Polling on Elections and Policy: Health Care, The 2008 Presidential
Elections
A Summary of Research from the 2012 AAPOR Conference in Orlando, FL
Sarah Cho Kaiser Family Foundation PAPOR Conference Chair
June 2012
Disclaimer Papers/presentations obtained with author permission. Any misinterpretations are my own.
Sarah Cho Kaiser Family Foundation PAPOR Conference Chair
June 2012
Understanding Public Opinion on Health Care
Public Knowledge and Misunderstanding About Health Reform: A Geographical Analysis Gerald M. Kosicki, Ohio State University Public Opinion on “New Frontier” Policy Efforts to Combat Chronic Disease Stephanie Morain, Harvard University Jordon Peugh, Knowledge Networks Sampling Low-Income Californians to Assess Their Healthcare Preferences Julie Phelan, Langer Research Associates Gregory Holyk, Langer Research Associates Gary Langer, Langer Research Associates David Dutwin, SSRS Eran N. Ben-Porath, SSRS The Affordable Care Act and the Republican Presidential Primaries Bianca DiJulio, Kaiser Family Foundation Sarah Cho, Kaiser Family Foundation Liz Hamel, Kaiser Family Foundation Claudia Deane, Kaiser Family Foundation Mollyann Brodie, Kaiser Family Foundation
sampling low-income Californians to assess their healthcare preferences survey sponsor: Blue Shield of California Foundation
Julie E. Phelan, Ph.D. Gregory Holyk, Ph.D. Gary Langer Langer Research Associates
Eran Ben-Porath, Ph.D. David Dutwin, Ph.D. Social Science Research Solutions
project overview: challenges Target sample: Californians age 19-64 at <200% of the federal poverty level (about $45,000 for a family of four).
Problems: • Low incidence (30% of CA HHs) means low efficiency,
high expense; worsened by difficulties reaching lower SES, minorities, and younger respondents
• Screening: will asking income at the beginning of a survey produce unacceptable levels of non-response?
Problem 1: expense and efficiency Solution: employ 12 mutually exclusive LL strata
•High Latino: landline exchanges associated with Census-block groups in which Latinos = min. 57.5% of population
•High Low-Income: remaining landline exchanges associated with Census blocks in which more than 40% have annual HH incomes <$35,000
•Residual: all remaining exchanges
•Listed Low-Income: all phone numbers associated with households whose infoUSA records indicate at least one resident aged 19-64 with annual HH income <$23,000
Each stratum further divided geographically: Los Angeles, San Francisco/San Diego/Sacramento and Other
Problem 1: expense and efficiency Oversample higher-incidence strata:
•High Latino, high low-income and low-income listed strata are called disproportionately, but not exclusively •Full coverage is maintained by also calling residual LL strata. •No SES strata for cell-phones. Randomly sample all CA cell-phone exchanges (oversampling LA County exchanges)
Full coverage is maintained: all low-income Californians have a known probability of selection, but efficiency is also achieved.
•Stratified design results in a deff of 1.6
Problem 2: screening Concern that asking annual income at the start of a survey will encourage non-response
Solution: ask income threshold rather than income level •Initial questions: Rating of overall health, household size, number of family members between the age of 19 and 64, then…
•To ask the right questions, we need to know whether in 2010, your (family’s) total annual income from all sources, before taxes, was more or less than [X AMOUNT]
•X AMOUNT determined using the 2010 weighted average poverty thresholds:
–If family size = 1, threshold = $23,000 –if family size = 2, threshold = $28,000 –etc.
Results
•Use of targeted strata increased incidence, among age qualifying respondents, from 32% to 46% •Using an income threshold: 96.5% of respondents answered (compare with typical non-response for income question)
•28-day field period, 10-call rule produced AAPOR 3 response rates of 29.3% LL, 19.8% CP (with 21 min QQ.)
Thank you
Presenters: Eran Ben-Porath, Ph.D. Gregory Holyk, Ph.D. Social Science Research Solutions Langer Research Associates
Public Opinion On The Affordable Care Act In The Wake Of The
Republican Presidential Primaries
Bianca DiJulio, Sarah Cho, Liz Hamel, Claudia Deane, and Mollyann Brodie Kaiser Family Foundation
May 2012
40
44
41
35
45
40
44
40 41
50 48 46 41
44 46 43 44 43
51
44 43 44 43
40
43%
14 14 10
14 12 11 15
18 18
9 8 13
18 14 12
15 17 16 15 19 17 19
15 19
15%
46
41
48 50
43
49
42
42 42
41 43 42 41 42 42 42 39 41
34 37
41 37
42
41
42%
0%
20%
40%
60%
80%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Overall Views Of The ACA Have Remained Fairly Flat Since Passage, Even After Supreme Court Arguments
As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?
Source: Kaiser Family Foundation Health Tracking Polls
Don’t know/Refused Unfavorable Favorable
ACA signed into law on March 23, 2010
2010 2011 2012
SLIDE 12
78
72 69
73 68
75
69 68 69 73
66 71
64
72
65 64 60
65
52
62 64 62 64 66 70%
36 37
49 48
41 42
34 37 37
34
43
37 41
35 33 38
33 36
32 34 33 30
40 40 39%
13 8
23 21 16
21
11 15
12 12 11 9 12
17 20
16
24
14 11 12
19
12 16
12 7%
0%
20%
40%
60%
80%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
As Election Nears, Partisan Gap Grows Even Wider
Percent who say they have a favorable opinion of the health reform law:
ACA signed into law on March 23, 2010
Source: Kaiser Family Foundation Health Tracking Polls
SLIDE 13
Republicans Independents Democrats
2010 2011 2012
Most Popular Provisions Among Least Widely Recognized (And Vice Versa)
80%
79%
71%
69%
57%
32%
49%
49%
51%
37%
35%
64%
Health plan decision appeals
Individual mandate/penalty
Medical loss ratio
Require easy-to-understand plan summaries
Percent who say they have a favorable opinion of each of the following and percent who say they are aware each is included in the health reform law:
Tax credits to small businesses
No cost sharing for preventive services
Percent with a favorable view of provision
Percent who are aware provision is included in ACA
Note: Items asked of separate half samples. Source: Percent favorable, Kaiser Family Foundation Health Tracking Poll (conducted February 29 - March 5, 2012); Percent aware, Kaiser Family Foundation Health Tracking Poll Omnibus Supplement (conducted March 1-4, 2012)
SLIDE 14
47 50 51 52 51 51 53 52 50 50 50
54
47%
10 10 10 14
10 12 10 12 11 11 11 9 12%
43 39 39
35 38 38 37 37 39 38 40
37 41%
0%
20%
40%
60%
80%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Edge Goes To Those Who Want Health Care Law Kept As Is Or Expanded
What would you like to see Congress do when it comes to the health care law?
Source: Kaiser Family Foundation Health Tracking Polls
Don’t know/Refused REPEAL law and REPLACE with Republican alternative or REPEAL law and NOT REPLACE it
EXPAND law or KEEP law as is
SLIDE 15
2011 2012
More Than Half Expect Court To Find Mandate Unconstitutional
In your own opinion, do you think the Supreme Court should rule that it is constitutional or unconstitutional for the federal government to require all Americans to have health insurance, or do you not know enough to say?
26%
23%
51%
Unconstitutional
Constitutional
Don’t know enough to say/
Ref.
Do you expect the Supreme Court to rule that the requirement that all Americans have health insurance is constitutional or unconstitutional?
30%
11%
59%
Unconstitutional
Constitutional
Dk/Ref.
Source: Kaiser Family Foundation Health Tracking Poll (conducted April 4-10, 2012)
SLIDE 16
Rank Democrats Independents Republicans
1 Economy/Jobs (64%)
Economy/Jobs (58%)
Economy/Jobs (60%)
2 Health care (25%)
Health care (20%)
Health care (22%)
3 Education (9%)
Debt/Deficit (11%)
Debt/Deficit (21%)
4 Taxes (9%)
Education (9%)
Taxes (9%)
5 Immigration (6%)
Immigration (8%)
Security/War (7%)
Public Wants Presidential Candidates To Discuss Economy And Health Care
Thinking about the campaign for the presidential election in November, what two issues would you most like to hear the presidential candidates talk about? (open-end)
Note: Only top five responses listed. Percentages may add to more than 100% due to multiple responses. “Other” answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 13-19, 2012)
SLIDE 17
Half Of Republicans Want To Hear More About Deficit, Immigration
As I read you some different issues, please tell me if you think the Republican candidates for President are paying too much attention, too little attention, or about the right amount of attention to each one.
36%
36%
40%
43%
45%
47%
50%
48%
46%
40%
41%
44%
37%
36%
13%
13%
14%
9%
8%
11%
9%
The health care reform law passed last year
The economy and jobs
Energy policy
Note: Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted December 8-13, 2011)
Too little attention Too much attention About the right amount
Taxes
The budget deficit
Immigration
The war in Afghanistan
AMONG THOSE WHO SELF-IDENTIFY AS A REPUBLICAN OR AN INDEPENDENT WHO LEANS REPUBLICAN
SLIDE 18
Health Costs, Medicare Most Important Health Issues; Others Not Far Behind
I’m going to read you a list of specific health care issues the presidential candidates may be talking about this year. For each, tell me how important the issue will be to your vote. Would you say this issue will be extremely important to your vote for president, very important, somewhat important, or not too important to your vote?
36%
35%
28%
27%
24%
24%
21%
46%
42%
38%
41%
40%
35%
27%
13%
17%
21%
23%
19%
21%
21%
4%
5%
11%
8%
8%
18%
24%
Medicare
Providing health coverage for the uninsured
The 2010 health care law
The cost of health care and health insurance
Medicaid
Note: Not at all important (vol.) and Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 13-19, 2012)
Reproductive health care services for women including birth control
Abortion
Extremely important Very important Not too important Somewhat important
SLIDE 19
Democrats Hold Edge In Public Trust On Health Policy Issues
Overall, which party, the Democrats or the Republicans, do you trust to do a better job with each of the following:
49%
47%
47%
47%
46%
12%
14%
14%
13%
12%
32%
33%
33%
32%
34%
Handling the Medicare program
Lowering health care costs for people like you
Democrats Neither (vol.) Republicans
Making decisions about insurance coverage of reproductive health care services for women
including birth control
Handling the Medicaid program
Note: Both (vol.) and Don’t know/Refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted February 13-19, 2012)
Dealing with the future of the 2010 health care law
SLIDE 20
More Say Obama And Romney’s Views On Health Are Different, Than Similar
Do you think Mitt Romney and Barack Obama have views on health care policy that are very similar, somewhat similar, somewhat different, or very different?
26%
19%
19%
21%
23%
23%
23%
23%
23%
21%
25%
22%
7%
8%
7%
7%
22%
29%
25%
27% Total
Democrats
Independents
Republicans
Source: Kaiser Family Foundation Health Tracking Poll (conducted January 12-17, 2012)
Very different Somewhat different Somewhat similar Very similar Don’t know/ Refused
SLIDE 21
A Few Final Thoughts…
SLIDE 22
• General election campaigning has only just begun, and, with 6 months until election day, many Americans are not yet tuned in.
• Views of the law are divided, and highly partisan. For many, opposition to the law reflects broader opposition to what’s going on in Washington.
• Opinion may not change much until law is a REALITY, affecting real people’s everyday lives, rather than an ideological debate.
• Health care will be one of many factors influencing vote choice.
• Supreme Court ruling: public opinion wild card.
Perspectives on the 2008 and 2010 General Elections
Race of Interviewer Effects in the 2008 Presidential Election Nuri Kim, Stanford University Yphtach Lelkes, Stanford University Jon A. Krosnick, Stanford University The Impact of Climate Change Issue in the 2008 U.S. Presidential Election Bo MacInnis, Stanford University Jon A. Krosnick, Stanford University What Actually Happened in the 2010 Midterm Elections? Scott F. Clement, The Washington Post Peyton M. Craighill, The Washington Post Jon Cohen, The Washington Post American Pride and Prejudice: Public Opinion on the Meaning of Obama’s Election as President David C. Wilson, University of Delaware
