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					Public Health Insurance Plan Option 
            Poll Results

             February 2009


                                       1
“Lawmakers will most likely question him 
sharply about one of the most contentious 
aspects of President-elect Barack Obama’s 
domestic agenda: his call for a new public 
health insurance plan to compete with private 
insurers. No other proposal so clearly defines 
the political and philosophical differences 
between Mr. Obama and Republicans, or 
provokes such deep disagreements.”
                         -Robert Pear in the New York Times
                                                              2
“The one principle conservatives seem to 
agree on is a willingness to fight the 
Democrats’ push to create a public plan, 
which they view as a back door to a 
single-payer system. Beyond that, little 
else is settled.” 
                                 -Politico



                                             3
      HCAN
      Statement of Common Purpose

• A choice of a private insurance plan, 
  including keeping the insurance you 
  have if you like it, or a public insurance 
  plan without a private insurer 
  middleman that guarantees affordable 
  coverage.


                                                4
Voter Attitudes on a Public Health
Insurance Plan

Findings From A Survey of 800 Likely 
Voters Nationwide




                             202.776.9066 | www.lakeresearch.com | January 26, 2009
                    Methodology


•   Lake Research Partners designed and administered this survey that 
    was conducted by telephone using professional interviewers between 
    January 8-13, 2009.  

•   The survey reached a total of 800 likely voters nationwide.  

•   Telephone numbers for the sample were generated by random digit dial 
    (RDD) methodology. The margin of error for this survey is +/- 3.5%.




                                                                            6
                    Overwhelming support for a public health insurance plan
                    choice – over 7 in 10 voters prefer having a choice of a
                    public or private health insurance plan.


Which of the following three approaches to health care reform do you prefer: one, everyone getting
health insurance through private health insurance plans; two, everyone getting health insurance through
a public health insurance plan; or three, everyone having a choice of private health insurance or a public
health insurance plan?




                                                                                                        7
Support for a public health insurance plan is strong across
the board, and solid majorities support it.

     % Prefer Choice of Private or Public Plan




                                                          8
                    The broad consensus in support of a choice of public
                    health insurance plan or private plan remains
                    overwhelming – even after hearing a battery of arguments
                    against a public health insurance plan.


Sometimes in a survey like this people change their minds. Which of the following three approaches to
health care reform do you prefer: one, everyone getting health insurance through private health
insurance plans; two, everyone getting health insurance through a public health insurance plan; or three,
everyone having a choice of private health insurance or a public health insurance plan?


                                                                     Initial Ballot

                      Final Ballot




                                                                                                       9
                             When comparing Obama’s plan for reform with the plan
                             supported by the insurance companies, Obama’s plan
                             wins by a margin of more than 2-to-1.
                                       Support for Obama’s Plan


                                        +43
                                       points




                                                                                    10

                                       Darker color indicates intensity
* Asked of half of sample.
                      Text of Health Plans
[AHIP PLAN] Under Plan A, proposed by the health insurance industry, the 
      government would require all private health insurers to offer at least a set 
      amount of health coverage through a high-deductible plan. Insurance 
      companies would determine how much to charge in premiums.  The 
      government would subsidize the cost of health insurance for low income and 
      some middle-income families.  Insurance companies would not be allowed to 
      deny people coverage for pre-existing conditions.  Everyone would be 
      required to get health insurance.  Most people would be covered through 
      private health insurance, with seniors covered by Medicare as they are now. 

[OBAMA’S PLAN] Under Plan B, proposed by President-elect Obama, the 
     government would require all health insurers to offer at least one standard, 
     comprehensive health plan with guaranteed benefits.  The cost of coverage 
     would depend on a family’s income.  Insurance companies would not be 
     allowed to deny people coverage for pre-existing conditions and would have 
     restrictions on how much they can charge.  Employers would be required to 
     provide health coverage or contribute to the cost of coverage, with tax credits 
     for small business.  Everyone would be able to keep the health insurance 
     they have, or have a choice of private insurance or a public insurance plan, 
     with seniors covered by Medicare as they are now. 
                             Despite some tax sensitivity in a weak economy, a majority
                             of voters favor progressive reform, even if it means raising
                             taxes.


Do you favor or oppose providing access to affordable, quality health care for all Americans even if it
means raising taxes? IF FAVOR/OPPOSE, ASK: Do you feel strongly or not so strongly about that
choice?*
                                     Health Care Despite Tax Raise




                                                                                                          12

                                        Darker color indicates intensity
* Asked of half of sample.
                             Over 7 in 10 voters accept a major government
                             role in health care, the highest level of support in
                             over a year.
Do you favor or oppose providing access to affordable, quality health care for all Americans even if it
means a major role for the federal government? IF FAVOR/OPPOSE, ASK: Do you feel strongly or not so
strongly about that choice?*

                                 Major Role For Federal Government




                                                                                                     13

                                      Darker color indicates intensity
* Asked of half of sample.
                             Quality: Voters reject an attack claiming that a public health
                             insurance plan will lower quality. Two thirds agree with the
                             response that the public plan will provide an affordable option
                             with a wide choice of doctors.

Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*
QUALITY - COMPREHENSIVE

                                                                                   +40
    A public health insurance                                                     points
    plan will force people into
   lower quality care including
      long waiting times and
         rationing of care.


     A public health insurance
    plan will provide people the
    choice of an affordable plan
     that includes a standard,
    comprehensive package of
     benefits, including a wide
         choice of doctors.
                                                The response is strongest with
                                                older women, older non-college
                                               educated voters, Democrats, and                   14
                                                those in the East North Central
                                                            region.
* Asked of half of sample.
                             Quality: A response to the same quality attack that mentions “the
                             same benefits as members of Congress” tests nearly as well.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*

         QUALITY - CONGRESS

A public health insurance plan will
  force people into lower quality                                                +38
care including long waiting times                                               points
      and rationing of care.




A public health insurance plan will
 provide people the choice of an
 affordable plan that includes at
    least the same benefits as
    members of Congress get,
    including a wide choice of
              doctors.                             This response is strongest
                                                    with African Americans,
                                                   younger women, older non-                     15
                                                   college educated men, and
                                                           Democrats.
* Asked of half of sample.
                             Bureaucracy: By over two to one, voters reject an attack on big
                             government bureaucracy, agreeing that the public health
                             insurance plan will provide real competition and help lower
                             costs.

Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*
                       BUREAUCRACY

      A public health insurance plan will be another                                   +34
      big, government bureaucracy that will increase                                  points
                   costs to taxpayers.




    A public health insurance plan will lower health
     care costs by providing real competition with
       private insurance while spending less on
       administration, marketing, and executive
    salaries, and it won’t have to generate a profit.


                                                              This response is
                                                          strongest with older non-              16
                                                          college educated women
                                                               and Democrats.
* Asked of half of sample.
                                Costs: Most voters don’t buy an attack that a public health
                                insurance plan will make insurance more expensive due to
                                underpayment and cost shifting. They believe that a public health
                                insurance plan will help control health care costs and provide
                                competition.
Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*

                             UNDERPAYMENT

         Like Medicare and Medicaid, a new public                                      +36
       health insurance plan will reimburse doctors                                   points
        and hospitals at much lower rates, causing
        many doctors and hospitals to shift higher
         costs onto people who buy private health
                        insurance.


       A public health insurance plan will be able to
            control overall health care costs for
        everyone by using its purchasing power to
       drive competition and lower the prices paid
         for health care services and prescription
                           drugs.

                                                                This response is
                                                            strongest with under 40              17
                                                             and women under 55.

* Asked of half of sample.
                             Using the VA as an example to counter the underpayment attack
                             increases support among seniors, women over 55, and those
                             with a high school education or less.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*
                   UNDERPAYMENT W/ VA
    Like Medicare and Medicaid, a new public health
       insurance plan will reimburse doctors and                                        +45
      hospitals at much lower rates, causing many                                      points
    doctors and hospitals to shift higher costs onto
        people who buy private health insurance.




        A public health insurance plan will be able to
      control overall health care costs for everyone by
       using its purchasing power - like the Veterans
    Administration does now - to drive competition and
     lower the prices paid for health care services and
                     prescription drugs.

                                                          This response is strongest
                                                              with seniors, older                18
                                                            women, and those high
                                                           school educated or less.
* Asked of half of sample.
                              Competition: Voters believe a public health insurance plan can
                              help increase competition and set rules.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*


                  UNFAIR ADVANTAGE
        A public health insurance plan will have
         an unfair competitive advantage over
                                                                                    +30
            private insurance because the
                                                                                   points
        government will set rules that favor the
                      public plan.




         A public health insurance plan option
          will increase competition and rein in
          costs because the private and public
         plans will have to play by the same set
                         of rules.

                                                     This response is strongest                  19
 * Asked of half of sample.
                                                           with older men.
                             Competition: Voters are convinced a public health insurance plan
                             will help increase competition and rein in costs. A direct
                             challenge to private insurance plans increases support with older
                             women and voters with a college degree.

Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*


           UNFAIR ADVANTAGE W/ EFFICIENCY

           A public health insurance plan will have an                                   +37
            unfair competitive advantage over private                                   points
           insurance because the government will set
                 rules that favor the public plan.




           A public health insurance plan option will
           increase competition and rein in costs. If
         private insurers are really more efficient than
             government, then they won’t have any
             trouble competing with a public health
                     insurance plan option.
                                                           This response is strongest
                                                             with older women and                20
                                                              those with at least a
                                                                 college degree.
* Asked of half of sample.
                             The argument that a public health insurance plan will promote
                             quality and control costs is strong across the board. Only a
                             small minority of voters believes that competition among private
                             plans is enough.

Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*
                 COMPETITION
       The best way to promote quality
         and control costs is through                                           +34
      competition among private health                                         points
       insurers without adding another
              government plan.




       The best way to promote quality
         and control costs is through
       competition between public and
       private health insurance plans.


                                                  This response is strongest
                                                  with Democrats and those
                                                    in the Middle Atlantic
                                                                                                 21
* Asked of half of sample.
                                                            region.
                             Voters are skeptical of private insurers and 6 in 10 believe that a
                             public health insurance plan is necessary to control costs, as
                             opposed to simply setting basic rules and regulations.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*

  RULES AND REGULATIONS W/ NON-PROFIT

  We don’t need a new government health insurance
 plan. Private health insurance can control costs and
                                                                                            +33
provide quality affordable health care if the government
                                                                                           points
  sets basic rules and regulations, such as requiring
   private health insurers to accept people with pre-
                   existing conditions.



  Private health insurers will always find ways to put
     profits before people. That’s why we need an
 independent non-profit public health insurance plan
that is not driven by making higher profits, in order to
     control costs and guarantee access to quality
                 affordable health care.
                                                            This response is strongest
                                                           with seniors, post-graduates,            22
                                                              and Independent men.

* Asked of half of sample.
                             A response that does not use the words “independent non-
                             profit” is not quite as strong.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*

      RULES AND REGULATIONS

 We don’t need a new government health insurance
plan. Private health insurance can control costs and
     provide quality affordable health care if the
 government sets basic rules and regulations, such                                        +16
as requiring private health insurers to accept people                                    points
            with pre-existing conditions.




 Private health insurers will always find ways to put
 profits before people. That’s why we need a public
 health insurance plan that is not driven by making
     higher profits, in order to control costs and
 guarantee access to quality affordable health care.
                                                                                                 23


* Asked of half of sample.
                             Attacks claiming a government health insurance plan will cause
                             people to lose their coverage do not hold up well.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*



  MILLIONS LOSE COVERAGE - GOVT INSURANCE

         Establishing a government health insurance
        plan will mean that millions of people will lose
                                                                                    +47
            their private health insurance coverage
                                                                                   points
           because employers will drop their private
        insurance and dump people in the public plan.



         Under the current system, millions of people
        are already losing their health coverage every
          year. Having a choice of public or private
          health insurance plans will make sure that
         Americans always have an option for quality
                    affordable health care.
                                                                                                 24


* Asked of half of sample.
                             An attack based on the cost of a government plan in a bad
                             economy is ineffective when the cost of private insurance is cited
                             in response.


Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or
not so strongly?*



           BAD ECONOMY - GOVT INSURANCE

        A new government health insurance plan will
        cost taxpayers a huge amount of money we                                 +31
        cannot afford right now during an economic                              points
         slowdown, and because the government is
        involved, it will make the health system less
                efficient and increase costs.


         Private insurance companies currently have
           little incentive to control premiums and
            deductibles, reaping huge profits while
         working families struggle to pay the bills. A
         public health insurance plan that competes
            directly with private insurers will help.
                                                                                                 25


* Asked of half of sample.
                     Messages in support of a public health insurance plan test
                     very strongly, and support is highest when referring to
                     Obama’s plan. Voters are also reassured by having a
                     guaranteed backup for peace of mind.


Next I’m going to read you a few short statements that have been made in favor of including a public
health insurance plan option as part of health care reform. For each one, please tell me if the statement is
a very convincing, somewhat convincing, not very convincing, or not at all convincing reason to support
a public health plan option.
                                                  % Convincing (intensity in dark)




                                                                                                        26
                 Text of Positive Messages
[Obama’s plan] President-elect Obama’s health care proposal includes the choice of a 
public health insurance plan.  Under Obama’s plan, if you lose your job or lose your current 
health coverage for any reason, you’ll always be covered because the public insurance plan 
option will be a guaranteed backup. Lobbyists for the private insurance industry are using 
scare tactics to try to get rid of the public plan option, which would cut the heart out of 
Obama’s plan.  Congress should listen to the voters, not the insurance companies, and 
enact Obama’s health plan.

[Peace of Mind w/Medicare] It’s just wrong for people who work hard and pay taxes to go 
without affordable, quality health care.  Many hard-working middle class people are finding it 
harder to afford health care they can count on for themselves and their families.  We need a 
public health insurance option like Medicare as a guaranteed backup that will always be 
there to ensure quality, affordable health care coverage is available no matter what happens.  
It would give millions of hard-working families peace of mind.

[Peace of Mind] It’s just wrong for people who work hard and pay taxes to go without 
affordable, quality health care.  Many hard-working middle class people are finding it harder 
to afford health care they can count on for themselves and their families.  We need a public 
health insurance option as a guaranteed backup that will always be there to ensure quality 
affordable health care coverage is available no matter what happens.  It would give millions 
                                                                                               27
of hard-working families peace of mind.
            The top message for Democrats, Independents and middle
            -aged voters is “Obama’s Plan.” For Republicans and
            seniors, “Choice and Quality with Medicare” is most
            effective.
Top Among Democrats, Independents, and Middle-Aged Voters:
   [Obama’s plan] President-elect Obama’s health care proposal includes the 
   choice of a public health insurance plan.  Under Obama’s plan, if you lose your 
   job or lose your current health coverage for any reason, you’ll always be 
   covered because the public insurance plan option will be a guaranteed backup.
   Lobbyists for the private insurance industry are using scare tactics to try to get 
   rid of the public plan option, which would cut the heart out of Obama’s plan.  
   Congress should listen to the voters, not the insurance companies, and enact 
   Obama’s health plan.


Top Among Republicans and Seniors:
   [Choice and Quality w/Medicare] We need an alternative to the harsh and 
   unfair practices of the health insurance industry.  We need a guarantee of 
   quality affordable health care for all of us.  We need to set and enforce the rules 
   so insurance companies put our health care before their profits.  We need to 
   have a choice  of keeping the health insurance we have, or choosing a public 
   health insurance plan like Medicare, so we’re not left at the mercy of the same 
   private insurance companies that have gotten us into this mess.  
                                                                                          28
                        In a test of plan names, 3 in 4 voters like the term “public
                        health insurance plan.”




                                                                                                          3.4

                                                                                                          3.3

                                                                                                          3.2

                                                                                                          3.1

                                                                                                          3.0

                                                                                                          3.0

                                                                                                          2.8



Now I’m going to read you some different names that could be used to describe the public insurance              29
plan option we have been talking about. For each one, please tell me on a scale of 0 to 5 how favorable
you feel toward that name, where a 5 means the name is very favorable, and a zero means the name is
very unfavorable, and you can rate it anywhere in between.
                       Key Findings
•   7 in 10 voters overwhelmingly support a public health insurance plan as
    part of national health care reform. Voters always prefer having a choice
    of public or private insurance over having either option alone.

•   Even after hearing multiple attacks against a public health insurance plan
    option, voter support remains overwhelming.

•   Attacks against a public health insurance plan do not work well. In paired
    statements supporting and attacking a public plan, a solid majority
    supports a public plan every time, and the response beats the attack by
    double digit margins.

•   Conservative attacks that a public health insurance plan will increase
    costs, contribute to unfair competition, cause rationing, and that
    employers will drop their private insurance are not believable to most
    voters.                                                                      30
                       Key Findings
•   Despite voters’ economic concerns, a majority support reform to provide
    quality, affordable health care for all, even if it means raising taxes.

•   Voters also support reform even if it means a large federal government
    role.

•   Voters believe a public health insurance plan option will increase
    competition, contain costs, and help control the cost of health care. They
    believe it will give private insurers incentives to control their costs and
    become more efficient, not less.

•   Voters favor the principle of having guaranteed health coverage and
    having a choice. A public health insurance plan increases their peace of
    mind.
     – These principles resonate most strongly with women.

                                                                                  31
                        Key Findings
•   Referring to Obama’s health care proposal further intensifies support for a
    public health insurance plan.
     – Referring to Obama is effective with Democrats and Independents but
       cuts support with Republicans.

•   Using Medicare as an analogy for a public health insurance plan helps
    most when referring to Medicare as a guarantee and providing peace of
    mind, especially with women, seniors, and minority voters.
     – Medicare is less effective with men, especially men under 55 and
       college-educated men.

•   When referring to the plan, call it a public health insurance plan.

•   Emphasize choice of public and private plans.


                                                                                  32
          Key Messaging Points
•   Voters strongly support having a choice of public or private 
    health insurance.

•   In messaging, voters respond positively to arguments that a 
    public health insurance plan will help contain costs, increase
    competition, provide choice, and be a guaranteed backup.

•   Referring to Obama’s health care proposal sharpens already 
    strong support for a public health insurance plan option among 
    Democrats and Independents.

•   Attacks on the public health insurance plan claiming increased 
    costs, big government or lower quality do not hold up when 
    effective responses are made.



                                                                      33
          Key Messaging Points
•   Using Medicare as an analogy for a public health insurance plan 
    helps most when referring to Medicare as a guarantee and
    providing peace of mind.  

     – Medicare resonates most strongly among women,
       especially women over 55 and non-college women, as
       well as with seniors and minority voters.

     – Medicare is less effective with men, especially men under 55 
       and college-educated men.

•   Naming it a public health insurance plan generates strong 
    support across the board.  

     – Key is to mention both public AND health insurance and to 
       emphasize choice. 
                                                                       34
Voter Attitudes on a Public Health
Care Plan

Findings From A Survey of 800 Likely 
Voters Nationwide




                             202.776.9066 | www.lakeresearch.com | January 26, 2009

				
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