Public Opinion on Health Care Issues November 2012

Public Opinion on Health Care Issues November 2012 HEALTH CARE FACTORED IN 2012 ELECTION, BUT FAR FROM A STARRING ROLE As predicted, there was a role for health care issues in rs 2012 election decision, but Kaiser s November Health Tracking Poll fielded in the days immediately following last week s presidential election suggests it was a trailing issue rather than a leading one. To keep the issue list in perspective, the November survey first asked rs to name the top two factors in their in an openended question, without providing answer choices. Here we confirm the importance of the candidates personal characteristics in rs decisions: for both those supporting President Barack Obama and those backing Governor Mitt Romney, it was the rs sense of the characteristics and records of the candidates themselves rather than any one issue that was at the top of their minds. Taken together, health care issues came in third (or tied for third) among both groups, volunteered by 16 percent of Obama rs and 13 percent of Romney rs as one of the two most important factors in their. More specifically, eight percent of all rs mentioned something about the Affordable Care Act (ACA) as important to their, either pro or con, while one percent volunteered something about the Medicare program and the same share volunteered Medicaid [see table 2 on the next page]. Interestingly, while the economy and jobs were just as important as the candidates own strengths for Romney rs, it was named by significantly fewer Obama rs. TABLE 1: Health Care On The List Of Most Important Factors To Vote, But Not At The Top What one factor mattered most to you in deciding who you d for in the presidential election? What would you say was the second most important factor in deciding who you d for in the presidential election? (Total mentions; open ended question) Rank President Obama Governor Romney 1 Candidate characteristics/record (55%) Candidate characteristics/record (48%) 2 Economy and jobs (18%) Economy and jobs (48%) 3 Health care (16%) Health care (13%) 4 Social issues (9%) Social issues (13%) 5 Women s issues (7%) Foreign policy (1) Budget deficit* (1) *Foreign policy and budget deficit tied for fifth among those who d for Governor Romney 1

TABLE 2: In Their Own Words A Closer Look At Voters Priorities What one factor mattered most to you in deciding who you d for in the presidential election? What would you say was the second most important factor in deciding who you d for in the presidential election? (Total mentions; Open ended question) President Obama Governor Romney All Voters Presidential characteristics/record (NET) 51 55 48 Candidate characteristics 15 18 13 Support President Obama/Approve of Obama's job performance/policies/ 9 17 3 characteristics Against President Obama/Disapprove of his performance/policies/want change 9 1 20 Political vision/direction of the country/smaller government 9 9 8 Incumbency/Let him finish his run 4 9 Against Governor Romney/Disapprove of his policies 3 6 Support Governor Romney/Like his policies/characteristics 3 1 6 Only Democratic 3 6 Only Republican 2 4 Against Democrats/their policies 1 2 Against Republicans/their policies 1 2 Didn t like either candidate/lesser of two evils 1 1 Vote for party (general) 1 1 1 Economy/Jobs (NET) 32 18 48 Economy 26 15 40 Jobs/Unemployment 6 3 9 Jobs moving overseas 1 1 2 Health Care (NET) 14 16 13 Health care (general) 4 5 4 In favor of/want to keep ACA 3 6 Opposed to/want to repeal ACA 3 7 ACA (general) 2 2 1 Medicaid 1 1 Medicare 1 1 1 Social issues/morals (NET) 10 9 13 Abortion 5 4 6 Morals/Religion/Ethics 3 1 5 Gay marriage/rights 2 2 1 Social issues unspecified/other/all of the above 2 3 2 Foreign Policy (NET) 8 5 11 Foreign policy/world affairs 4 3 5 War/Troops/Military/Veterans 2 2 3 National security/terrorism 1 * 2 Budget Deficit/Spending/national debt 5 1 11 NOTE: Percentages may add to more than 100 because multiple responses were accepted. Only mentions of 5 percent or more among all rs shown. See topline (http://www.kff.org/kaiserpolls/8382.cfm) for full list of responses and question wording. 2

HEALTH CARE IS MORE THAN JUST THE ACA As previous months of Kaiser polling have shown, however, when rs talked about health care they were talking about much more than the ACA, even though the signature Obama administration legislation looms large for those deeply immersed in the latest health policy developments. When rs were asked to assess the importance of a lengthy list of issues to their s, large shares named a variety of health issues as a major factor in their, including: the future of the Medicare program (70 percent), the ACA (69 percent), the future of Medicaid (61 percent), and the candidates views on women s health issues (57 percent). Pressed to choose among this admittedly long laundry list of issues, rs splintered in their priorities, and no health care issue garnered more than single digit support as the biggest factor in their choice in 2012. That honor was saved for the economy (19 percent), the direction of the nation (15 percent), and President Obama s performance during his first term (15 percent). The Issue List: Economy, Direction Of Nation, And Obama s Job Performance At Top Percent who say each of the following was a major factor in their for president: AMONG ALL VOTERS Which of these would you say was the BIGGEST factor in your for president? The economy The direction the country is headed 87% 87% 19% 15% President Barack Obama s job performance over the last four years 78% 15% The future of the Medicare program The 2010 health care law The candidate s ability to relate to the middle class The future of the Medicaid program The candidate s views on the size and role of government Foreign policy The candidate s views on women s health issues 70% 69% 65% 6 6 60% 57% 3% 5% 9% 4% 6% Governor Mitt Romney s background as a businessman 46% President Barack Obama s handling of the response to Hurricane Sandy Whether the candidate is a Democrat or Republican 35% 3 < Note: None of these were the biggest factor (vol.), All were equally a big factor (vol.), Something else was the biggest factor (vol.), and Don t know/refused answers not shown for follow up question. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 7 10, 2012) 3

DID HEALTH CARE ISSUES BENEFIT ONE CANDIDATE OVER THE OTHER? The national exit poll 1 conducted by a consortium of major media organizations on election night also found health care in the mix as a second tier issue (18 percent picked health care from a list of four possible issues, compared to 59 percent that picked the economy), and suggested that health care rs were much more likely to have d for President Obama than for Governor Romney. Kaiser s November tracking survey also found rs that volunteered a health care related issue as one of the top two factors in their choice gave the edge to President Obama, 55 percent to 41 percent, though by a significantly smaller margin than the exit poll found in answer to a closed ended version of the most important issue question. TABLE 3: A Look at How Health Care Voters Voted: Across Several Possible Definitions of Health Care Voters, President Obama Had the Edge. The One Exception, The ACA, Where The Candidates Were Tied Data from National Exit Poll Data from KFF November Health Tracking Poll selected health care as their top issue (closed end) mentioned health care as top factor to (open end) said the 2010 health care law was a said the future of the Medicare program was a said the future of the Medicaid program was a said the candidate s stance on women s health issues was a Share of electorate 18% 14% 69% 70% 6 57% Percent who d for Pres. Obama 75% 55% 46% 50% 5 59% Percent who d for Gov. Romney 24 41 47 41 39 31 Pres. Obama Gov. Romney percentage point difference +51 +14 1 +9 +13 +28 Among the much larger groups of the electorate that did not necessarily name a health care issue as the biggest factor in their, but still agreed that a variety of related issues did play some role, President Obama s edge over Governor Romney varied. For example among those that agreed women s health or Medicaid played a role, the incumbent had a double digit advantage over his challenger (28 percentage points and 13 points respectively). On one of the other controversial issues of the election, the 70 percent of rs that said the future of Medicare played some role in their went for President Obama somewhat more narrowly, 50 percent compared to 41 percent for Gov. Romney. Finally, the two candidates were tied among those rs that said the ACA was a major factor in their, suggesting that the controversial health law worked both ways in the election. According to the November tracking poll, supporters of the law were just as likely to name it as a factor in their as opponents, suggesting it motivated both sides on the issue in equal measure. TABLE 4: ACA Motivated Both Opponents And Supporters Equally Among rs who have a FAVORABLE view of the ACA Among rs who have an UNFAVORABLE view of the ACA Percent of rs that said the 2010 health care law was a for president 7 73% the biggest factor in their for president 5% 7% 1 Data for the 2012 exit poll were collected by Edison Research for the National Election Pool, a consortium of ABC News, The Associated Press, CBS News, CNN, Fox News and NBC News. The data from this survey is available online on a number of media websites. See, for example, http://www.washingtonpost.com/wpsrv/special/politics/2012 exit polls/table.html 4

Women were a key constituency in the president s win and women s issues, including those related to their reproductive health choices, were a small, but measureable factor for this group. Six percent of women rs specifically mentioned women s issues as one of the most important factors to their in the open end, compared to one percent of men. Two thirds (65 percent) of female rs rated the candidate s views on women s health issues, including birth control and abortion as a major factor in their choice (compared to about half of men), with eight percent naming it as the biggest factor. A POST ELECTION LOOK AT SENIORS Seniors have been an interesting group to watch this election cycle: previous polling shows that they have been more likely than others to prioritize Medicare in their electoral choice, more likely to oppose changing the program to a premium support system along the lines proposed by Gov. Romney and his running mate Congressman Paul Ryan, but at the same time more likely to give Gov. Romney a small edge as the candidate they trusted with the future of the program. This new post election poll finds similar results, but also echoes the theme above that health care wasn t moving extremely large portions of any segment of the electorate this year. There was an age gap in prioritizing the nation s primary health program for retirees: A large majority of rs aged 65 and older said Medicare s future was a major factor in their (82 percent), 16 percentage points higher than among younger rs. But, as was true nationwide, few senior rs named it as the biggest single factor in their choice (5 percent), and in the open ended item, only 12 percent of seniors named any health issue as one of the primary elements in their decision, with only one percent offering up Medicare specifically. Meanwhile, though seniors have remained somewhat more skeptical than younger Americans of the Affordable Care Act, the November survey finds them more in line with the rest of the public on the 2010 law, with 40 percent favorable versus 40 percent unfavorable and the remaining two in ten not offering an opinion. The Issue List For Seniors Percent who say each of the following was a major factor in their for president: AMONG SENIORS WHO VOTED The economy The direction the country is headed The future of the Medicare program President Barack Obama s job performance over the last four years The 2010 health care law The candidate s ability to relate to the middle class Foreign policy The candidate s views on the size and role of government The future of the Medicaid program The candidate s views on women s health issues Governor Mitt Romney s background as a businessman President Barack Obama s handling of the response to Hurricane Sandy Whether the candidate is a Democrat or Republican Which of these would you say was the BIGGEST factor in your for president? Note: None of these were the biggest factor (vol.), All were equally a big factor (vol.), Something else was the biggest factor (vol.), and Don t know/refused answers not shown for follow up question. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 7 10, 2012) 76% 73% 69% 69% 68% 64% 54% 5 4 38% 84% 83% 8 18% 9% 5% 19% 4% 8% 4% 3% According to the national exit poll, Gov. Romney won among seniors by a comfortable margin. Even so, more of those aged 65 and up say that President Obama s policies will be good for seniors as a group than expect they will be bad (47 percent versus 33 percent). Similarly, somewhat more seniors expect his policies will be good for the Medicare program than bad (45 percent compared to 35 percent). 5

AS TO THE AFFORDABLE CARE ACT, NOT EVEN AN ELECTION CAN DISTURB ITS CONSISTENT RATINGS Meanwhile, not even a presidential election can disturb the relatively stable opinion trend on the Affordable Care Act. Looking among the American public as a whole in the days after the long race ended, the November survey found the public comfortably in the relatively narrow band that we have seen since passage of roughly split views. Meanwhile, not surprisingly, threequarters of Obama rs reported having favorable views of the ACA, while eight in ten Romney rs reported the opposite, with 65 percent saying their views of the law were very unfavorable. Nation Still Divided On ACA 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? 80% 60% 40% 20% 0% ACA signed into law on March 23, 2010 Favorable Unfavorable Don t know/refused 50 51 48 50 49 48 46 44 45 46 44 41 44 46 43 44 43 44 43 44 43 43 44 41 44 45 42 42 43 43 43% 41 43 40 41 41 42 40 40 41 41 43 42 41 42 42 42 41 41 42 42 39 40 41 40 39% 35 34 37 37 37 38 38 38 14 14 14 15 18 18 18 12 13 14 15 17 19 19 19 19 16 17 18 19 19 19% 17 15 15 15 14 10 11 12 9 8 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 May Jun Jul Aug Sep Oct Nov 2010 2011 2012 Source: Kaiser Family Foundation Health Tracking Polls At the same time, the proportion of Americans that report wanting to see the law repealed dropped to a new low of 33 percent. (Last week returning Republican House Majority Leader John Boehner told a network TV interviewer that Obamacare is the law of the land and the House will not move forward with further s to repeal the law.) After Election, Proportion Wanting Repeal Ticks Down What would you like to see Congress do when it comes to the health care law? 80% 60% 47 EXPAND law or KEEP law as is 50 51 52 51 51 53 52 REPEAL law and REPLACE with Republican alternative or REPEAL law and NOT REPLACE it 50 50 50 54 47 47 Don t know/refused 53 49 49% 46 40% 43 39 39 35 38 38 37 37 39 38 40 37 41 39 38 45 40 33% 20% 10 10 10 14 10 12 10 12 11 11 11 9 12 13 10 10 11 18% 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2011 2012 Source: Kaiser Family Foundation Health Tracking Polls 6

GOING FORWARD: VIEWS OF PRESIDENT OBAMA S SECOND TERM A clear majority of Americans anticipate President Obama s second term will be good for lower income Americans and for women, while Americans are quite divided on what it will mean for the wealthy. In terms of health issues, more think President Obama s policies will be good for Medicare, Medicaid and the ACA, than think they will be bad. Majority Say Obama s Second Term Good For Lower Income, Bad Or Status Quo For The Wealthy As president, do you think the policies of Barack Obama will be good or bad for each of the following or will his policies not make much of a difference? Good Not make much of a difference Bad Lower income Americans 59% 1 2 Women 56% 17% 17% The country as a whole 5 8% 34% Middle class Americans 5 1 3 Seniors, that is those ages 65 and older 50% 13% 27% You and your family 48% 14% 3 Medicare 48% 1 29% Medicaid 47% 1 25% The 2010 health care law 43% 1 30% Wealthy Americans 3 25% 3 Note: Don t know/refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted November 7 10, 2012) This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., including Claudia Deane, Sarah Cho, and Theresa Boston. The survey was conducted November 7 10, 2012, among a nationally representative random digit dial telephone sample of 1,223 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Computer assisted telephone interviews conducted by landline (708) and cell phone (515, including 274 who had no landline telephone) were carried out in English and Spanish by Braun Research, Inc. under the direction of Princeton Survey Research Associates International (PSRAI). The combined landline and cell phone sample was weighted to balance the sample demographics to match Census estimates for the national population on sex, age, education, race, Hispanic origin, nativity (for Hispanics only), region, and telephone usage. All statistical tests of significance account for the effect of weighting. The number of respondents and the margin of sampling error for key subgroups are presented in the table below. For results based on other subgroups, the margin of sampling error may be higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Number of respondents Margin of sampling error Total 1,223 3 percentage points All rs 947 4 percentage points Obama rs 452 5 percentage points Romney rs 410 5 percentage points Did not 276 6 percentage points Note, the data was not weighted to the final popular numbers and as a result the reported number in the topline does not exactly match the popular. In this survey, 70 percent of the public overall reported voting in the presidential election, which is much higher than the estimated 57.5 percent of the voting eligible population that actually turned out to. Vote over reporting is common in public opinion surveys. In this poll, 47 percent of rs reported voting for President Obama and 43 percent reported voting for Governor Romney. If these responses are re calculated based on those who reported their for president, then 50 percent reported voting for President Obama and 45 percent for Governor Romney. This is reasonably close to the actual national count of about 50.5 percent Obama, 48 percent Romney. The full question wording and methodology of the polls can be viewed online at: http://www.kff.org/kaiserpolls/8382.cfm. This publication (#8382-F) is available on the Kaiser Family Foundation s website at www.kff.org. The Henry J. Kaiser Family Foundation: Headquarters 2400 Sand Hill Road, Menlo Park, CA 94025 Phone: 650.854.9400 Fax: 650.854.4800 Washington Offices and Barbara Jordan Conference Center: 1330 G Street N.W., Washington, DC 20005 Phone: 202.347.5270 Fax: 202.347.5274 www.kff.org The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.