Claudia Deane Associate Director Public Opinion and Media Research Kaiser Family Foundation February 2008

1. Claudia DeaneAssociate DirectorPublic Opinion and Media ResearchKaiser Family Foundation February 2008 Hello. I�m Claudia Deane, Associate Director for Public Opinion and Media Research at the Kaiser Family Foundation, and a recovering media pollster. You�ve probably noticed we�re deep into a season of politics and polls, as the long-running 2008 presidential and Congressional elections finally close in. Here at Kaiser, we track public opinion on health care issues, and as a piece of that we�re looking closely at the role health as a policy issue is playing in the election campaign. Hello. I�m Claudia Deane, Associate Director for Public Opinion and Media Research at the Kaiser Family Foundation, and a recovering media pollster. You�ve probably noticed we�re deep into a season of politics and polls, as the long-running 2008 presidential and Congressional elections finally close in. Here at Kaiser, we track public opinion on health care issues, and as a piece of that we�re looking closely at the role health as a policy issue is playing in the election campaign.

2. Tutorial Overview In this tutorial, I want to share some of the data we�ve collected with you. To do this, I�m going to rely on public opinion surveys of the general public to give you a sense of Americans� basic feelings about health care, their basic interests this election season, and how those two are intersecting. Before we begin looking at data specific to the 2008 elections, I want to orient you a little bit to the public�s views on health care in America more broadly, looking at this both from a personal and a nationwide standpoint. In this tutorial, I want to share some of the data we�ve collected with you. To do this, I�m going to rely on public opinion surveys of the general public to give you a sense of Americans� basic feelings about health care, their basic interests this election season, and how those two are intersecting. Before we begin looking at data specific to the 2008 elections, I want to orient you a little bit to the public�s views on health care in America more broadly, looking at this both from a personal and a nationwide standpoint.

3. From the personal standpoint, there are two competing strands of opinion in the country today. First, those who are insured � which is upwards of eight in ten Americans and an even larger percent of voters � are quite satisfied with their own personal care. This slide shows satisfaction with quality of care, with Americans� ability to get the latest treatments, and with coverage overall. As you can see, all the ratings are quite high. For example, in 2006, 88 percent of those with health care coverage rated that coverage as �excellent� or �good�. At the same time, however, there is a real undercurrent of worry, even among the insured, about rising costs and the possibility of losing coverage.From the personal standpoint, there are two competing strands of opinion in the country today. First, those who are insured � which is upwards of eight in ten Americans and an even larger percent of voters � are quite satisfied with their own personal care. This slide shows satisfaction with quality of care, with Americans� ability to get the latest treatments, and with coverage overall. As you can see, all the ratings are quite high. For example, in 2006, 88 percent of those with health care coverage rated that coverage as �excellent� or �good�. At the same time, however, there is a real undercurrent of worry, even among the insured, about rising costs and the possibility of losing coverage.

4. This next slide shows the substantial number of Americans who say they are �very worried� about paying more for care or losing their coverage. Last December, fully four in ten were very worried about the cost of their care, or their insurance, going up. It�s worth noting that surveys also show that Americans are much less satisfied with the cost of their care than with its quality. This next slide shows the substantial number of Americans who say they are �very worried� about paying more for care or losing their coverage. Last December, fully four in ten were very worried about the cost of their care, or their insurance, going up. It�s worth noting that surveys also show that Americans are much less satisfied with the cost of their care than with its quality.

5. There are also a fair number of people who are having trouble paying their medical bills. And contrary to what you might think, it�s not just the 47 million uninsured Americans who face challenges on this front. The large majority of those who reported having a problem paying bills over the past year actually have health insurance. This slide shows that one in four Americans had problems paying medical bills sometime over the past year. Among that group, fully 69 percent were people with health insurance. Keeping in mind these two trends � Americans� basic satisfaction with many aspects of what they have, along with an undercurrent of worry about cost and coverage -- let�s turn to how health care is playing this election season.There are also a fair number of people who are having trouble paying their medical bills. And contrary to what you might think, it�s not just the 47 million uninsured Americans who face challenges on this front. The large majority of those who reported having a problem paying bills over the past year actually have health insurance. This slide shows that one in four Americans had problems paying medical bills sometime over the past year. Among that group, fully 69 percent were people with health insurance. Keeping in mind these two trends � Americans� basic satisfaction with many aspects of what they have, along with an undercurrent of worry about cost and coverage -- let�s turn to how health care is playing this election season.

6. Looking Back: Health Care as a Voting Issue National Exit Polls To see whether health care seems to be registering as an issue, it helps to have a comparison point, so for that, we turn to the past two elections. To find out what voters had on their minds when they cast their ballot, we use exit polls, which are in-person polls administered to a random sample of voters as they leave the polling place. As you can see from the 2004 and 2006 exit polls, health care did not rank too highly as an issue. In 2004, the last presidential election, it was fifth on the issue list, after moral values, the economy, terrorism and Iraq, and was named by only 8 percent of voters. To see whether health care seems to be registering as an issue, it helps to have a comparison point, so for that, we turn to the past two elections. To find out what voters had on their minds when they cast their ballot, we use exit polls, which are in-person polls administered to a random sample of voters as they leave the polling place. As you can see from the 2004 and 2006 exit polls, health care did not rank too highly as an issue. In 2004, the last presidential election, it was fifth on the issue list, after moral values, the economy, terrorism and Iraq, and was named by only 8 percent of voters.

7. Is Health Care Breaking Through as a Political Issue? In the fall, however, we saw this issue moving to the number two slot in many polls, behind only Iraq, which is consistently the number one issue. This puts health care back in the position it was in the 2000 and 2002 elections, where it followed only the economy as a top issue. This slide shows an item that asks what issue Americans want to hear the presidential candidates discuss this election season, another way of measuring interest in the issue, and again we find health care is ranking second, named by 30 percent of Americans. In the fall, however, we saw this issue moving to the number two slot in many polls, behind only Iraq, which is consistently the number one issue. This puts health care back in the position it was in the 2000 and 2002 elections, where it followed only the economy as a top issue. This slide shows an item that asks what issue Americans want to hear the presidential candidates discuss this election season, another way of measuring interest in the issue, and again we find health care is ranking second, named by 30 percent of Americans.

8. Is Health Care Breaking Through as a Political Issue? This number trended up over the summer and early fall of 2007 and then ticked down in late fall as immigration and the economy gained some steam as top issues. This number trended up over the summer and early fall of 2007 and then ticked down in late fall as immigration and the economy gained some steam as top issues.

9. Interest in Health Care by Party Identification When you are thinking about elections, though, you almost always want to dig down deeper into the overall numbers to see how different groups might feel. In particular, you want to look at people by their partisan affiliation, since Democrats, Republicans and political independents reliably see the world quite differently. Here you see health care running nearly even with Iraq among Democrats, and also a clear second among independents. Among Republicans, however, health care is roughly tied for second with immigration. Other polls and other variations of this �most important issue� question have found the Republican �issue race� even more tightly packed, with Iraq, the economy, immigration, health care, terrorism and even taxes all jostling for room at the top of the list. The Democratic race has been consistently more clear cut: Iraq, health care and the economy are the three issues that have cleared the bar thus far.When you are thinking about elections, though, you almost always want to dig down deeper into the overall numbers to see how different groups might feel. In particular, you want to look at people by their partisan affiliation, since Democrats, Republicans and political independents reliably see the world quite differently. Here you see health care running nearly even with Iraq among Democrats, and also a clear second among independents. Among Republicans, however, health care is roughly tied for second with immigration. Other polls and other variations of this �most important issue� question have found the Republican �issue race� even more tightly packed, with Iraq, the economy, immigration, health care, terrorism and even taxes all jostling for room at the top of the list. The Democratic race has been consistently more clear cut: Iraq, health care and the economy are the three issues that have cleared the bar thus far.

10. When we ask people what specific health care-related issues they want to hear about, cost and coverage have been dominating the answers, no matter in what form the question is asked. But note that again, there are big differences here between Democrats and Republicans, with cost being the clear concern among GOP voters, while Democrats are more closely divided between cost and coverage. When we ask people what specific health care-related issues they want to hear about, cost and coverage have been dominating the answers, no matter in what form the question is asked. But note that again, there are big differences here between Democrats and Republicans, with cost being the clear concern among GOP voters, while Democrats are more closely divided between cost and coverage.

11. You find a similarly larger appetite for a �big plan� among Democrats in the question shown here. About six in ten Democrats want to hear their candidates talk about a plan that would make a major effort to expand coverage to those currently uninsured. Among Republicans, closer to three in ten want to hear about a major push. Take these together � Democrats� greater interest in coverage and their willingness to spend some money on it, compared to Republicans� greater interest in cost control � and you will go a long way in understanding the very different types of health care reform proposals that are being put forward by the major candidates in both parties. And of course each party�s primary election winner will take a plan that reflects many of the needs and desires of their own base into a general election context, where voters� interests will be much more diverse. This suggests that the general election could provide an interesting contrast when it comes to health plans. That said, nothing in the data we�ve looked at so far can provide us with an ironclad prediction of how health care will play in the general election, or if it will play at all. And that is even more true when it comes to looking beyond November 2008, to the new Administration and Congress that take office in 2009 and the actual concrete legislation they may or may not propose.You find a similarly larger appetite for a �big plan� among Democrats in the question shown here. About six in ten Democrats want to hear their candidates talk about a plan that would make a major effort to expand coverage to those currently uninsured. Among Republicans, closer to three in ten want to hear about a major push. Take these together � Democrats� greater interest in coverage and their willingness to spend some money on it, compared to Republicans� greater interest in cost control � and you will go a long way in understanding the very different types of health care reform proposals that are being put forward by the major candidates in both parties. And of course each party�s primary election winner will take a plan that reflects many of the needs and desires of their own base into a general election context, where voters� interests will be much more diverse. This suggests that the general election could provide an interesting contrast when it comes to health plans. That said, nothing in the data we�ve looked at so far can provide us with an ironclad prediction of how health care will play in the general election, or if it will play at all. And that is even more true when it comes to looking beyond November 2008, to the new Administration and Congress that take office in 2009 and the actual concrete legislation they may or may not propose.

12. Back to the data�.One important thing to keep in mind, as we see in this slide, the public may support the goal of increased coverage�(here 85 percent say they would favor the federal government doing more to help provide health insurance for more Americans) Back to the data�.One important thing to keep in mind, as we see in this slide, the public may support the goal of increased coverage�(here 85 percent say they would favor the federal government doing more to help provide health insurance for more Americans)

13. But when it comes to solutions, the public is all over the map. The slide below shows that a number of different, individual solutions � from tax credits to expanding Medicare to cover younger individuals -- are popular with the majority of Americans. This is on the one hand an opportunity: since many different solutions are popular, candidates can bundle them together in ways that might provide for a more widespread appeal. But it�s also a challenge, since there is no agreement on the one best way to proceed. This is a common finding in public opinion on public policy: it�s much easier to get agreement on goals than to get agreement on the best way to reach those goals. But when it comes to solutions, the public is all over the map. The slide below shows that a number of different, individual solutions � from tax credits to expanding Medicare to cover younger individuals -- are popular with the majority of Americans. This is on the one hand an opportunity: since many different solutions are popular, candidates can bundle them together in ways that might provide for a more widespread appeal. But it�s also a challenge, since there is no agreement on the one best way to proceed. This is a common finding in public opinion on public policy: it�s much easier to get agreement on goals than to get agreement on the best way to reach those goals.

14. One interesting note on coverage: one natural constituency for increased coverage, the uninsured, are also substantially less likely to vote. Another constituency with strong views when it comes to health care � the elderly � on the other hand, are disproportionately likely to vote. One interesting note on coverage: one natural constituency for increased coverage, the uninsured, are also substantially less likely to vote. Another constituency with strong views when it comes to health care � the elderly � on the other hand, are disproportionately likely to vote.

15. And an important caveat to all this high minded talk about issues and elections, whether it be health care we are talking about or any other issue: issues are only one thing that people keep in mind when they go to the voting booth. A large group of voters places more importance on personal traits such as character and leadership abilities. And an important caveat to all this high minded talk about issues and elections, whether it be health care we are talking about or any other issue: issues are only one thing that people keep in mind when they go to the voting booth. A large group of voters places more importance on personal traits such as character and leadership abilities.

16. Places to Turn for More Information www.kff.org/kaiserpolls www.health08.org www.kaiseredu.org/tutorials_index.asp#PublicOpinion1 www.newsu.org/polling www.aapor.org www.ncpp.org www.washingtonpost.com/polls www.abcnews.go.com/pollingunit www.pewresearch.org www.pollster.com Election 2008 is shaping up to be one of the most competitive and dynamic presidential races in years. At least through the first stages of the primary process, health care policy has been a staple of the Democratic discussions on the trail and in the media, and has been figuring in the Republican race as well. But as with candidate preferences, issue preferences can shift and change. This year in particular, an uncertain economic climate is an important factor to watch. So keep an eye on those polls. On this last slide, a couple places you can turn for more information about how polls are conducted, how to interpret them and what they�re saying about the American public�s preferences today. Election 2008 is shaping up to be one of the most competitive and dynamic presidential races in years. At least through the first stages of the primary process, health care policy has been a staple of the Democratic discussions on the trail and in the media, and has been figuring in the Republican race as well. But as with candidate preferences, issue preferences can shift and change. This year in particular, an uncertain economic climate is an important factor to watch. So keep an eye on those polls. On this last slide, a couple places you can turn for more information about how polls are conducted, how to interpret them and what they�re saying about the American public�s preferences today.