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Post-Election Survey: Priorities for the 106th Congress – News Release

Voters Say Medicare Top Health Issue For New Congress

Embargoed for release until: Thursday, January 14, 1999

For more information contact: Matt James or Missy Krasner: (650)854-9400

Best Chance for Bipartisan Voter Support in Health on Patients’ Rights

Washington, DC — A new survey conducted immediately after the election by The Kaiser Family Foundation and Harvard School of Public Health has found that health issues rank high on the voters’ list of top priorities for the new Congress. Of sixteen issues voters were asked about, seven – including three health issues – were identified by at least half of voters as top priorities: keeping Social Security financially sound (80%), keeping Medicare financially sound (73%), helping the uninsured get coverage (61%), passing tougher anti-crime laws (60%), establishing federal education standards for public schools (55%), HMO/managed care reform (54%) and cutting taxes (50%).

However, as in the past, when specific solutions are offered on health care issues, little consensus is found among voters. The survey finds substantial partisan differences between Republican and Democratic voters on policy options, suggesting that enacting major health legislation during the next session may be difficult. The lone exception is patients’ rights legislation, where there is more bipartisan support among voters for action.

Medicare and Social Security

Both Republican and Democratic voters list keeping Social Security and Medicare financially sound as their top priorities, but there is little agreement among voters about what should be done. For example, while 52% of those who voted Democratic in the congressional elections say they would be in favor of using the Federal budget surplus to help make Social Security and Medicare financially sound, 38% of those who voted Republican favor this proposal.

Among the major Medicare reform proposals voters were asked about, only one – reducing the payments made to doctors and hospitals for treating Medicare patients – gains the support of voters in both parties. Fifty-nine percent of voters support reducing provider payments, including 60% of Republican voters and 59% of Democratic voters. On the other hand, voters do not support requiring seniors to pay a larger share of Medicare costs out of their own pockets (81% of all voters opposed), raising the age of Medicare eligibility from 65 to 67 (65% opposed), or increasing payroll taxes that workers now pay to fund Medicare (55%). Voters from both parties are opposed to these proposals, suggesting that any effort to gain voter support for significant changes in Medicare will be difficult.

Consensus may also be hard to find over proposals to reform Social Security. When asked about a proposal that would allow retirees to invest some of their social security payroll contributions in the stock market, voters are almost equally divided, with 49% favoring the idea and 47% opposing it. Differences between Republican and Democratic voters also makes consensus unlikely. Fifty-seven percent of Republican voters support the proposal, while 53 percent of Democratic voters oppose it.

“When the smoke clears from impeachment, both the Republicans and Democrats will want to show some legislative results. Medicare and dealing with the uninsured may be more important, but they require painful choices and big money. A modest patient’s rights bill is likely to emerge as the path of least resistance,” said Drew Altman, president of the Kaiser Family Foundation.

The Uninsured

Although helping the uninsured ranks third among voters’ overall list of priorities for the new Congress, Republican and Democratic voters assign different degrees of importance to the issue. For Democrats, the issue is the third highest priority (73% said it should be a “top” priority, behind Social Security and Medicare). For Republicans, the issue ranks sixth (48%), behind outlawing late-term abortions.

Furthermore, there is little agreement between voters from each party on just how to accomplish the goal of expanding access to insurance. When given a choice of three proposals – a national plan that would cover everyone, a mandate placed on all businesses to require them to provide coverage to their employees, or an income-tax refund to help the uninsured pay for their own coverage – none emerges with support from a majority of voters. Republican voters are most likely to pick the income tax refund (42% support it), while Democratic voters are most likely to prefer the employer mandate (39% support it).

Most importantly, Republican and Democratic voters diverge widely when it comes to their willingness to pay more in premiums or taxes to finance the costs of expanding health coverage to the uninsured. Among all voters, there is almost an equal split, with 46% saying they would be willing to pay more, and 49% saying they would not. Republican voters (59%) are much more opposed to paying higher premiums than Democratic (38%) voters.

Consensus Possible on Managed Care Reform?

The survey suggests potential for consensus on managed care reform. Overall, 78% support the so-called patients’ rights legislation, which would require HMOs and other managed care plans to provide people with more information about their plan, make it easier to see medical specialists, allow appeals to independent reviewers, and give people the right to sue their health plan. Large percentages of Democratic (87%) and Republican (71%) voters support the proposal. Support falls (to 51%) when voters are told that such a law might increase health insurance premiums by as much as $20 per month. Republican voters are the most likely to switch from support to opposition when told about the potential increase in premiums, dropping from 71% to 43%. By contrast, Democratic voter support continues, declining somewhat to 59% after hearing about the increase.

“If Congress wants to pass some health legislation rapidly, patients’ rights is definitely the one. No other proposal has a higher level of bipartisan voter support, nor the potential to gain presidential approval,” said Robert Blendon, Professor, Harvard School of Public Health.

There is also strong, bipartisan support on the specific issue of allowing patients to sue their health plan for malpractice, as they can now sue doctors. Seventy-six percent of Republican voters and 80 percent of Democrats support the proposal. When told that such a law might lead to an increase in premiums, a majority of voters nonetheless retain support for the proposal (53%), although the percentage of Republican voters drops to 50%.

Abortion

Voters are divided in their views about abortion, which was one of the most talked about issues in the 1998 fall campaign.

Overall, a majority of Republican voters (57%) believe that abortion should be either prohibited completely or allowed only in cases of rape, incest and the life of the mother. Thirty-seven percent of Democratic voters hold that view.

Passing a law to deal with late-term abortion is a much higher priority for Republican voters than Democratic voters. Overall, it was cited by 50% of Republican voters as a top priority issue, as compared to 30% of Democrats. Majorities of both parties favor banning the late-term procedure except in cases where the life of the mother is threatened, although Republican voters are much more supportive of the ban (71%) than Democratic voters (51%), who are divided on the issue.

Methodology

The Post-Election Survey was designed by researchers at the Kaiser Family Foundation and Harvard School of Public Health, and conducted by Princeton Survey Research Associates (PSRA). A nationally representative sample of 1,501 adults, including 751 voters in the 1998 general election, was interviewed by telephone between November 4 and December 6, 1998. The margin of sampling error for the voter sample is plus or minus 4 percent; for Democratic and Republican voter subsamples the margin of error is plus or minus 6.5 percent.

The Kaiser Family Foundation, based in Menlo Park, California is a non-profit, independent national health care philanthropy, and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation provides research and information on a variety of health issues for policymakers, journalists, and the general public. For more than ten years, the Foundation has also operated a major program supporting health and development in South Africa.

Copies of the questionnaire and national top line data for the findings reported in this release are available by calling the Kaiser Family Foundation’s publication request line at 1-800-656-4533. (Ask for document #1452). This release is also available on the Kaiser Family Foundation website at http://www.kff.org.

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Voters Say Medicare Top Health Issue For New Congress
Press Release