THE TIMES POLL : Americans Sending Mixed Messages on Health Reform

For members of Congress confronted with difficult choices over health care and hoping for guidance, the polls have an answer: You’re on your own.

The near-gridlock in Congress over health care reflects the reality in the nation. On almost every major issue involved in the yearlong debate over health reform--from universal coverage to cost-control efforts--Americans remain closely divided, according to The Times Poll.

On the one hand, health care has risen once again on the scale of public concerns, after being partly eclipsed earlier this year by public worries over crime. Asked to name the nation’s most important problem, 22% said it was health care, up from 18% in the last Times Poll in April and only 12% in January. In comparison, 38% named crime or related issues such as violence in society and drug use--down from 51% in April and 43% in January.

An overwhelming majority of Americans would like to see Congress pass some kind of health reform plan. Despite the recent remark by Senate Minority Leader Bob Dole (R-Kan.) that “there might be a big sigh of relief around the country” if Congress passed nothing, only 14% of those polled said that Congress should “pass no health reform plan.”

A sizable minority, 35%, said that they will be “angry” if Congress “cannot get a health care plan passed by the end of this year.” That sentiment was strongest among Democrats--44% of whom said they would be angry--but exists among 23% of Republicans and 28% of conservatives as well. Moreover, asked if Republicans were “offering constructive criticism” or “being obstructionist for mostly political reasons,” 57% overall, and even 37% of Republicans, said that GOP members of Congress were obstructionist. Only 28% overall said that they were being constructive.

On the other hand, concern about health care and a desire to see some plan pass does not translate into a consensus. To make matters more complicated, core constituencies of the two parties have staked out strongly opposing positions--weakening the ground under members of Congress from either party searching for a middle position.

Unusually large numbers of registered Democrats, 45%, and liberals, 49%, said that they would be inclined to oppose their representative in Congress if he or she voted against universal coverage. On the other side, while only 14% of all those polled said that Congress should pass no health bill, 25% of self-identified Republicans said that is what they think.

The net result for members of Congress is political peril in almost every direction. Democrats who move too far away from coverage for everyone risk alienating their core supporters--something that could cost the seats of members from closely divided districts. Republicans who vote for any health reform plan may anger supporters who have decided that no bill would be best. But with the public so divided about what reform should mean, compromise would appear necessary to produce any bill that would garner majority support.

The poll, supervised by Times Poll director John Brennan, was conducted nationally among 1,515 adults from Saturday through Tuesday. The results have a sampling margin of error of plus or minus 3 percentage points.

The poll confirms the sense in Congress that abortion coverage probably will have to be dropped or severely watered down for a health reform bill to pass. Asked if companies should be required to “make abortion coverage available to any worker who desires it,” only 33% said that they favored the idea, while 60% opposed it--with 46% strongly opposed.

But the poll contradicts several other beliefs that have gained strong currency in the health reform debate.

First, support for universal coverage, although large in the abstract, is far shakier than many Democrats assert.

By 58% to 31%, poll respondents said they favor a bill that would guarantee insurance for all by requiring companies to cover all their workers rather than “more limited reform that would . . . leave some people without coverage.” But asked if they would still go along if the coverage requirement “would cause job losses,” almost half the supporters defected. Overall, 28% of those polled supported the mandate even if it would cause job losses, 31% supported it, but not at the cost of jobs, and 31% said that they wanted Congress to pass a more limited bill regardless.

Analysts generally agree that requiring all companies to provide insurance would cost jobs in some industries while creating them elsewhere, but they disagree on the net effect.

Two other central elements of most reform plans are also highly controversial.

On efforts to control health costs, the poll found that 47% favor some government price limits even “at the risk of limiting the availability and quality of health care,” while 40% would leave prices to the free market “even if that might mean higher health care costs for the average person.”

And asked about the proposal that insurance companies be required to charge all residents of the same community roughly the same premium for health insurance, Americans were evenly divided--48% in favor, 46% opposed. People between the ages of 18 and 29, whose insurance premiums typically would go up under community rating, opposed the idea, 58% to 38%.

Those polled, however, strongly rejected an argument made by some conservative leaders that insurers should be allowed to charge gay Americans more because, the conservatives argue, gays are more likely to engage in unhealthy sexual practices. By 63% to 30%, those polled rejected that argument. The margin was closer, but still negative, 51% to 43%, among those who identified themselves as conservatives.

While Democrats have overstated support for key elements of reform, the poll contradicts Republican claims that support has collapsed for Clinton’s proposal.

Asked what they would like Congress to do on health care, the largest group in the poll, 38%, said that they want Congress to pass Clinton’s plan either as is or with only “minor changes.” In addition to the 14% who want nothing passed, another 32% would like to see Clinton’s plan with “major changes” or “a plan other than Clinton’s.” Those numbers are largely unchanged since April.

What has changed since April is public confidence in Clinton’s ability to handle health care issues. Three months ago, 50% said that Clinton could handle such issues better than congressional Republicans. Now only 37% say so. Belief in the Republicans, however, has not risen substantially--going from 27% in April to 31% now.

Americans are almost equally split on Clinton’s argument that limited reforms will end up costing society more in the long run than would universal coverage, with 43% agreeing and 40% disagreeing. That argument, however, does not necessarily determine people’s overall position. More than a third of those who said that they would prefer limited reforms do so even though they believe that those reforms eventually will cost more.

The widely held belief that pressure for health reform is driven primarily by Americans’ concerns about the security of their own care also appears overdrawn.

About one-third of Americans, 36%, said they are “very concerned” about losing “the health coverage you currently have” sometime in the next few years. Another 24% said that they were “somewhat concerned” and 10% said they have no benefits now. Only 30% of Americans are comfortable with the security of their benefits, saying that they are either “not concerned at all” or are “not too concerned.”

Those who are very concerned about their coverage and those who have no coverage are slightly more likely than other Americans to support Clinton’s plan or something close to it--40% would like to see his plan pass as is or with only minor changes--but the difference from the rest of the population is not large.

The only group that stands out as having a substantially different view than other Americans are the 15% who said that they are “not concerned at all” about losing benefits. Those Americans give scant support to Clinton’s plan or something close to it--only 12%--and 29% said that they would like Congress to do nothing on health care. But that opposition probably stems as much from the anti-Clinton demographics of that group--who are more likely to be Americans earning more than $60,000 a year, Republicans, conservatives--as it does from the group’s personal health care circumstances.

Indeed, most Americans, 53%, do not think health reform will change their family’s circumstances one way or the other, according to the poll. Only 16% of those polled said they believed that their circumstances would improve, while 23% said they expected them to worsen, if reform passes. Most of those questioned, 75% to 23%, said they think that their own coverage is currently sound but they have far more doubts about the overall health system. Only 31% said that they think the overall system is sound, while 63% called it unsound.

Instead of being driven primarily by personal circumstances, support or opposition for health reform appears to be propelled mostly by ideology, with Democrats and liberals strongly supporting a plan similar to Clinton’s, and Republicans and conservatives opposing it.

One problem clearly facing Clinton and his allies is the “knowledge gap” on health care. Despite--or perhaps because of--months of media coverage of the health reform debate, only 26% of those polled said that they believe that they know a “great deal” or a “good amount” about “the details of the health care proposals that are currently being considered.”

Another 31% said that they do not know much at all, while 42% said they know only some of the details. Those numbers have changed only slightly since last September.

The percentage saying that they are well informed about the health reform debate rises sharply with income. Among those earning more than $60,000 per year, 42% said they were well informed, but only 16% of those earning less than $20,000 and 21% of those earning between $20,000 and $40,000 made that claim.

Clinton’s plan, indeed nearly all health reform plans, would shift money from upper-income Americans to lower-income working families--providing government subsidies, for example, to make insurance more affordable to those with lower incomes but paying for those subsidies by changes that would raise premiums for most upper-income Americans. The poll strongly indicates that those who stand to lose in health reform know more about it and are, therefore, in more of a position to influence the process than those who stand to gain by it. That could change as the debate enters its final stage.

The health reform debate has clearly had a major impact on Clinton’s popularity--in both directions. When people who have a favorable impression of Clinton were asked why, 16% mentioned his health reform proposals--the only policy issue to get substantial mention. At the same time, when people who have a negative impression of Clinton were asked why, 10% mentioned health reform--the most often raised substantive issue on that side.

Reaction to Reform

Americans are divided in their priorities and split over different health care proposals. Most are concerned about losing health coverage, but don’t think theirs will improve if reforms are passed.

What should Congress and the President make their top priority this year?: Health care reform: 30% Welfare reform: 25% anti-crime bill: 31% Campaign finance reform: 7% Other/Don’t know: 7%

Do you support funding universal health care by requiring employers to pay for insurance: Yes: 28% Yes, but only if no job loss: 31% Want more limited reform: 31% Neither/Other/Don’t know: 10%

How concerned are you that in the next few years you will lose the health care coverage you currently have?: Concerned: 60% Not concerned: 30% Don’t have benefits: 10%

Do you prefer a health care reform plan where everyone in the same community pays the same, regardless of age, lifestyle or health status?: Pay the same: 48% Pay different rates: 46% Don’t know: 6%

Do you prefer a plan limiting the amount or medical or insurance bills, at the risk of limiting availability, or do you prefer a free market system even if it might mean higher costs for the average person? Government sets prices: 47% Free market: 40% Don’t know: 13%

If Congress passes health care reform, how do you think you and your family will end up?: With better health care: 16% With worse health care: 23% Don’t expect change: 53% Too early to say: 3% Don’t know: 5%

Source: Los Angeles Times national poll of 1,515 adults, taken July 23-26. Telephone numbers were chosen from a list of all exchanges in the nation. Random-digit dialing techniques were used so that listed and non-listed numbers could be contacted. Interviewing was conducted in English and Spanish. The sample was weighted slightly to conform with census figures for sex, race, age and education. The margin of sampling error for the total sample is plus or minus 3 percentage points. For certain sub-groups the error margin may be somewhat higher.