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Public Opinion Update-3006-Public-Opinion-Update

Public Opinion Update

Public Opinion Update

Public Opinion Update

THE UNINSURED

The debate over how to expand health insurance coverage to the over 44 million Americans without it continues to be one of the most challenging issues facing policymakers today. This Public Opinion Update summarizes key findings from several surveys conducted by the Kaiser Family Foundation and the Harvard School of Public Health and a new survey conducted by the Foundation in conjunction with the NewsHour with Jim Lehrer. The surveys show that the public is concerned about the problem of the uninsured, but that solutions remain elusive because of a lack of public consensus on the best approach and the unwillingness of a sizeable part of the public to pay for solutions.

THE PUBLIC IS CONCERNED ABOUT THE PROBLEM

In a recent survey, 28% of registered voters cited health care as a top issue influencing their vote. Which health care issues are most on the public s mind? Several concerns are closely bunched. Nearly half (47%) of Americans say providing insurance coverage for people who are currently uninsured will be “very important” in deciding their vote for President in 2000, and an additional 33% say the issue will be “somewhat important.” Slightly more people ranked making Medicare financially sound (52%) and providing coverage for prescription medicines for the elderly (51%) as “very important.” (Figure 1)

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Concern over insurance coverage also exists on a personal level. In January, 2000, more than half (53%) of the public reported that they personally knew someone who doesn’t have health insurance, and 57% of insured Americans said they were “very” or “somewhat concerned” that they might not have health insurance for others in their family.

KNOWLEDGE ABOUT THE UNINSURED

The majority of Americans (60%) realize that the number of Americans without health insurance has been increasing, but the public s knowledge about who the uninsured are is limited. The majority of the public (57%) incorrectly say that more of the uninsured are unemployed or from families where people are unemployed (39%) (Figure 2). There has been little improvement in public knowledge. In 1996, half the public (50%) incorrectly believed that the uninsured are more likely to come from unemployed families.

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On the other hand, Americans recognize many, though not all, of the troubles the uninsured have getting care and the potential health consequences the uninsured face as a result. Around 7 in 10 Americans know that the uninsured are less likely than the insured to have had a recent physician visit (74%) or to have a regular source where they get medical care (68%), and 65% of Americans know the uninsured are more likely than the insured to put off or postpone seeking medical care. More than 6 in 10 Americans know that the uninsured are less likely than the insured to get needed medical care (64%) or use preventive health services (62%). However, over half of Americans (52%) do not realize that the uninsured are more likely than the insured to have hospital or emergency room visits for basic care.

POLICY PREFERENCES

While the public supports action to extend coverage, there is little agreement on how to solve the problem. In January 2000, only 11% of the public said that the government should keep things the way they are now rather than do something to help people who don’t have health insurance. However, Americans are divided between whether the government should make “a limited effort to provide health insurance for some of the uninsured which would not require a tax increase” (43%) or “a major effort to provide health insurance for nearly all uninsured Americans which would require a tax increase” (39%).

A majority of Americans favor the status quo when asked to chose between maintaining the current employment based health insurance system, or switching to a system of tax credits or subsidies for individuals. The majority (54%) favor building on the current system in which employers contribute to their employees health insurance and the government covers the cost of insurance for the poor and unemployed, but 39% favor switching to a system in which all individuals would buy their own health insurance but would receive a tax credit or subsidy.

While the public expresses a high level of support for a broad range of policy options that would provide insurance for the uninsured, with over half of Americans favoring all but one option (Table 1), when asked to choose the best option, no single one attracts widespread support.

TABLE 1

Percent Who Favor When Asked about Each Option

Percent Who Chose It When Forced to Pick the Best Option

Expanding state government programs for low-income people, such as Medicaid and the Children’s Health Insurance Program, to provide coverage for people without health insurance

78

21

A new law that would require businesses to offer private health insurance for their employees

77

21

A new law that would offer uninsured Americans income tax deductions, tax credits, or other financial assistance to help them purchase private health insurance on their own

74

20

Expanding Medicare to cover people under age 65 who do not have health insurance

67

14

A national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan

44

21

Source: NewsHour with Jim Lehrer/Kaiser Family Foundation National Survey on the Uninsured, 2000

WILLINGNESS TO PAY

Willingness to pay remains one of the toughest obstacles to providing insurance coverage for the uninsured. Fifty-three percent of Americans say they are willing to pay a substantial amount more per month in higher premiums or taxes to cover the uninsured (41% were willing to pay $50 per month more and another 12% were willing to pay $30). However, 46% were willing to pay only $5 a month more (26%) or not willing to pay anything more (20%).

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Foundation surveys over several years show that the public has remained closely divided in their willingness to pay. In 1993, 50% said they would support a 3% national sales tax on purchases to pay for health coverage for the uninsured, but 40% said they would oppose such a tax. Similarly, in 1996, 47% of Americans said they were willing to pay more in health insurance premiums or higher taxes to increase the number of Americans with health care coverage, but 47% said they were not willing to pay. The unwillingness to pay more by a sizeable share of the public continues to present an obstacle to comprehensive solutions and suggests that incremental approaches will continue to be favored.

FACTS ABOUT THE UNINSURED

  • Over 44 million Americans are uninsured over 18% of the total nonelderly population.
  • The uninsured are predominantly workers and their families, many of whom have low incomes. Over 8 in 10 uninsured Americans are workers or dependents of workers. The large majority (74%) of the uninsured are in families with at least one full-time worker, and most of these workers are in permanent positions.
  • Over half (59%) of uninsured Americans have been without insurance for more than two years.
  • Over half of the uninsured (56%) have low incomes, making less than 200% of the federal poverty level ($32,900 for a family of four in 1998).
  • While the majority (52%) of the uninsured are White, Hispanics (25%) and African Americans (17%) are over-represented among the uninsured population.
  • Over one-third (39%) of uninsured adults say they have postponed care in the past year 12% for a “very serious” condition because they could not afford it. Eighteen percent of uninsured adults say they had a health condition that got worse because they postponed seeking care.
  • Thirty-nine percent of the uninsured skipped a recommended medical test or treatment in the last year, and 30% did not fill a prescription because of the cost.
  • The uninsured also face greater financial burdens than the insured, for example, the uninsured are more likely than the insured to have been contacted by a collection agency about unpaid medical bills (39% vs. 27%).

Source: Kaiser Commission on Medicaid and the Uninsured

Unless otherwise noted, trends used in this Public Opinion Update are from the following surveys conducted by the Kaiser/Harvard School of Public Health Program on The Public and Health Policy; a joint program of the Kaiser Family Foundation and Dr. Robert Blendon and his research team from the Harvard School of Public Health: November, 1991, Survey of Voters in the Pennsylvania Senate Election (11/91); June, 1996, Survey of Americans on Health Policy (#1166) (7/96); November, 1996, Post-Election Survey of Voters 1997 Health Care Agenda (#1216) (1/97); November, 1998, Post-Election Survey: Priorities for the 106th Congress (#1452) (1/99); November, 1999, National Survey on Health Care and the 2000 Elections (#1572) (1/00). Other surveys include the January, 2000 NewsHour with Jim Lehrer/Kaiser Family Foundation National Survey on the Uninsured (#3013) (4/00). For more information on the uninsured and analysis of policy proposals to cover them, or for complete question wordings, margins of error or other analysis, please contact us or look for our information on the web at http://www.kff.org. To request additional free copies of this publication, contact our Publications Request Line at 1-800-656-4533 (ask for document #3006).

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