Indiana University

Survey

It Doesn’t Matter How You Frame It – Americans Remain Divided on Support for Government Involvement in Health Insurance, No Matter What the Role.

Researchers from Indiana University’s Center for Health Policy and Professionalism Research (CHPPR) have found that support for government-sponsored health insurance for individuals under age 65 remains virtually the same regardless of how the plan is described or how involved the government would be. 

Many have argued that public support of a government-sponsored health insurance option, such as that being proposed by President Barack Obama, can be significantly influenced by changing how the plan is described or by varying the description of the role government would play. 

To test this idea, researchers from CHPPR developed three scenarios that each described a government health insurance plan for individuals under age 65 regardless of employment status.  One scenario described an optional “public health insurance plan,” another scenario described an optional “health insurance program similar to Medicare,” and a third described a scenario where, similar to other countries everyone received government insurance with an option to supplement with private insurance.  The survey had three main goals:

  1. To determine how the general public feels about the U.S. government sponsoring its own public health insurance plan for people under age 65. 
  2. To determine whether the manner in which this type of public health insurance plan is framed makes a difference in its appeal.
  3. To gauge appeal of a single-payer system  

Market Strategies International conducted the survey on behalf of CHPPR during the period between July 29 and August 5, 2009.  A total of 609 adults, ages 18 and older, living in the 48 contiguous states and the District of Columbia responded to this survey.   The margin of sampling error for results based on the total sample is plus or minus 4 percentage points. 

 

The Role of Government Doesn’t Matter
When respondents were presented with the three scenarios, 43% of respondents found the “public health insurance plan” appealing compared to 44% for the Medicare-like plan and 39% for the single-payer option.   The differences between the three options fell within the margin of error.


Public Plan Scenario:  Imagine if the system changed in the following way…Everyone under the age of 65 would decide whether or not they want to purchase private health insurance through a private company or public health insurance offered by the United States government This public health insurance plan would compete with private health insurance plans, like Blue Cross-Blue Shield and Cigna, and would be available to anyone regardless of employment.  On a scale from 0 to 10 where 0 means “Not at all appealing” and 10 means “Very appealing”, how appealing does this health insurance plan?

public plan appeal

 

 

Medicare Like Scenario: Imagine if the system changed in the following way…Everyone under the age of 65 would be able to decide whether or not they want to enroll in a health insurance program similar to the current Medicare program.  You would be allowed to decide whether you want to receive your coverage through private health insurance plans or through Medicare. This Medicare-like plan would compete with private health insurance plans, such as Blue Cross-Blue Shield and Cigna, and would be available to anyone regardless of employment.  On a scale from 0 to 10 where 0 means “Not at all appealing” and 10 means “Very appealing”, how appealing does this health insurance plan?

medicare-like appeal

 

 

Single-Payer Scenario: Imagine if the system changed in the following way…Similar to other countries, everyone under the age of 65 would automatically be enrolled in a health insurance program provided by the United States government.  In addition to receiving government funded health care, you would have the option of purchasing additional coverage from private health insurers, like Blue Cross-Blue Shield and Cigna.  This program would enroll everyone, regardless of employment.  On a scale from 0 to 10 where 0 means “Not at all appealing” and 10 means “Very appealing”, how appealing does this health insurance plan?

single-payer appeal

 

 

The top reasons cited for the appeal of the “public health insurance” and “Medicare like” plans included larger numbers of Americans who would be covered by health insurance, increased choice of insurance options, lower costs, and ability to make comparisons between private and public insurers.  For the single-payer option the overwhelming reason for its appeal was the increased number of Americans who would be covered by health insurance. 

For those respondents who found the plans unappealing, the top reasons cited included expected inefficiency with government run programs, a general dislike of government involvement in health care, and concerns that this would cause increased costs.

 

Partisan Reactions
Support for the public option was strongest among Democrats with 63% finding a “public health insurance” plan appealing, 64% finding a “Medicare like” plan appealing, and 69% finding a single-payer option appealing.  On the other hand, these options garnered far less support among Republicans.  45% of Republicans found the “public health insurance” plan unappealing, 37% found the “Medicare-like” plan unappealing, and 56% found the single-payer plan unappealing. Those who reported no party affiliation had rather stable support for any of the three scenarios at 41%, 41%, and 40%.

 

Public Plan Scenario

partisan public plan

 

Medicare Like Scenario

partisan medicare-like appeal

 

Single Payer Scenario 

partisan single-payer appeal

 

Age Divide
Age also played a role in evaluation of these scenarios.  Those respondents 18 to 34 years of age found the single-payer plan (53%) to be most appealing of the three scenarios, while those over 75 favored the “Medicare-like” plan (51%).

Public Plan Scenario

age public plan appeal

 

Medicare Like Scenario

age medicare-like appeal

  

Single Payer Scenario

age single-payer appeal   

 

Bottom Line
Many in Washington have spent a great deal of time finessing the descriptions and level of government involvement in the proposed options for health care reform.  These results seem to indicate, however, that while support for different descriptions or levels of government involvement may shift amongst certain demographics, the overall levels of support do not differ greatly when dealing with a “public option,” “Medicare-like” plan, or a single-payer plan.  It may be that people have already decided if they support or oppose government involvement in reform, no matter what the specifics or level of such reform are.

 

Survey Methodology and Full Report

Download a full report of polling results.