A Pivotal Political Moment on Health Care. July 31, 2012

A Pivotal Political Moment on Health Care July 31, 2012

2 Methodology and Overview This presentation is based on a survey conducted by Greenberg Quinlan Rosner Research for Democracy Corps and Women s Voices. Women Vote Action Fund. The survey of 900 likely 2012 voters (700 weighted) nationwide was conducted from July 21-25, 2012. This survey includes a unique oversample of 200 unmarried women to allow for an in-depth analysis of this important electoral group. Unless otherwise noted, margin of error= +/-3.70 percentage points at 95% confidence.

3 Key Findings Support for health care reform has risen steadily over this year; if proponents engage the issue, it is more likely to help than hurt in November. Republicans are running heatedly on healthcare repealing ObamaCare is a cornerstone of their strategy. Winning on health care is critical to their motivation and to what they believe is the edge they need to ultimately prevail over Obama and congressional Democrats in November. Republicans do not own this issue with voters. This poll suggests that Republicans are right that health care will be a significant factor in the vote, but woefully wrong on the consequences. If Democrats take up the debate with confidence educate voters on the benefits and, above all, denounce the battle to repeal and refight health care they will win the issue.

4 Key Findings Unmarried women one of the main beneficiaries of health care reform and one of the groups most affected by the economic crash are also politically disengaged. Their support for Obama now falls short of their 2008 vote by 10 points. Importantly, they are also the voters who learn the most in this argument. If Democrats take up health care in a serious way that is both educative and compelling they are likely to make their biggest gains among these voters. Medicaid expansion represents a huge opportunity. Voters are intensely opposed to Republican governors intransigence on Medicaid expansion. This is a powerful debate among all voters, and among unmarried women in particular. Among unmarried women, the margin (62 percent Democratic candidate, 30 percent Republican candidate) exceeds the current congressional ballot by 9 points (57 percent Democratic candidate, 34 percent Republican candidate).

Unmarried Women: Unfinished Story Unmarried women and whole Rising American Electorate lag behind 2008 vote Engagement is down among these voters compared to all voters, unmarried women are 10 points less likely to say they they are following the election closely and 11 points less likely to turn out But, unmarried women are ready to be drawn in: they have the greatest potential to turn out if they are engaged on issues that matter most Republicans will heatedly race the issue, but proponents want them to and to join the debate 2012 Greenberg Quinlan Rosner 5

Engagement gap: unmarried women and youth less likely to be following election closely How closely have you been following news about candidates for this year s presidential election? Following very closely Fairly Closely 81 74 71 68 41 36 29 29 All voters Rising American Electorate Unmarried women Youth 6

7 Unmarried women least likely to turn out in November: 11 points below average and 18 points below seniors I know it s a long way off, but what are the chances of your voting in the election for President and Congress this November? Very likely to turn out 89 82 77 83 78 72 73 71 65 65 All voters Seniors White non-college RAE Unmarried women

8 Unmarried women: not back to 2008 level of support for Obama and Democrats Among unmarried women Presidential Vote Congressional Vote +40-13 +27 +40-17 +23 70 69 60 57 30 33 29 34 Obama McCain Obama Romney Democratic candidate Republican candidate Democratic candidate Republican candidate 2008 July 2012 2008 July 2012

Democrats hold steady among unmarried women, but not reaching previous levels of support I know it is a long way off, but thinking about the elections for Congress in 2012, if the election for U.S. Congress were held today, would you be voting for DEMOCRATIC HOUSE CANDIDATE or REPUBLICAN HOUSE CANDIDATE*? November 2008 Among unmarried women July 2012 69 62 64 61 59 60 62 55 56 57 Democrat Republican +40 +23 63 59 56 59 57 57 50 29 40 36 33 29 26 30 32 33 29 39 35 34 35 33 34 34 Democrat RepublicanNov-10 Feb-11 May-11 Aug-11 Nov-11 Feb-12 May-12 Democrat Republican * In the landline sample, the incumbent names were inserted preceded by party identification. Generic the Democratic candidate or the Republican candidate were inserted for the opposition. For the cell phone sample and open seat districts, both candidates were given as generic.

10 Obama holds significant margin among unmarried women, but not back to 2008 level of support I know it's a long way off, but thinking about the presidential election in 2012, if the election for president were held today and the candidates were Democrat Barack Obama and Republican Mitt Romney, for whom would you vote? Among unmarried women November 2008 +40 62 60 Obama 65 Romney 60 63 60 July 2012 +27 70 54 60 30 26 37 34 30 37 32 33 33 Obama McCain Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Obama Romney

11 Obama approval among unmarried women unchanged higher than 2010, but below peak Do you approve or disapprove of the way Barack Obama is handling his job as president? Total Approve Total Disapprove Among unmarried women 52 58 66 60 67 64 59 57 56 Birth Control Debate 69 58 53 56 63 61 42 35 31 33 26 29 32 37 36 36 36 28 37 31 35 Nov-10 Jan-11 Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jul-12

12 Unmarried women show greater faith in Obama on the economy than Republicans or Democrats Now I am going to ask you something different. I am going to read a list of issues and I want you to tell me whether, overall, you think the Democrats/Barack Obama or the Republicans/Mitt Romney would do a better job with this issue The economy. The economy 56 Obama/Democrats much better +25 Romney/Republicans much better 49 +15 38 31 32 34 19 15 Obama Romney Democrats Republicans Among unmarried women

13 Obama and Democrats have electoral advantage on health care reform Now I am going to ask you something different. I am going to read a list of issues and I want you to tell me whether, overall, you think the Democrats/Barack Obama or the Republicans/Mitt Romney would do a better job with this issue health care reform. Health care reform Obama/Democrats much better Romney/Republicans much better 48 +6 46 42 41 +5 36 25 24 32 Obama Romney Democrats Republicans Among all voters

14 Strong majority of unmarried women trust Obama, Democrats with health care reform Now I am going to ask you something different. I am going to read a list of issues and I want you to tell me whether, overall, you think the Democrats/Barack Obama or the Republicans/Mitt Romney would do a better job with this issue health care reform. Obama/Democrats much better Health care reform Romney/Republicans much better 59 +29 54 +23 45 30 31 40 20 19 Obama Romney Democrats Republicans Among unmarried women

Unmarried women uniquely suited to benefit from this law. But don t know it yet. Fully 25 percent of unmarried women ages 18-64 are uninsured, compared to 15 percent of married women. Three-quarters of married women have employment-based health insurance, compared to half of unmarried women. Because unmarried women mostly rely on a single income, their coverage is uniquely vulnerable to recessionary pressures. Unemployment among single mothers increased by 40 percent last year. More than four in ten (43 percent) of unmarried mothers reported not filling a prescription because they could not afford it last year. 2012 Greenberg Quinlan Rosner 15

Unmarried women: concerns about insurance affordability, health care costs, and Medicare stand out 16

17 Among unmarried women, large shift after hearing facts about health care reform and debate on both sides Unmarried Women All in all, do you think you and your family will be better off or worse off under the health care reform law? Now let me ask you again, all in all, do you think you and your family will be better off or worse off under the health care reform law? 51 +19 58 +29 32 29 24 21 27 18 Better Off Worse Off Better Off Worse Off Initial Ask Re-ask

18 Just a third of unmarried women start out strongly believing health care law will affect them All in all, do you think the health care reform law will have an effect on you or not have much effect on you? 67 58 43 34 Will affect All Voters Will affect Unmarried women

19 Health care law starts out even among all voters; they say law will affect them, but split on whether they ll benefit Among All Voters Overall, do you favor or oppose the health care reform law that passed in 2010? Even All in all, do you think you and your family will be better off or worse off under the health care reform law? All in all, do you think the health care reform law will have an effect on you or not have much effect on you? +1 +40 67 46 46 44 43 28 37 22 30 43 27 Favor Oppose Better off Worse off Will affect Will not affect Support Better off Will affect

20 By comparison, unmarried women more favorable, but much less likely to believe it will have impact on them Among Unmarried Women Overall, do you favor or oppose the health care reform law that passed in 2010? All in all, do you think you and your family will be better off or worse off under the health care reform law? All in all, do you think the health care reform law will have an effect on you or not have much effect on you? +23 +19 +25 56 51 58 35 33 32 34 33 23 24 21 Favor Oppose Better off Worse off Will affect Will not affect Support Better off Will affect

Health care debate The health care reform law has improved in popularity over the last year, making it less potent for Republicans, particularly when voters are eager for Congress to focus on economy. Republican effort to make repeal a cornerstone has backfired. Stronger support among unmarried women and shift when hear overall benefits of the law. Voters turn against Republican governors who would reject Medicaid expansion in their states. 2012 Greenberg Quinlan Rosner 21

Dramatic improvement in health care law favorability since 2010 Now, I'd like to rate your feelings toward THE NEW HEALTH CARE REFORM LAW with one hundred meaning a VERY WARM, FAVORABLE feeling; zero meaning a VERY COLD, UNFAVORABLE feeling; and fifty meaning not particularly warm or cold. You can use any number from zero to one hundred, the higher the number the more favorable your feelings are toward that person or organization. Very warm (75-100) Very cool (0-25) The new health care reform law Mean: 37.1 Mean: 37.3 Net: -23 Net: -20 29 27 Mean: 41.6 Net: -9 35 Mean: 44.7 Net: -3 40 16 13 19 26 44 39 38 37 52 September 2010 47 44 43 November 2011 June 2012 July 2012 22

23 Republicans don t get majority support for their repeal vote Last week, Republicans in Congress voted to repeal the health care reform law. Here is what some Republicans said about the reason they voted to repeal the law. From what you know, do you support or oppose the Republicans who voted to repeal the health care law? The president's health care law has made a tough economy even worse by increasing the deficit, raising health care costs, increasing insurance premiums, and causing uncertainty for businesses and state governments. The only way to change this is by repealing ObamaCare. The president's health care law was supposed to lower health care costs and create jobs. Instead it has raised costs and made it harder for small businesses to hire new workers, making things worse. What Americans want is a common-sense approach to health care reform -- not a costly government takeover of our health system. Government should focus on cutting spending and the deficit, not spending billions taking over the insurance industry and making decisions that are better left to doctors and their patients. 46 38 Oppose +3 49 39 Support

24 Repeal politics backfires among unmarried women Last week, Republicans in Congress voted to repeal the health care reform law. Here is what some Republicans said about the reason they voted to repeal the law. From what you know, do you support or oppose the Republicans who voted to repeal the health care law? Among unmarried women The president's health care law has made a tough economy even worse by increasing the deficit, raising health care costs, increasing insurance premiums, and causing uncertainty for businesses and state governments. The only way to change this is by repealing ObamaCare. The president's health care law was supposed to lower health care costs and create jobs. Instead it has raised costs and made it harder for small businesses to hire new workers, making things worse. What Americans want is a common-sense approach to health care reform -- not a costly government takeover of our health system. Government should focus on cutting spending and the deficit, not spending billions taking over the insurance industry and making decisions that are better left to doctors and their patients. 55 44 Oppose +17 38 28 Support

Republican governors could pay the price for blocking Medicaid expansion in their states Under the new health care reform law, states have the option to expand Medicaid, with funding from the federal government, to cover more people without health insurance. Some Republican governors are refusing to participate. The federal government will pay the entire cost of the Medicaid expansion for three years and 90 percent of the costs thereafter. Considering just these two statements, for which candidate would you vote, the Democratic candidate or the Republican candidate? For the sake of stopping President Obama, the Republicans are refusing federal funds that will allow many to have health insurance instead of just going to the emergency room and leaving the rest of us to foot the bill. Republicans are preventing tax credits for small businesses and those earning under 50,000 dollars. Instead of more political fighting, we should focus on making health care more affordable for everyone. We should do everything possible to stop ObamaCare in (STATE). The cost of Medicaid is already 15 percent of our budget and growing every year. This is an unfunded mandate and a federal power grab. The federal government imposes new requirements and leaves (STATE) to pick up the tab. +7 50 43 Democratic candidate Republican candidate 25

26 Blocking Medicaid expansion backfires and Republican governors sharply rejected by unmarried women Under the new health care reform law, states have the option to expand Medicaid, with funding from the federal government, to cover more people without health insurance. Some Republican governors are refusing to participate. The federal government will pay the entire cost of the Medicaid expansion for three years and 90 percent of the costs thereafter. Considering just these two statements, for which candidate would you vote, the Democratic candidate or the Republican candidate? For the sake of stopping President Obama, Republicans are refusing federal funds that will allow many to have insurance instead of going to the emergency room and leaving the rest of us to foot the bill. Republicans are preventing tax credits for small businesses and those earning under 50,000 dollars. Instead of more political fighting, we should focus on making health care more affordable for everyone. We should do everything possible to stop ObamaCare in (STATE). The cost of Medicaid is already 15 percent of our budget and growing every year. This is an unfunded mandate and a federal power grab. The federal government imposes new requirements and leaves (STATE) to pick up the tab. +7 +32 62 50 43 30 Democratic candidate Republican candidate Democratic candidate Republican candidate All Voters Unmarried women

Framing the health care debate Strongest facts in debate: letting kids stay on their parents insurance, ensuring coverage for children with pre-existing conditions drives the vote for Democrats in regression modeling. These are strong among all voters, even stronger among unmarried women. Strongest arguments revolve around making sure most vulnerable get and keep their health coverage, preventing insurance companies from increasing costs. Regression analysis shows if Democrats argue it s time to move on, they can shift the vote. 2012 Greenberg Quinlan Rosner 27

Moving forward, keeping insurance companies from raising costs drive the vote in regression analysis Dep. Variable: Congressional Re-vote; Ind. Variables: Democratic Attacks SPLIT A Odds Ratio Std. Err. Party I.D. 4.24 1.10 (MOVE ON) The Supreme Court has spoken and it's now time for us to move forward. Republicans in Congress have tried to repeal the health care law 33 times, which wastes time and tax dollars. Now we need to focus on the economy and getting people back to work but the Republicans want to refight the same old health care political battles. 3.76 0.65 Obama approval 2.05 0.53 R-Square =.59 Dep. Variable: Congressional Re-vote; Ind. Variables: Democratic Attacks SPLIT B Odds Ratio Party I.D. 3.85 0.85 (INSURANCE COMPANIES) Mitt Romney and the Republicans want to turn health care decisions back over to insurance companies and prescription drug companies who are driving up health care costs and making billions of dollars in profit lowering benefits and shedding people who get ill, but who invested millions of dollars in paying for Republican campaigns. 2.14 0.41 Obama approval 1.97 0.32 R-Square =.57 Dep. Variable: Are you better or worse off with the health care law re-ask; Ind. Variables: Health care law facts Odds Ratio Obama approval 2.86 0.47 (ENDS LIFETIME LIMITS) The law ends lifetime coverage limits by preventing insurance companies from setting dollar limits on the amount of medical care they will cover. 2.27 0.76 Party I.D. 1.72 0.31 Gender 1.56 0.38 (PRE-EXISTING CONDITIONS) Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition. 1.50 0.35 R-Square =.35 Std. Err. Std. Err.

29 Insuring children, preventative care top considerations in health care debate Now I am going to read you some things some people who support the health care reform law say will help the country. After I read you the list, I want you to tell me which two you favor the most. Percent saying favor most (top 2 combined) Children can remain on their parents' insurance plans up to age 26. 40 Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition. 39 Preventive health care for women, such as mammograms, screenings for cervical cancer and other services, must be covered by all new insurance plans. 35

30 Among unmarried women, covering children and women s health coverage are critical Now I am going to read you some things some people who support the health care reform law say will help the country. After I read you the list, I want you to tell me which two you favor the most. Among unmarried women Percent saying favor most (top 2 combined) Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition. 50 Children can remain on their parents' insurance plans up to age 26. 35 Preventive health care for women, such as mammograms, screenings for cervical cancer and other services, must be covered by all new insurance plans. 33

31 Those priorities are shared by the Rising American Electorate at large Now I am going to read you some things some people who support the health care reform law say will help the country. After I read you the list, I want you to tell me which two you favor the most. Among Rising American Electorate Percent saying favor most (top 2 combined) Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition. 44 Children can remain on their parents' insurance plans up to age 26. 39 Preventive health care for women, such as mammograms, screenings for cervical cancer and other services, must be covered by all new insurance plans. 35

32 More than a quarter favor prohibition against insurance companies dropping ill policy holders Now I am going to read you some things some people who support the health care reform law say will help the country. After I read you the list, I want you to tell me which two you favor the most. Percent saying favor most (top 2 combined) Insurance companies cannot drop your health coverage if you become sick. 27 Women can choose their OB/GYN provider without another doctor's referral or approval from the insurance company. 25 Insurance companies can no longer be allowed to charge women higher premiums than men. 20 All new health plans will be required to offer essential benefits for women, including maternity and reproductive health care. 20

33 Last tier of facts about the law Now I am going to read you some things some people who support the health care reform law say will help the country. After I read you the list, I want you to tell me which two you favor the most. Percent saying favor most (top 2 combined) The law prevents sudden rate increases by requiring insurance companies to justify any rate increase of 10 percent or more. 19 Insurance companies and employers, with the exception of churches and other places of worship, must cover contraception without any additional co-pays. 17 The law ends lifetime coverage limits by preventing insurance companies from setting dollar limits on the amount of medical care they will cover. 17

34 Strongest attacks: women charged higher rates and denied preventive coverage; deny coverage to most vulnerable Now I'm going to read you some of the things President Obama has said about Mitt Romney and Republicans' efforts to repeal the health care law. After I read each one, please tell me whether this raises very serious doubts, serious doubts, minor doubts, or no real doubts in your own mind about Mitt Romney and the Republicans. Very serious doubts Serious doubts (WOMEN) By repealing this law, Mitt Romney and the Republicans will once again allow insurance companies to charge women higher insurance rates than men, not cover mammograms, screenings for cervical cancer and other services, and discriminate against women by not covering birth control. Total Unmarried women 26 34 53 63 (MOST VULNERABLE) By repealing this law, Mitt Romney and the Republicans would deny health care coverage, for the first time for many, to over 30 million of the most vulnerable families, including families headed by single mothers. It is wrong when a country like the United States denies people in need access to decent, affordable health care. Total Unmarried women 20 26 50 59

Half don t trust insurance companies; say Republicans need to move on and focus on economy 35 Now I'm going to read you some of the things President Obama has said about Mitt Romney and Republicans' efforts to repeal the health care law. After I read each one, please tell me whether this raises very serious doubts, serious doubts, minor doubts, or no real doubts in your own mind about Mitt Romney and the Republicans. Very serious doubts Serious doubts (INSURANCE COMPANIES) Mitt Romney and the Republicans want to turn health care decisions back over to insurance companies and prescription drug companies who are driving up health care costs and making billions of dollars in profit lowering benefits and shedding people who get ill, but who invested millions of dollars in paying for Republican campaigns. Total Unmarried women 22 22 49 64 (MOVE ON) The Supreme Court has spoken and it's now time for us to move forward. Republicans in Congress have tried to repeal the health care law 33 times, which wastes time and tax dollars. Now we need to focus on the economy and getting people back to work but the Republicans want to refight the same old health care political battles. Total Unmarried women 22 23 48 56 (MIDDLE CLASS) The middle class is being smashed in this country and rising health care costs are a major part of the problem. By repealing this law, Mitt Romney and the Republicans put at risk every middle class family who could lose everything because of some major illness and their insurance company deciding to cut them off. Total Unmarried women 19 23 47 60

36 Republicans nuclear arsenal taxes and Medicare barely garner majority Now I'm going to read you some of the things Republicans in Congress are saying about President Obama's health care law. After I read each one, please tell me whether this raises very serious doubts, serious doubts, minor doubts, or no real doubts in your own mind about President Obama and the Democrats. Very serious doubts Serious doubts (TAX) ObamaCare increases taxes by 500 billion dollars on the American people and requires everyone to buy health insurance or pay what the Supreme Court says is a new tax that could cost middle-class families who cannot afford insurance more than 2,000 dollars per year. After Obama promised no middle class tax increase, the Supreme Court said Obamacare was a tax. Total Unmarried women 22 28 45 52 (MEDICARE) ObamaCare hurts seniors by cutting 500 billion dollars from Medicare and takes away benefits offered under Medicare Advantage. Additionally, beginning in 2015, ObamaCare will impose caps on the spending growth of Medicare each year. These cuts and caps on future growth will lead to further reductions in seniors' access to vital medical services. Total Unmarried women 22 20 50 49

37 Republican attacks on Democrats not nearly as strong Now I'm going to read you some of the things Republicans in Congress are saying about President Obama's health care law. After I read each one, please tell me whether this raises very serious doubts, serious doubts, minor doubts, or no real doubts in your own mind about President Obama and the Democrats. Very serious doubts Serious doubts (BIG GOV) Obama's health care reform law intrudes on decisions best left to individuals. It socializes one-sixth of the American economy and puts health care bureaucrats, rather than you or your doctor, in charge of your health. The federal government can't tell American citizens what they must buy with their own money, including health insurance. Total Unmarried women 16 23 43 49 (COST) ObamaCare is bad for America. The massive tax increases, new regulations, and uncertainty created by the law make it much harder for both large and small businesses to create new jobs and hire new workers. ObamaCare is one of the main reasons our economy has not been able to pull out of the recession. Total Unmarried women 12 20 32 45

38 Talking about health care reform does not shift voters beliefs about whether they will be better or worse off All in all, do you think you and your family will be better off or worse off under the health care reform law? Now let me ask you again, all in all, do you think you and your family will be better off or worse off under the health care reform law? +1 +3 44 43 43 46 30 29 22 23 Better Off Worse Off Better Off Worse Off Initial Ask Re-ask

39 But among unmarried women, large shift after hearing facts about health care reform and debate on both sides Unmarried Women All in all, do you think you and your family will be better off or worse off under the health care reform law? Now let me ask you again, all in all, do you think you and your family will be better off or worse off under the health care reform law? 51 +19 58 +29 32 29 24 21 27 18 Better Off Worse Off Better Off Worse Off Initial Ask Re-ask

40 Debate does not work for Republicans Overall, do you favor or oppose the health care reform law that passed in 2010? Now, let me ask you again. Overall, do you favor or oppose the health care reform law that passed in 2010? Even +1 46 46 47 48 37 28 28 41 Favor Oppose Favor Oppose Initial ask of support Re-ask of support

41 And does not change favorability among unmarried women Among unmarried women Overall, do you favor or oppose the health care reform law that passed in 2010? Now, let me ask you again. Overall, do you favor or oppose the health care reform law that passed in 2010? +23 56 58 +25 33 33 35 36 23 24 Favor Oppose Favor Oppose Initial ask of support Re-ask of support

42 Arguments about the law do not hurt President Obama in race against Romney I know it's a long way off, but thinking about the presidential election this November, if the election for president were held today and the candidates were -- Democrat Barack Obama and Republican Mitt Romney, for whom would you vote? +4 I want you to imagine you are watching one of the presidential debates on the topic of the federal budget. In his concluding statement, Mitt Romney says that you should vote for him because he opposes the health care reform law. President Obama says you should vote for him because he supports the health care reform law. Considering these two statements, if the election for president were held today and the candidates were Democrat Barack Obama and Republican Mitt Romney, for whom would you vote? +3 50 50 46 47 Obama Romney Obama Romney Initial Vote Re-vote

43 But Obama makes small gains among unmarried women, due to drop in support for Romney Among unmarried women I know it's a long way off, but thinking about the presidential election this November, if the election for president were held today and the candidates were -- Democrat Barack Obama and Republican Mitt Romney, for whom would you vote? I want you to imagine you are watching one of the presidential debates on the topic of the federal budget. In his concluding statement, Mitt Romney says that you should vote for him because he opposes the health care reform law. President Obama says you should vote for him because he supports the health care reform law. Considering these two statements, if the election for president were held today and the candidates were Democrat Barack Obama and Republican Mitt Romney, for whom would you vote? +27 60 61 +31 33 30 Obama Romney Obama Romney Initial Vote Re-vote

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