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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Mark Mellman on Health Care Reform

This items is a memo to Democratic senators from noted progressive pollster Mark Mellman. It is cross-posted from Politico.
Voters support the content of healthcare reform, while expressing opposition to a “content-less” plan identified with Congress. The individual elements of the legislation are very popular, as is the bill in total, when it is explained. Moreover, the public continues to trust Democrats and the President over Republicans to deal with the issue.
Public Opinion On Healthcare Reform Is Evenly Split
The news media has recently highlighted polls showing double-digit margins in opposition to the current healthcare plan. But these cursory stories often neglect to mention two salient facts.
First, these poll questions fail to give any content, any specific meaning to the reform proposal. Voters are simply asked whether they favor or oppose “healthcare proposals being discussed in Congress.” Focus group research makes clear that voters know little about the substance of the plan—all they know is that some on both the left and the right don’t like it and that it is the subject of intense controversy. In essence then, these questions ask people whether they favor or oppose “a controversial plan that is in constant flux.” Understood that way, it is surprising we find any support.
Second, public poll analyses often ignore the fact that a chunk of opposition to the current plan comes from those who support reform, but would like to see Congress go further. A late-November AP/Ipsos poll found nearly identical numbers in favor of the bill (34%) and opposed (35%), without describing its content. A crucial 12% initially say they oppose the plan, but told pollsters their opposition was based on their belief that it did not go far enough. So what initially appears to be a 12-point margin against reform is actually an even division.


Hints of this phenomenon are evident in other poll questions. When the bill is described as “proposed changes to the healthcare system,” reminding voters of its basic purpose, the margin of opposition shrinks. When voters are
asked to recommend action to their legislators—voting either for or against the bill—opinion splits evenly.
This increase in support almost certainly comes from progressives who in an ideal world want more than the bill provides, but recognize political realities and support an “AYE” vote.
Individual Elements of Healthcare Reform Are Popular
The individual elements of healthcare reform are popular, and so is the bill when described in detail.
The most popular provisions of the bill protect against insurance company abuses, expand coverage and make healthcare more affordable. The public supports requiring large and mid-sized businesses to provide health insurance for their employees by nearly a 3-to-1 margin (73%-25%, CNN). The same is true for expanding Medicaid to the poor (75%-25%, CNN). Providing subsidies for families that make up to $88,000 a year is favored by a 2-to-1 supermajority (67%-32%, CNN). Additional regulations on insurance companies, such as banning rescission and denial of coverage for those with preexisting conditions are also very popular (60%-39% and 60%-40%, respectively, CNN).
When the entire proposal is described to voters, they strongly favor healthcare reform. Louisiana voters received this description of the bill:

This plan would require every American citizen to have health insurance and require large employers to provide coverage to their employees. It would require insurance companies to cover those with pre-existing conditions and prevent them from dropping coverage for people who get sick, while providing incentives for affordable preventive care. Individuals and small businesses that do not have coverage would be able to select a private insurance plan from a range of options sold on a National Insurance Exchange. Lower and middle income people would receive subsidies to help them afford insurance, while those individuals who like the coverage they already have will be able to keep their current plan.

After hearing these details Louisianans supported the bill 57% to 38%, with 43% strongly
supporting reform. Another poll we conducted among senior voters (over 60) in Maine using a very similar
description found 54% in favor with just 36% opposed.
A question in a December NBC/Wall St Journal that described both the exchange and Medicare buy-in found similar levels of support among Americans as a whole (58% to 32%).
Voters Oppose Filibustering The Plan
Our polling shows that voters, even in the deep red state of Louisiana, overwhelmingly oppose using the filibuster to prevent a final vote. In general, the filibuster is an unpopular tool. After hearing a description, a majority (53%) oppose even allowing a filibuster, while 42% believe it should be permitted in the Senate. When framed in the context of the healthcare debate specifically, opposition to the filibuster was even more substantial. We offered strong arguments on both sides. Support for filibustering healthcare was predicated on the view that the plan would mean:

…a government takeover of healthcare, higher costs, higher taxes, cuts to Medicare, lower quality of care and less choice; and if we don’t have a national consensus in favor of the bill, we need to use whatever rights and tools we have to stop it.

Opposition to a filibuster stemmed from the view that:

….Congress has done nothing to stop skyrocketing healthcare costs and we need reform that makes healthcare more affordable and prevents insurance companies from dropping people with pre-existing conditions or those who get old or sick. No Senator should let Washington gridlock or special interests stop Congress from doing its job.

Confronted with these arguments on both sides, Louisiana voters said they want their Senators to vote against a filibuster by nearly two to one (62%-33%).
The Public Trusts President Obama And Democrats More than Republicans
Voters continue to trust Obama and Congressional Democrats more than Republicans on the issue of healthcare. Two recent polls conducted by the Washington Post and Quinnipiac report nearly identical numbers: 45% of the public trusts Obama more while 38% put more faith in Congressional Republicans (average of two polls).

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