Health care reform and the voters – perception v. reality

There has been much speculation interpreting the “message” of the voters in last week’s special election for the Massachusetts Senate seat formerly held by the late Ted Kennedy and its national significance. One issue dominating that discussion is the direction the President should take on pending health reform proposals before Congress.

The Kaiser Family Foundation has just released a poll taken before the Massachusetts election. (The poll was conducted January 7th through the 12th of 2,002 adults with a sampling error of plus or minus 3 percent.) The poll finds the perception of the American people of this legislation doesn’t match what this legislation really is. Americans are evenly divided (41% oppose and 42% support with the remainder undecided) BUT when asked about the key specifics in the proposals there is a significant swing towards support on all but a couple parts of the legislation.

This from the Kaiser Family Foundation press release:

The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment. However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills. Majorities reported feeling more favorable toward the proposed legislation after learning about many of the key elements, with the notable exceptions of the individual mandate and the overall price tag.

For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines. Of the 27 elements of the legislation tested in the poll, 17 moved a majority to feel more positively about the bills and two moved a majority to be more negative.

In some cases elements of the legislation were popular enough to prompt a majority of skeptics to soften their opposition, including the tax credits for small businesses (62% of current opponents said it made them more supportive), the fact that most people’s existing insurance arrangements would not change (59%), and the stipulation that no federal money would go to abortion (55%).

A smaller number of provisions cut the other way. When told that nearly all Americans would be required to have health coverage, for instance, 62 percent of people said it made them less likely to support the legislation and 51 percent said they were less likely to support the reform package after learning it will cost at least $871 billion over 10 years.

“It’s one thing to talk about the public’s perception of health care reform legislation, which right now is in some ways negative, but it’s another to tell people what’s actually in the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.

The poll finds that even after a year of substantial media coverage of the health reform debate, many Americans remain unfamiliar with key elements of the major bills passed by the House and Senate. About half are aware that tax credits would be available to small businesses, one of the most popular provisions. And 44 percent recognize that the legislation would help close the Medicare “doughnut hole.”

Awareness can matter. Among the least known elements of the bills, those with the biggest potential to change minds include the fact that the Congressional Budget Office has said health reform would reduce the deficit (only 15% expect the legislation to reduce the deficit, but 56% said hearing that makes them more supportive) and that the legislation would stop insurers from charging women more than men (37% are aware that the legislation would do this, but 50% said this provision makes them more supportive). There were no lesser known provisions that would push a majority of supporters away from the bill.

In politics, as in much of life, perception becomes reality. A large percentage of this country is skeptical of overall health reform because of a muddled perception of what it really is. The Republicans have done their job by creating confusion and distorting what this legislation will do. The Democrats have a choice – they can either cave in or they can education the public to secure the support that is really there just below the surface. The American people by and large already support the key parts of the legislation. What the Democrats need to do is clarify these parts are what make up the whole.

You can read the entire Kaiser news release here and the results of their poll here.