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THE HENRY ].
KAISER
THE KAISER-HARVARD PROGRAM ON
FAMILY
FOUNDATION
THE PUBLIC AND HEALTH/SOCIAL POLICY
Survey of Americans on Health Policy
Questionnaire and National Toplines
July 30, 1996
A JOINT PROGRAM OF THE HENRY J. KAISER FAMILY FOUNDATION AND HARVARD UNIVERSITY
KAISER FAMILY FOUNDATION: 2400 SAND HILL ROAD, MENLO PARK, CA 94025 415 854-9400 FAX 415 854-4800
HARVARD SCHOOL OF PUBLIC HEALTH: 677 HUNTINGTON AVENUE, BOSTON, MA 02115 617 432-4502 FAX 617 432-0092
KAISER FAMILY FOUNDATION/
HARVARD UNIVERSITY
PRINCETON SURVEY RESEARCH ASSOCIATES
HEALTH POLICY SURVEY
FINAL TOPLINE
July 30, 1996
METHODOLOGY: The Kaiser/Harvard/PSRA survey was a national random sample conducted by
telephone with 1,011 adults between June 20 and July 9, 1996. The margin of error is plus or minus
3 percent.
1.
Looking ahead to the presidential election in November, what issue will be MOST important
to you in deciding who to vote for? (RECORD VERBATIM RESPONSE FOR UP TO
TWO MENTIONS. PROBE ONCE, IF NECESSARY, FOR A 2ND MENTION: Is
there another issue that will be almost as important to you?
Total
Republicans
Democrats
Independents
14%
13%
17%
14%
Economy/Jobs
11
17
9
10
Candidate characteristics
10
6
15
9
Health care (excluding Medicare)
8
10
7
7
Deficit/Government spending
8
10
6
8
Taxes
6
8
5
6
Abortion
5
3
6
6
Crime/Guns/Violence
5
2
6
3
Medicare
4
4
6
4
Education
4
6
3
4
Welfare
4
2
5
5
Social Security
4
5
4
4
Other issues
6
5
7
5
None
32
26
29
36
Don't know/Don't plan to vote
Note: Adds to more than 100% due to multiple responses.
2
2.
Now thinking ONLY about issues relating to HEALTH CARE (EXCLUDING
MEDICARE), what specific issue, if any, will be of MOST concern to you in deciding who
to vote for? (RECORD VERBATIM RESPONSE FOR UP TO TWO MENTIONS.
PROBE ONCE, IF NECESSARY, FOR AN ADDITIONAL MENTION: Is there any
other specific health care problem that will matter almost as much in your voting decision?
TOTAL MENTIONS OF THOSE SAYING "HEALTH CARE IN Q1"
Total
Of Those Saying
"Health Care" in Q1
27%
25%
Medicare
15
18
Health care cost/Health insurance cost
14
17
Health care availability/Access/Universal coverage
2
7
Health care for children
4
6
Government interference in choosing health care coverage
(doctors)
12
20
Other specific issues
3
3
Health care in general
8
4
None
26
17
Don't know/Don't plan to vote
3.
Do you think the health care system in this country is getting better, getting worse, or staying
about the same?
Total
Republicans
Democrats
Independents
12%
15%
9%
15%
Better
49
42
54
50
Worse
34
39
33
31
Same
4
3
4
3
Don't know
100
3
4.
Now, on another subject. I'm going to read you a list of concerns some people have. As I read
each one, please tell me how much, if at all, it concerns you. (First/next), how concerned are
you about (INSERT-READ AND ROTATE) : very concerned, somewhat concerned, not
too concerned, or not at all concerned?
Some-
Not
Not
Very
What
Too
At All
DK/
Concerned
Concerned
Concerned
Concerned
Refused
a.
Being unable to save enough
money to put a child
through college
48%
18%
10%
22%
2%
=100
b.
Losing your job or taking a
cut in pay
39
16
15
28
2
=100
C.
Being unable to afford mental
health care if you or a family
member needs help
43
28
16
13
* =100
d.
Becoming a victim of crime
41
32
19
7
1
=100
e.
Your taxes getting too high
65
25
7
2
1
=100
f.
Being unable to afford necessary
health care when a family
member gets sick
61
18
13
8
*
=100
g.
Life for our children not
being better than it
has been for us
71
20
5
3
1
=100
4
Not
Some-
Not
Very
What
Too
At All
DK/
Concerned Concerned Concerned Concerned Refused
h.
Being unable to take care of
your parents, grandparents,
or spouse if they need
long-term care
59
-21
7
10
3
=100
I.
You or your spouse losing
your health insurance
coverage
53
16
15
13
3
=100
j.
Government interfering
too much in your life
46
29
18
6
1
=100
k.
Being unable to get adequate
health insurance if you
change jobs
56
15
11
12
6
=100
1.
Your family's income not keeping
up with the cost of living
58
25
11
5
1
=100
5
5.
Next, I'm going to read you some words and phrases and ask you to describe your overall
feelings toward each one. If I name something you're not familiar with, please say so.
(First,) how would describe your overall feelings toward (INSERT--READ AND
ROTATE) : very positive, somewhat positive, neutral, somewhat negative, or very
negative? Next, how about
Not
Some-
Some-
Familiar
Very
what
what
Very
With
DK/
Positive
Positive
Neutral
Negative
Negative
Term
Refused
a.
Health care reform
26%
21%
21%
20%
8%
2%
2% =100
b.
Medicaid
20
22
26
16
9
5
2 =100
C.
Welfare
11
13
17
32
25
0
2 =100
d.
A balanced budget for the
federal government
30
17
19
16
14
1
3 =100
e.
Medicare
29
21
26
15
7
1
1 =100
f.
Managed care
8
16
26
14
7
25
4 =100
g.
Medical savings
account
14
17
20
6
6
35
2 =100
h.
For-profit health care
8
16
26
15
8
24
3 =100
i.
Universal health care
coverage
18
24
19
14
7
16
2 =100
j.
Health Maintenance
Organization or
H-M-O
12
25
23
19
9
9
3 =100
6
6.
You said that the following issues... (READ ITEMS RATED AS MOST IMPORTANT
ABOVE) should be among the most important health care issues for the next President and
Congress to address. Which ONE of these do you think should be most important?
Total
Republicans
Democrats
Independents
10%
11%
9%
10%
Health care costs
5
3
7
6
Long-term care for elderly people
3
2
4
3
Prescription drugs for the elderly under
Medicare
9
6
12
9
Americans losing their health insurance
9
5
13
8
Health insurance for those who can't
afford it
4
3
5
4
Medicare
2
1
2
1
Medicaid
12
11
12
12
Health care for children
17
26
10
16
Waste, fraud, and abuse in government
health care programs
1
1
2
1
Malpractice costs
1
1
1
1
Mental health benefits in insurance
policies
25
29
22
26
No item rated most important
2
1
1
3
Don't know
*
*
*
*
Refused
100
100
100
100
7
7.
How familiar are you with the term "MANAGED CARE PLAN?" Do you know what
this term means OR have you heard of it, but are not sure what it means, OR have you
never heard the term "managed care plan" before this interview?
Total
Republicans
Democrats
Independents
27%
32%
23%
26%
Know what it means
36
33
38
39
Heard of, not sure what it means
37
35
39
35
Never heard of a managed care plan
0
0
0
0
Refused
8.
If in the future you and your family received your health care through a managed care
plan, do you think that would be a good thing, a bad thing, or would not make much
difference either way?
Total
Republicans
Democrats
Independents
11%
8%
12%
9%
Good thing
19
21
17
20
Bad thing
20
25
17
21
Not much difference
37
35
39
36
Never heard of managed care plan
13
11
15
14
Don't know
*
*
*
*
Refused
Of Those Who Have
Heard of Managed Care
17%
Good thing
30
Bad thing
32
Not much difference
21
Don't know
*
Refused
8
9.
What is the MAIN reason you feel this way? Is it your own experience with a managed
care plan; what you've learned from friends and family; or what you've seen, heard, or
read on television, in newspapers or other media?
BASED ON THOSE WHO THINK MANAGED CARE WOULD BE A BAD THING
Total
Republicans
Democrats
Independents
33%
23%
34%
42%
Own experience
25
28
17
27
From friends and family
36
43
39
28
TV, newspapers and other media
5
4
9
3
Other (SPECIFY)
1
2
1
*
Don't know
*
*
*
*
Refused
(n=211)
10.
I'm going to read you five different approaches to health care the next President might
take. After I read you all five, tell me which ONE you would most like to see taken by
whoever is elected President next November. The first one is
(READ LIST, DO
NOT ROTATE)
a. A comprehensive health reform plan similar to the one President Clinton introduced a few
years ago
OR
b. A new bill that would guarantee health insurance coverage for all Americans, and would
require less government intervention than the earlier Clinton plan
OR
C. A new bill that would be the first step in addressing the problems of the health care
system and guarantee health insurance for some -- but not all -- Americans
OR
d. A new bill that would make private insurance more available and affordable through
insurance reforms without any government guarantees
OR
e. Do nothing on health care?
9
Total
Republicans
Democrats
Independents
9%
5%
15%
6%
Option A - (should remain
as it is today)
44
30
55
45
Option B - - (Clinton Plan)
11
14
11
9
Option C - (Coverage for all
with less government)
31
48
16
35
Option D - (Coverage for
some, but not all)
2
2
2
2
Option E - (Do nothing)
1
*
*
2
Other (VOL.)
2
1
4
1
Don't know
*
*
*
*
Refused
11.
Which ONE of the following three things do think the government should do... (READ)
a.
Take some action to ensure that all Americans have health insurance coverage
b.
Make a start by helping some groups get health insurance
OR.
C.
Leave things they way they are now?
Total
Republicans
Democrats
Independents
60%
43%
76%
57%
Option A - (Coverage for
all)
24
31
16
30
Option B - - (Help some
groups)
13
24
4
12
Option C - (Leave as is)
*
1
*
1
Other (VOL.)
2
*
4
*
Don't know
1
1
*
*
Refused
10
12.
Medicare is the government program that provides health insurance primarily to people
who are 65 and older. Do you think the recent debate about reducing future Medicare
spending was MAINLY about
Total
Republicans
Democrats
Independents
31%
39%
29%
26%
Preventing the Medicare program
from going bankrupt
34
32
37
34
Balancing the federal budget?
20
15
24
23
Paying for a tax cut?
3
2
1
3
None of these/other (VOL.)
12
12
9
14
Don't know
*
*
*
*
Refused
13.
Do you think Congress should or should NOT make major reductions in future spending on
Medicare to balance the federal budget?
Total
Republicans
Democrats
Independents
19%
31%
10%
16%
Should
77
65
87
80
Should not
4
4
3
4
Don't know
*
*
*
*
Refused
11
14. Do you think Congress should or should NOT make major reductions in future spending on
Medicare to prevent the Medicare program from going bankrupt?
Total
Republicans
Democrats
Independents
37%
52%
32%
33%
Should
54
41
60
56
Should not
9
7
7
10
Don't know
*
*
1
1
Refused
15.
Now I'm going to read you two statements about the future of the Medicare program. After
I read both statements, please tell me which one comes closer to your own view. The first
one is (READ)
a. Medicare should remain as it is today, with a defined set of benefits for people over 65
and the government providing them with a single insurance card.
OR
b. Medicare should be changed so that people over 65 would receive a check or voucher
from the government each year for a fixed amount they can use to shop for their own
private health insurance policy
Total
65 years+
Republicans
Democrats
Independents
64%
86%
50%
72%
70%
Option A - (should
remain as it is today)
32
12
48
26
26
Option B - (should be
changed)
3
2
2
2
3
Don't know
1
*
*
*
1
Refused
12
16.
What about the idea of giving people over 65 the VOLUNTARY choice of receiving a check
for a fixed amount each year instead of current Medicare benefits? Would you prefer this
change over keeping Medicare as it is today, or not?
Total
65
Republicans
Democrats
Independents
years+
13%
7%
8%
15%
16%
Prefer voluntary voucher
32
12
48
26
26
Prefer voucher system in
Q23
49
76
41
54
53
Keep Medicare as is
5
5
2
5
4
Don't know
1
*
1
*
1
Refused
17.
Would you still feel this way if you knew that it might increase costs for those who chose
to stay in traditional Medicare?
Total
65 years+
Republicans
Democrats
Independents
21%
13%
32%
16%
20%
Favor change despite
cost issue
19
3
20
18
18
Would no longer favor
49
76
41
54
53
Do not favor charge
10
8
7
11
9
Don't know
1
*
*
1
*
Refused
13
18.
Currently, the federal and state governments share the responsibility for Medicaid, the
program which provides health and nursing home benefits for the poor, low-income
elderly, and disabled. In general, do you favor or oppose proposals to turn over the
responsibility for Medicaid to the states?
Total
Republicans
Democrats
Independents
47%
63%
34%
47%
Favor
43
30
55
41
Oppose
10
7
11
12
Don't know
*
*
*
*
Refused
19.
Would you still feel this way if you knew that each state would be given only a fixed amount
of federal dollars along with the flexibility to decide how to spend it?
Total
Republicans
Democrats
Independents
29%
48%
16%
30%
Yes, would still favor
14
12
15
13
No, would change my mind
43
30
55
41
Don't favor state run Medicaid
14
10
14
16
Don't know
*
*
*
*
Refused
20.
Would you be willing to see the federal government spend more to provide long-term
care for the elderly, even if it means you would have to pay more in taxes?
Total
Republicans
Democrats
Independents
68%
54%
77%
70%
Yes, willing
28
42
19
27
No, not willing
4
4
4
3
Don't know
*
*
*
*
Refused
14
21.
Would you be willing to pay more through higher health insurance premiums in order to
improve mental health coverage for all Americans, or not?
Total
Republicans
Democrats
Independents
38%
29%
46%
40%
Yes, willing
57
67
49
55
No, not willing
5
4
5
5
Don't know
*
*
*
*
Refused
22.
Compared to five years ago, do you think the cost of health care for families is a bigger
problem, less of a problem, or about the same?
Total
Republicans
Democrats
Independents
73%
65%
79%
75%
Bigger
1
2
1
*
Less
24
31
18
23
Same
2
2
2
2
Don't know
*
*
*
*
Refused
23.
Compared to five years ago, do you think the problem of Americans not having health
insurance is a bigger problem, less of a problem, or about the same?
Total
Republicans
Democrats
Independents
70%
57%
75%
74%
Bigger
2
2
3
2
Less
26
38
20
22
Same
2
3
2
2
Don't know
*
*
*
*
Refused
15
24.
I'd like to ask you to think about uninsured Americans--that is, people with no health
insurance at all. Would you say that more of them are.. (READ AND ROTATE)
a. Employed people and people from families in which someone is employed?
OR, that more of them are
b. Unemployed people and people from families in which no one is employed?
Total
Republicans
Democrats
Independents
42%
41%
44%
41%
Option A - (employed)
50
52
46
52
Option B - (unemployed)
8
7
10
7
Don't know
*
*
*
*
Refused
25.
Is it your impression that people in your community without health insurance are unable to
get medical treatment, or that those uninsured people are still able to get the medical care
they need from doctors and hospitals?
Total
Republicans
Democrats
Independents
30%
18%
35%
33%
Unable to get care
62
76
56
60
Still able to get care
7
6
9
7
Don't know
1
*
*
*
Refused
16
26.
For which ONE of the following groups, if any, do you think we should try to provide health
insurance coverage first? (READ AND ROTATE ITEMS 1-4)
Total
Republicans
Democrats
Independents
48%
53%
45%
46%
Children
22
21
22
23
Working people who are currently
uninsured
15
13
16
15
All low-income people
10
9
10
11
People who need long-term care
4
2
6
4
Don't know
1
1
1
1
Other (VOL.)
*
1
*
*
None (VOL.)
*
*
*
*
Refused
27.
Would you be willing to pay more--either in higher health insurance premiums or higher
taxes--in order to guarantee health insurance coverage for all Americans, or not?
Total
Republicans
Democrats
Independents
60%
46%
72%
63%
Yes, willing
36
49
26
35
No, not willing
3
5
2
1
Don't know
1
*
*
1
Refused
17
28.
Some members of Congress have proposed legislation that would require health insurers to
offer coverage to people who lose or change jobs -- without regard to pre-existing medical
conditions -- as long as they pay their insurance premiums. Before this interview, had you
heard or read about this proposal, or not?
Total
Republicans
Democrats
Independents
43%
47%
40%
44%
Yes, heard of
56
52
59
56
No, not heard
I
I
1
*
Don't know
*
*
*
*
Refused
29.
(READ AND ROTATE ORDER OF ARGUMENTS A AND B)
ARGUMENT A:
Supporters say this legislation would help protect some people who change or lose their
jobs from being denied the opportunity to continue their coverage and would make
insurance available to more Americans. They also say that helping to solve this problem is
the federal government's responsibility.
ARGUMENT B:
Opponents say this legislation would raise health insurance costs for many people and
would result in more people dropping their coverage. They also say the federal
government should not be telling insurance companies how to run their business.
After hearing these arguments, do you favor or oppose this proposed legislation, or don't
you know enough about these issues to have an opinion?
Total
Republicans
Democrats
Independents
31%
31%
32%
30%
Favor
12
10
9
11
Oppose
57
52
58
59
Don't know enough
*
*
*
*
Refused
18
29. (Continued)
Of Those Who Are Aware
of Kassebaum/Kennedy
47%
Yes, willing
14
No, not willing
38
Don't know
1
Refused
30.
Some members of Congress have proposed legislation that would allow employers to
offer their employees health insurance through a new arrangement called a Medical
Savings Account. Before this interview, had you heard or read about this proposal, or
not?
Total
Republicans
Democrats
Independents
30%
37%
26%
31%
Yes, heard or read
69
63
73
68
No, not heard or read
1
*
1
1
Don't know
*
*
*
*
Refused
INTRODUCTION TO Q.31:
I'm going to give you some information about how Medical Savings Accounts would
work, and then ask your opinion of them Medical Savings Accounts would allow
employers to purchase plans with lower premiums that would only provide coverage after
the employee pays about
FORM A: $2,000 a year in medical bills.
FORM B: $5,000 a year in medical bills.
Any savings the employer gets by offering this less expensive plan could be put into the
employee's tax-free medical savings account, which could be used to help pay the first
($2,000/$5,000) in medical bills or any additional medical expenses. If it is not spent, it
could be withdrawn as additional taxable income or saved to spend on next year's
medical bills.
19
31.
(READ AND ROTATE ORDER OF ARGUMENTS A AND B)
ARGUMENT A:
Supporters of Medical Savings Accounts say this will lower individuals' health care costs,
because it would give individuals the incentive to spend their own money more carefully.
They also say this would reduce hassle for people to go to a doctor of their own choice
without getting the approval of the insurance company.
ARGUMENT B:
Opponents say that, because people would have to pay the first
FORM A: $2,000
FORM B: $5,000
for doctor and hospital visits at the time they receive care, Medical Savings Accounts
would discourage people from getting needed services and preventive care. They also
say that, because healthier people are more likely to sign up for Medical Savings
Accounts, this would leave sicker people paying higher premiums.
After hearing these arguments, do you favor or oppose this proposed legislation to create
Medical Savings Accounts, or don't you know enough about these issues to have an
opinion?
Form A - $2,000 (n=528)
Total
Republicans
Democrats
Independents
28%
43%
18%
25%
Favor
36
30
43
38
Oppose
36
26
39
37
Don't know enough
*
1
*
*
Refused
Form B - $5,000 (n=483)
Total
Republicans
Democrats
Independents
18%
25%
10%
22%
Favor
42
35
52
39
Oppose
40
40
38
39
Don't know enough
0
0
0
0
Refused
20
Of Those Who Follow the MSA Debate
$2,000
$5,000
44%
33%
Favor
35
42
Oppose
21
25
Don't know enough
*
*
Refused
32.
If you were given a choice, how likely would you be to choose the Medical Savings
Accounts option for your health insurance coverage? (READ)
Form A - $2,000 (n=528)
Total
Republicans
Democrats
Independents
21%
28%
15%
18%
Very likely
22
22
21
23
Somewhat likely
20
25
23
14
Not too likely
32
24
34
40
Not at all likely
4
2
5
5
Don't know
1
*
2
*
Refused
Form B - $5,000 (n=483)
Total
Republicans
Democrats
Independents
12%
19%
9%
11%
Very likely
25
28
22
26
Somewhat likely
22
25
25
18
Not too likely
37
25
42
41
Not at all likely
4
3
2
4
Don't know
*
*
*
*
Refused
THE HENRY
KAISER
THE KAISER-HARVARD PROGRAM ON
FAMILY
FOUNDATION
THE PUBLIC AND HEALTH/SOCIAL POLICY
HARVARD UNIVERSITY:
ROBERT ). BLENDON, ScD
DIRECTOR
PROFESSOR OF HEALTH POLICY AND
EMBARGOED FOR RELEASE UNTIL:
Contacts: Matt James
POLITICAL ANALYSIS,
SCHOOL OF PUBLIC HEALTH AND
KENNEDY SCHOOL OF GOVERNMENT,
9:30 a.m. E.T., Tuesday, July 30, 1996
or Tina Hoff,
HARVARD UNIVERSITY
(415) 854-9400
JOHN BENSON
DEPUTY DIRECTOR
KAISER FAMILY FOUNDATION:
DREW E. ALTMAN, PHD
PUBLIC NOT FOLLOWING BATTLES IN WASHINGTON
PRESIDENT.
KAISER FAMILY FOUNDATION
OVER KASSEBAUM/KENNEDY AND MEDICAL SAVINGS ACCOUNTS
MATT JAMES,
VICE PRESIDENT OF
COMMUNICATIONS AND MEDIA PROGRAMS,
KAISER FAMILY FOUNDATION
Most Say Don't Know Enough To Express An Opinion;
Those Who Do, Favor Insurance Reform and Are More Negative Toward MSAs
Most Americans Oppose Changes in Medicare, Even to Save Program from Bankruptcy
Washington, D.C. -- While Congress wrestles with health insurance reforms and medical savings
accounts (MSAs), most Americans say they have neither read nor heard about these debates.
Even after being read descriptions of the proposals, many say they don't know enough to form an
opinion, according to a new national survey. Those who offer an opinion regarding insurance
reforms are favorable, while those with an opinion on MSAs tend to be more negative with the
size of the MSA deductible affecting the levels of support and opposition.
After the extended debate of the last year, Americans are more likely to have opinions about
Medicare and Medicaid. The public is resistant to major spending reductions in the Medicare
program, even to prevent it from going bankrupt. Americans are split over whether responsibility
for Medicaid should be turned over to the states, but the majority of the public opposes a
Medicaid block grant when they learn that along with more flexibility states would also get a fixed
amount of federal money.
After a considerable lapse in public interest following the demise of the health reform debate,
health appears to be rising again on the list of issues people say they are concerned about. Health
care in general (excluding Medicare) ranked third, behind concerns about the economy and
candidate characteristics among issues that people say would influence their vote in the upcoming
presidential election. In addition, Medicare was tied for seventh. The vast majority of Americans
believe that health care costs and the uninsured are bigger problems today than five years ago.
And, a plurality believe that the health care system is getting worse.
These findings are from the latest survey designed to monitor public knowledge, opinions, and
beliefs on health and health-related issues conducted by the Kaiser-Harvard Program on the Public
and Health/Social Policy. The survey was designed by the Kaiser Family Foundation, Harvard
University, and Princeton Survey Research Associates (PSRA), and conducted by PSRA.
more --
A JOINT PROGRAM OF THE HENRY J. KAISER FAMILY FOUNDATION AND HARVARD UNIVERSITY
KAISER FAMILY FOUNDATION: 2400 SAND HILL ROAD, MENLO PARK, CA 94025 415 854-9400 FAX 415 854-4800
HARVARD SCHOOL OF PUBLIC HEALTH: 677 HUNTINGTON AVENUE, BOSTON, MA 02115 617 432 4502 FAX 617 432-0092
When asked if they would choose an MSA if they had a choice, 21 percent of Americans say they
would be very likely to choose an MSA with a $2,000 deductible and 22 percent say they would
be somewhat likely to choose an MSA at this level of deductible. Only 12 percent would be very
likely to choose an MSA with a $5,000 deductible and 25 percent would be somewhat likely.
Only a minority of Americans (30 percent) say they have followed the debate over MSAs, but
they are more favorable than the general public toward the proposal -- 44 percent favor a MSA
that would provide coverage after an employee pays $2,000 in medical bills, while one-third (35
percent) oppose it. For a MSA with a $5,000 deductible, support among those following the
debate falls to 34 percent and opposition rises to 42 percent.
Medicare
In the war of words over the future of the Medicare program, much has been staked on whether
the debate is about the future solvency of the program, balancing the Federal budget, or tax cuts.
When asked what they believe the debate over Medicare is about, the public is divided with 34
percent saying that the debate is about balancing the federal budget, 31 percent to save the
program from bankruptcy, and 20 percent to pay for a tax cut. Regardless of the rationale
offered, however, there is little support for altering the present system. A majority of Americans
believe Congress should not make major reductions in future spending on Medicare, even to head
off insolvency (54 percent). Changes to the Medicare system draw even less support when the
objective is balancing the budget (77 percent oppose).
Likewise, the public has not entirely warmed up to a defined contribution or voucher plan for
Medicare: only 32 percent favor mandatory vouchers that would be used to purchase private
health insurance, while 64 percent favor keeping Medicare as it is today. Attitudes towards a
voluntary voucher are more mixed with slightly more Americans opposing a voluntary voucher
system (49 percent) than favoring it (45 percent). Support for a voluntary voucher drops to (21
percent) if told that such a program might increase costs to those who remain in the traditional
Medicare program, a criticism some made of voucher plans. Among those 65 years and older,
only 19% support a voluntary voucher plan.
Among Americans who say health care or Medicare will influence their vote in the 1996 election
(14 percent of the general public), almost nine out of ten (89 percent) oppose major reductions in
Medicare spending to balance the federal budget. Twenty-two percent of Americans 65 years and
older say health care or Medicare is one of the top two issues which will influence their vote.
Medicaid
Americans are split on whether they think responsibility for Medicaid should be turned over to the
states with 47 favoring state control and 43 percent opposing it. However, support for state
control drops to 29 percent and opposition rises to 57 percent when the public is informed that in
addition to being given flexibility in running Medicaid, each state would be given a fixed amount
of Federal dollars under a block grant.
3
Health care for children, 12 percent;
Health care costs, 10 percent;
Americans losing their health insurance, 9 percent; and
Health insurance for those who can't afford it, 9 percent.
In a period when the public is very resistant to discussions of tax increases, the majority of the
public (60 percent) say they are willing to pay higher taxes or insurance premiums to guarantee
health insurance coverage to more people. At the same time, however, the public ranked rising
taxes among their top overall concerns. The public expressed support for action on long-term
care, with 68 percent saying they would be willing to pay more in taxes to help provide such care
to the elderly. Thirty-eight percent say they would be willing to pay more to improve mental
health coverage for all Americans.
Methodology
The Kaiser/Harvard/PSRA survey was conducted by telephone with 1,011 adults nationwide
between June 20 and July 9, 1996. The margin of error is plus or minus 3 percent.
The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent
national health care philanthropy and is not associated with Kaiser Permanente or Kaiser
Industries. The Foundation's work is focused on four main areas: health policy, reproductive
health, HIV, and health and development in South Africa.
Copies of the actual questionnaire and national top line data for the findings reported in this
release (#1166) are available by calling the Kaiser Family Foundation's publication request line at
1-800-656-4533.
5
CHART PACK
THE KAISER-HARVARD PROGRAM ON THE PUBLIC AND HEALTH/SOCIAL POLICY
Survey of Americans on Health Policy
July 30, 1996
Conducted for the Foundation by
Princeton Survey Research Associates
CALIFORNIA OFFICE: 2400 Sand Hill Road, Menlo Park, California 94025 (415) 854-9400 FAX (415) 854-4800
WASHINGTON OFFICE: 1450 G Street, NW, Suite 250, Washington, DC 20005 (202) 347-5270 FAX (202) 347-5274
FIGURE 1
PUBLIC DOES NOT THINK DEBATE OVER MEDICARE
IS ABOUT PREVENTING BANKRUPTCY
PERCENT WHO SAID DEBATE WAS MAINLY ABOUT
BALANCING THE
34%
FEDERAL BUDGET
PREVENTING
MEDICARE FROM
31%
GOING BANKRUPT
20%
PAYING FOR A
TAX CUT
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 2
AMERICANS OPPOSE MAJOR REDUCTIONS
IN FUTURE SPENDING ON MEDICARE
PERCENT WHO SAY CONGRESS SHOULD NOT MAKE REDUCTIONS TO
BALANCE THE
77%
FEDERAL BUDGET
PREVENT MEDICARE
PROGRAM FROM
54%
GOING BANKRUPT
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 3
PUBLIC OPPOSED TO MANDATORY VOUCHERS FOR
MEDICARE PROGRAM, MIXED ON VOLUNTARY VOUCHERS
100%
OPPOSE
FAVOR
80%
64%
60%
49%
45%
32%
40%
20%
0%
MANDATORY VOUCHER
VOLUNTARY VOUCHER
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 4
AMERICANS SPLIT ON TURNING OVER
RESPONSIBILITY FOR MEDICAID TO THE STATES
47%
FAVOR
43%
OPPOSE
10%
DON'T KNOW
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 5
WHEN CAP OF FEDERAL DOLLARS EXPLAINED,
AMERICANS OPPOSE TURNING MEDICAID OVER TO STATES
57%
OPPOSE
29%
FAVOR
14%
DON'T KNOW
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 6
MEDICAID VIEWED FAVORABLY BY MANY AMERICANS
PERCENT VIEW
PERCENT VIEW
POSITIVELY
NEGATIVELY
MEDICARE
50%
22%
HEALTH CARE REFORM
47%
28%
MEDICAID
42%
25%
FOR-PROFIT HEALTH
24%
23%
MANAGED CARE
24%
21%
WELFARE
24%
57%
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 7
MOST AMERICANS HAVE NOT FORMED AN OPINION
ON THE KASSEBAUM / KENNEDY BILL
31%
FAVOR
12%
OPPOSE
57%
DON'T KNOW ENOUGH
TO HAVE AN OPINION
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 8
MORE AMERICANS OPPOSE THAN FAVOR MEDICAL SAVINGS ACCOUNTS,
ALTHOUGH SIZE OF DEDUCTIBLE MATTERS
100%
FAVOR
OPPOSE
80%
DON'T KNOW ENOUGH
60%
42%
40%
36%
36%
40%
28%
18%
20%
0%
$2,000 DEDUCTIBLE
$5,000 DEDUCTIBLE
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 9
AMERICANS' PERSONAL INTEREST IN CHOOSING
A MEDICAL SAVINGS ACCOUNT
100%
VERY LIKELY
SOMEWHAT LIKELY
80%
NOT TOO LIKELY
NOT AT ALL LIKELY
60%
37%
32%
40%
25%
21%
22%
20%
22%
13%
20%
0%
$2,000 DEDUCTIBLE
$5,000 DEDUCTIBLE
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 10
AMERICANS THINK HEALTH CARE PROBLEMS GETTING WORSE
PERCENT WHO SAY
HEALTH COSTS FOR
FAMILIES BIGGER
73%
PROBLEM NOW THAN 5
YEARS AGO
AMERICANS NOT
HAVING HEALTH
INSURANCE BIGGER
70%
PROBLEM NOW THAN
5 YEARS AGO
HEALTH CARE
SYSTEM IS GETTING
49%
WORSE
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 11
MOST IMPORTANT ELECTION ISSUES
ECONOMY / JOBS
14%
CANDIDATES'
11%
CHARACTERISTICS
HEALTH CARE
10%
(Excluding Medicare)
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 12
AMONG AMERICANS WHO SAY HEALTH CARE IS A VOTING ISSUE,
MEDICARE IS THE TOP CONCERN
MEDICARE
25%
HEALTH CARE COSTS
18%
HEALTH CARE AVAILABILITY / ACCESS /
17%
UNIVERSAL COVERAGE
HEALTH CARE FOR CHILDREN
7%
GOVERNMENT INTERFERENCE
6%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 13
DIFFERENCES BETWEEN REPUBLICANS AND DEMOCRATS
ON MAJOR HEALTH POLICY ISSUES
63%
FAVOR TURNING MEDICAID
OVER TO STATES
34%
CONGRESS SHOULD REDUCE
52%
MEDICARE SPENDING TO
PREVENT PROGRAM FROM
32%
BANKRUPTCY
48%
FAVOR MANDATORY
VOUCHERS FOR MEDICARE
26%
43%
FAVOR MSAs WITH $2,000
REPUBLICANS
DEDUCTIBLE
18%
DEMOCRATS
25%
FAVOR MSAs WITH $5,000
DEDUCTIBLE
10%
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 14
WOMEN MORE LIKELY TO RANK HEALTH CARE
AMONG THEIR TOP VOTING ISSUES
MEN
WOMEN
1
ECONOMY / JOBS (18%)
1
HEALTH CARE (13%)
(Excl. Medicare)
2 CANDIDATE
2 ECONOMY / JOBS (11%)
CHARACTERISTICS (13%)
3
DEFICIT / GOVT. SPENDING
3(t) ABORTION (9%)
(9%)
4
TAXES (8%)
3(t) CANDIDATE
CHARACTERISTICS (9%)
5
HEALTH CARE (7%)
5
TAXES (7%)
(Excl. Medicare)
Source: Kaiser/Harvard/PSRA Sruvey of Americans on Health Policy, July 1996.
FIGURE 15
WOMEN MORE LIKELY TO THINK HEALTH SYSTEM IS GETTING WORSE
PERCENT WHO SAY HEALTH CARE SYSTEM IS GETTING
53%
WORSE
45%
9%
WOMEN
MEN
BETTER
16%
34%
SAME
34%
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 16
FEW AMERICANS KNOW WHAT THE TERM
"MANAGED CARE PLAN" MEANS
37%
NEVER HEARD TERM
36%
HEARD OF TERM, BUT NOT
SURE OF MEANING
27%
KNOW WHAT TERM MEANS
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 17
AMERICANS HAVE MIXED FEELINGS TOWARD MANAGED CARE
PERCENT OF THOSE WHO HAVE
HEARD OF MANAGED CARE
PERCENT OF ALL AMERICANS
NEVER HEARD OF
NO DIFFERENCE
MANAGED CARE
32%
37%
GOOD THING
GOOD THING
17%
11%
NOT MUCH
DIFFERENCE
20%
BAD THING
DON'T KNOW
30%
13%
DON'T KNOW
21%
BAD THING
19%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.
FIGURE 18
WHAT INFLUENCES NEGATIVE VIEWS ON MANAGED CARE?
QUESTION: WHAT IS THE MAIN REASON YOU SAID MANAGED CARE
WOULD BE A BAD THING FOR YOU AND YOUR FAMILY?
36%
TV, NEWS PRESS, OTHER MEDIA
33%
OWN EXPERIENCE
25%
LEARNED FROM FRIENDS AND
FAMILY
0%
20%
40%
60%
80%
100%
Source: Kaiser/Harvard/PSRA Survey of Americans on Health Policy, July 1996.