Understanding Polling On New Government-Controlled Health Insurance Systems

MEMORANDUM

TO: Interested Parties
FROM: Lauren Crawford Shaver, Partnership for America’s Health Care Future
RE: Understanding Polling On New Government-Controlled Health Insurance Systems
DATE: January 30, 2020

As caucus-goers and primary voters begin deciding the first contests of the 2020 presidential primary, expect increased attention to be paid by journalists, prognosticators and pundits to polling that tests Americans’ attitudes about the key issue of health care, specifically when it comes to proposed new government-controlled health insurance systems like Medicare for All, Medicare buy-in and the public option.  But, in considering any polling, it’s important to look beyond top-line figures that aren’t fully illustrative of the data, nor of the American public’s views.

For instance, a newly-released national survey from the Kaiser Family Foundation (KFF) reveals that – even after months of intense public debate – most Americans, including most Democrats, remain unaware of what proposals such as Medicare for All and the public option would entail.  Yet, while some have been quick to point to the survey’s finding that a majority of Democrats say they support Medicare for All, fewer have taken notice of the fact that, according to the same survey, a mere 41 percent of Democrats understand that Medicare for All would eliminate employer-provided and other private coverage.

Polling has made it clear that once Americans understand what Medicare for All means for them, support plummets.  Another national poll conducted last year by Kaiser revealed that support for Medicare for All “drops as low as -44 percentage points” when people find out it would “lead to delays in some people getting some medical tests and treatments,” and “is also negative if people hear it would threaten the current Medicare program (-28 percentage points), require most Americans to pay more in taxes (-23 percentage points), or eliminate private health insurance companies (-21 percentage points).”

Inevitably, Americans will become increasingly aware of Medicare for All’s unaffordable costs and negative consequences as the proposal faces continued scrutiny, as is the case with a new analysis from the University of Pennsylvania’s Wharton School, which finds that Medicare for All could wreak havoc on the nation’s economy, and even “shrink GDP by 24 percent by 2060, as the large increase in federal debt crowds out productive investment and reduces the capital stock by 43 percent.”

Likewise, more than a year’s worth of public polling data has shown the importance of how respondents are asked about their attitudes towards proposals.  For example, providing respondents with the option – as the most recent KFF survey does – to support any or all of the proposals does not, ultimately, reveal what voters actually want.  This is a point backed up by KFF’s own previous polling, which has clearly shown that Americans’ top preference is to build upon our current health care system, rather than to start over with Medicare for All.

Additionally, those seeking to understand the data should look closely at the terminology and how key proposals are defined.  While Medicare for All is sometimes described in a manner that suggests the possibility for continued consumer choice, it is far more appropriate for pollsters to define it as a system that would eliminate private insurance and create a single government-run insurance system, or would replaceprivate insurance plans with a single government-run insurance system.

Similarly, pollsters sometimes repeat the mistaken claim that the public option would “compete” with private coverage, which is misleading because the public option would not compete on a level playing field with private coverage.  Rather than playing by the same rules as other plans offered within the marketplace, the public option would compel hospitals and other providers to accept unsustainably low reimbursement rates, which not only artificially undercuts private plans, but, as research has found, would put millions of Americans’ access to care at risk.

In fact, a study by Navigant found that the public option could put more than 1,000 rural U.S. hospitals in 46 states “at high risk of closure,” while another study by KNG Consulting found that “[f]or hospitals, the introduction of a public plan that reimburses providers using Medicare rates would compound financial stresses they are already facing, potentially impacting access to care and provider quality.”

And rather than relying on a single survey, it’s important to recognize the year-long trend of weak and declining support for Medicare for All.

Three new polls in the swing states of Pennsylvania, Michigan and Wisconsin from Third Way “reveal that voters are deeply skeptical about Medicare for All,” and understand that “Medicare for All will lead to middle-class tax hikes and lower quality of care.”

Voters’ skepticism about Medicare for All begins with the belief that it will raise their taxes.  Half of voters in each of the Blue Wall states believe they will pay much more in taxes personally, and more than two-thirds say it is unlikely that a Medicare for All health care plan could be enacted without raising middle-class taxes.

While large numbers of Blue Wall voters are certain of the costs, there is also a high degree of doubt about the benefits.  By a three-to-one margin, voters in each of the Blue Wall states say they are less confident in the government running the entire health care system compared to the system we have now.  As a result, they are worried about the quality of care.  By huge margins (ranging from 21-points in Wisconsin to 32-points in Michigan), voters think that “Medicare for All would lead to lower-quality care and longer wait times.”

Some of this skepticism may be because most voters in our poll are satisfied with the coverage they now have.  Sixty-six percent of those with coverage in Pennsylvania, 64% in Michigan, and 62% in Wisconsin rate their current health insurance plan as “excellent” or “good.” 

This tracks closely with a recent poll from the Kaiser Family Foundation and the Cook Political Report finds that nearly two-thirds (62 percent) of swing voters in the states of Michigan, Minnesota, Pennsylvania and Wisconsin rate Medicare for All as a “bad idea.”  In fact, The Wall Street Journal reports that in Michigan, “supporters of a single-payer health care system are finding a tough audience.”

A recent poll from Morning Consult and the Bipartisan Policy Center finds that “[i]mproving the current health-care system received the most support among voters, far more than repealing Obamacare or adopting ‘Medicare-for-All,” Bloomberg reports.  And the second edition of Voter Vitals – a tracking poll conducted nationwide and in 2020 battleground states by Locust Street Group for the Partnership for America’s Health Care Future – which finds that “as voters learn more about new government-run health care proposals, support for them is declining with a majority of voters preferring to build on and improve what we have today rather than start over with Medicare for All or the public option.” 

Other polling over the previous year backs these findings up:  

• Kaiser CEO Drew Altman wrote in Axios that support for Medicare for All is “headed in the wrong direction” – meaning down – while “polling shows that support drops much further, and opposition rises, when people hear some of the most common arguments against Medicare for All.” 

• A national poll from Quinnipiac University, finds that “Medicare for All has grown increasingly unpopular among all American voters,” with a majority saying it’s a “bad idea.”  Medicare for All is “a real problem for … candidates.  Not just because of the cost, but because few swing voters want to dump private health insurance,” Axios adds. 

• POLITICO has noted that polls show “growing opposition to ‘Medicare for All’” while a national poll by the Kaiser Family Foundation “probes Democrats’ views about the general approaches to expanding health coverage and lowering costs” and finds that “[m]ost Democrats and Democratic-leaning independents (55%) say they prefer a candidate who would build on the Affordable Care Act to achieve those goals.  Fewer (40%) prefer a candidate who would replace the ACA with a Medicare-for-all plan.”

• A separate poll released by Kaiser in July found support for Medicare for All on the decline, as “a larger share of Democrats and Democratic-leaning independents would prefer lawmakers build on the existing ACA” and “the share of Democrats who now say they ‘strongly favor’ a national Medicare-for-all plan is down” 12 percentage points in the three months since Kaiser last asked the question.

Meanwhile, a Gallup poll finds that “[s]ome 71% of Americans rate their private coverage as ‘excellent’ or ‘good,’” CNN reports.  “Americans continue to prefer a healthcare system based on private insurance (54%) over a government-run healthcare system (42),” according to Gallup’s annual Health and Healthcare poll, which finds that a government-controlled health insurance system “remains the minority view in the U.S.  This could create a challenge in a general election campaign for a Democratic presidential nominee advocating a ‘Medicare for All’ or other healthcare plan that would greatly expand the government’s role in the healthcare system.”

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