THE TIMES POLL : GOP Medicare Proposals Win Broad Support

Heading into a critical stage of their campaign to curb the growth of Medicare, Republicans appear to be winning solid support for several proposals that GOP strategists had feared would be highly controversial, a new Times Poll has found.

By large margins, poll respondents supported some measures that would directly increase costs to Medicare beneficiaries. Surprisingly, however, the respondents opposed another proposal--one that GOP lawmakers had thought was relatively safe politically--to reduce payments to doctors and hospitals.

Six out of 10 of those surveyed said that they favor an across-the-board increase in the monthly premiums, now $46.10, which the elderly pay for Medicare coverage, and that affluent retirees should pay even more. By roughly the same margin, respondents said they favored measures to encourage the elderly to join health maintenance organizations as part of a program to keep Medicare financially sound.

By 58% to 32%, however, those polled said they opposed cuts in payments to doctors and hospitals if those cuts “might mean some doctors would stop covering Medicare patients and some hospitals might close or pass those costs along to younger patients”--results that health-policy analysts believe are likely.

House Republican leaders have proposed large cuts in payments to doctors and hospitals precisely because they feared that the alternative--large increases in the costs that beneficiaries must pay directly--would be too controversial.

Warning Signs

Although the poll finds broad support for key GOP proposals to change Medicare, the results are riddled with political warning signs for Republicans. A solid majority of 57% agreed with Democrats’ charges that Republicans are trying to cut the growth of Medicare more than is needed so that some of the savings can be used to finance a GOP-proposed tax cut. A plurality of 41% said President Clinton can do a better job of handling Medicare than the GOP.

And support for elements of the GOP cost-cutting plan, such as the emphasis on HMOs, eroded sharply among the elderly, a politically potent constituency. For example, the proposal to encourage the elderly to enter HMOs won support from 64% of those younger than 65, but only 37% of those older than 65.

The proposal to increase Medicare premiums was supported by majorities of both young and old--54% of those older than 65 and 62% of younger respondents. Wealthier people were more inclined to support the idea than were the poor. Respondents earning less than $20,000 a year said they opposed the proposal, 50% to 41%, while an overwhelming 81% of respondents earning more than $60,000 a year backed the idea.

The poll also shows support for GOP efforts to reform welfare and balance the federal budget. The numbers provide a snapshot of public sentiment about GOP policies just as Republicans in Congress are trying to win approval of proposals at the heart of their ambitious legislative agenda: Medicare spending curbs, cuts in farm subsidies, welfare reform and reductions in spending for scores of domestic programs. The political and economic stakes are extraordinarily high because the failure of any of the key initiatives could derail the Republicans’ effort to put the federal government on the path to a balanced budget by the year 2002.

The Times Poll, supervised by poll director John Brennan, was conducted among 1,152 adults nationwide from Sept. 16 to Sept. 18--just after House Republicans released the general outlines of their plans to cut $270 billion from projected spending for Medicare during the next seven years. The survey’s margin of sampling error is plus or minus 3 percentage points.

The survey presents a portrait of a public supportive of many elements of the Republican program to transform Medicare and welfare, but wary of other initiatives, such as the GOP effort to roll back regulation affecting the environment and the workplace.

Respondents remain divided on the GOP proposal for a tax cut, with only 18% saying a tax cut is “very important.” Among self-identified Republicans, however, 30% say a tax cut is very important.

GOP Agenda Gains

Although Democrats have argued that public support for Republican policies will erode as voters learn more about the details, the survey found approval of GOP policies has increased slightly in the last five months, when much of the party’s legislative agenda has unfolded. About 43% now voice approval of the GOP program--a rebound since June when a Times Poll found that approval of the GOP program had dropped to 36%.

A plurality of 41% say they think Republicans have better ideas than Clinton for solving problems facing the country.

And while Democrats have tried to portray Republicans as a party dominated by conservative extremists, the poll found only 21% of respondents--most of them Democrats--said they thought that Republicans had gone too far in their efforts to scale back government. That figure is up from 14% in March, but 41% said the GOP has not gone far enough.

But many respondents remain skeptical about Republican claims to be making fundamental change. A solid 56% said Republicans were governing in a “business as usual” manner, while only 34% said they believe that the GOP is “working hard to bring fundamental change.” Clinton’s rating on that question is slightly more favorable, with 39% saying he is working for fundamental change and 54% saying he is governing in a “business as usual” manner.

Asked if they believe that the country is better or worse off because the Republicans now control Congress, only 21% said better, while 25% said worse and 41% said they did not think GOP control had changed things very much either way. Moreover, 48% said they believe that splits between Clinton and Congress are a good thing because the two can act as checks on each other. Only 38% said such partisan splits are bad because they prevent things from getting done. Clinton is likely to stress that argument as a theme in his reelection campaign.

Welfare Overhaul

The poll found broad support for major elements of Republicans’ most recent legislative coup, passage of legislation overhauling the welfare system. A whopping 91% of respondents--including 87% of those at the bottom of the income scale--supported GOP proposals to require welfare recipients to work after they receive benefits for two years--a move that Clinton also supports.

By 56% to 38%, those surveyed said they favored a controversial proposal to deny benefits to mothers who have additional children while they are on welfare. The Senate rejected that so-called family cap, but the more conservative House has accepted it. The issue will need to be resolved by a House-Senate conference committee.

Respondents were more closely divided over other elements of the welfare initiative.

Nearly half said they favored plans to limit welfare recipients to five years of benefits, while 42% said they opposed the idea.

By 44% in favor, 49% against, a plurality of those questioned said they opposed a proposal--also rejected by the Senate--that would deny cash benefits to teen-age mothers. And respondents were almost evenly split--46% in favor, 45% opposed--on the basic structural change being pursued by the Republicans: ending welfare’s status as an entitlement, which for decades guaranteed aid to anyone who qualifies.

Other elements of the GOP agenda are not sitting well with the poll respondents. A resounding 62% said they thought Republican proposals to cut back workplace health and safety standards was a bad thing because less regulation could endanger workers, while only 29% said it was a good thing. Even among Republicans, more than half said they thought it was a bad idea.

Respondents were more closely divided on GOP efforts to scale back environmental regulation, with 47% saying they thought it was a bad thing, while 38% thought it a good policy. That is primarily a reflection of opposition to the environmental rollback among self-described Democrats; a plurality of independents and 51% of Republicans said they favored the GOP environmental policy, while 40% of Republicans said they opposed it.

On broader budget issues, the survey portrayed a public deeply ambivalent about what it takes to reduce the deficit. Fully 70% of respondents said it was important to balance the budget by 2002. But when asked what was the most important priority for improving the economy, a plurality of 40% called for increasing government spending on domestic programs, such as education, public works and research, compared to 29% who cited reducing the deficit as a priority. Only 37% said they believe that the country should spend more on defense, which GOP leaders have advocated, compared to 56% who said they support less defense spending.

Getting the Message

Still, the Medicare findings indicate that the public may be beginning to understand that reducing the deficit may require sacrifices in programs that benefit them. For one thing, poll respondents seem to have gotten the GOP message that the Medicare system is in financial trouble and that changes are needed to keep it solvent into the 21st Century. Eight out of 10 said Medicare was in financial trouble. However, the young seem far more concerned about Medicare’s future than the elderly: Fully 63% of those younger than 65 said they thought Medicare was in major financial trouble, while only 36% of those older than 65 agreed.

Support for proposed Medicare premium increases suggests that there may not be as much political leverage as Democrats have thought in criticizing GOP plans for raising costs to the elderly. It may also signal a big change in public sentiment from six years ago, when a new catastrophic health insurance benefit under Medicare was repealed in the face of opposition from the more affluent elderly who faced a surcharge to finance the benefits.

In other areas, the Times Poll found:

* Overwhelming public support--from 85% of respondents--for the President’s proposed new curbs on tobacco advertising aimed at teen-agers.

* Signs that public support for the FBI has plummeted in recent months, as the spotlight has turned toward agents’ behavior during shootouts near Waco, Tex., and at Ruby Ridge, Ida.

Only 16% reported that they had a “very favorable” impression of the FBI, down from 34% in a May, 1995, ABC News/Washington Post poll. The agency retains an overall positive image, however, and just over half of the respondents said their view was not affected by recent GOP hearings into the Waco and Ruby Ridge incidents.

Times assistant poll director Susan Pinkus contributed to this story.

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Differences Over Medicare

More than half of the poll respondents say that Medicare is in financial trouble. Many favor increasing premiums for most Medicare recipients and encouraging the elderly to enter health maintainence organizations. However, many are opposed to reducing payments to doctors or hospitals.

Q. Medicare is the government’s health insurance program for the elderly and disabled, which has grown tremendously since 1965. Looking down the line toward the next 10 or 15 years, do you think Medicare is financially sound or is in financial trouble?

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AGES ALL 18-64 65+ Financially sound 9% 20% 11% Minor financial trouble 16% 20% 16% Major financial trouble 63% 36% 58% Financial trouble-don’t 4% 8% 6% know how serious Don’t know 8% 16% 9%

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Q. Medicare recipients are allowed a choice of doctors. In order to help keep Medicare financially sound, would you favor or oppose encouraging Medicare recipients to enter into health maintenance organizations or other types of managed-care health programs, which might cost less and provide a wider range of services but would limit a recipient’s choice of doctors?

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AGES ALL 18-64 65+ Favor 64% 37% 60% Oppose 32% 52% 35% Don’t know 4% 11% 5%

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Q. Currently, all Medicare recipients pay the same premium of $46.10 a month. In order to keep the system financially sound, lawmakers are considering raising the monthly premium for nearly all beneficiaries to at least $90 a month by the year 2002. More-affluent elderly would pay even higher premiums. Do you favor or oppose this proposal to help keep Medicare financially sound?

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AGES ALL 18-64 65+ Favor 62% 54% 61% Oppose 34% 29% 33% Don’t know 4% 17% 6%

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Q. Medicare sets the fees that doctors and hospitals receive from patients. In order to help keep Medicare financially sound, would you favor or oppose reducing Medicare payments to doctors and hospitals, even if that might mean some doctors would stop accepting Medicare patients and some hospitals might close or pass those costs along to younger patients?

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AGES ALL 18-64 65+ Favor 31% 37% 32% Oppose 61% 46% 58% Don’t know 8% 17% 10%

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How the poll was conducted. The Times Poll contacted 1,152 adults nationwide by telephone Sept. 16-18. 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. The sample was weighted slightly to conform with census figures for sex, race, age, education and region. The margin of sampling error is plus or minus 3 percentage points; for certain sub-groups the error margin may be somewhat higher. Poll results can also be affected by other factors such as question wording and the order of questions.