and hospitals the same then where exactly is the savings?

Another problem is the fact that its so customer centered now and doctors are taking advantage of that. There should be a federal law that says a doctor cannot profit from sending someone to get a test or work done. that would save serious money too.

Posted by: visionbrkr | September 17, 2010 2:43 PM | Report abuse

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