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Health provisions among public's top priorities for economic stimulus

Health reform rated among top priorities for new president and Congress, insurance regulations stand out for broad bipartisan support

The public ranks action on health care highly as part of efforts to stem the impact of the economic recession and also views reforming health care as one of the top priorities for President-elect Obama and Congress, according to a new national survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.

Americans rank helping the newly unemployed afford health insurance coverage second (picked by 33% as a top priority) behind helping businesses keep or create jobs (45%).

Providing states with more federal help to pay for health care of lower income residents ranks third (picked by 31%).

These proposed health provisions of the stimulus package ranked ahead of repairing the country's infrastructure, cutting taxes for the middle class, helping people pay their mortgages (each picked by 27%), and helping large businesses hurt by the recession (13%).

While improving the economy is overwhelmingly Americans' top priority for the new president and Congress - cited by nearly three-quarters (73%) of the public - over four in ten (43%) Americans view reforming health care as a top concern, ranking it third just behind fighting terrorism (48%) and above reducing the federal budget deficit (39%), improving public schools (37%), working to create more clean energy sources (36%) and dealing with Iraq (35%).

A solid majority of Americans (61%) believe that given the serious economic problems facing the country, "it is more important than ever to take on health reform now."

As Congress begins work on the reauthorization of the State Children's Health Insurance Program (SCHIP), half (51%) of the public favors increasing spending on SCHIP, while four in ten (39%) would maintain current program funding.

"The economic crisis has created an unprecedented window of opportunity for health reform.

"But we are in the early happy talk stage on health reform, and the window could close if policymakers cannot move fairly quickly to take advantage of the opportunity they have," said Kaiser President and CEO Drew Altman.

Large majorities of Americans say coverage expansion, cost reduction and delivery system change are all important pieces of health care reform.

But when asked to choose which of these sometimes competing goals is most important, affordability tops the priority list, named by four in ten (39%).

Slightly fewer - three in ten (30%) - choose expanding coverage and roughly two in ten (18%) pick improving the quality and cost-effectiveness of the health care delivery system.

Clear and Bipartisan Support for Regulation

A key health reform idea that draws public support and stands out in the support it gets across the political spectrum is the idea of more consumer protections and regulation of health insurance.

Almost eight in ten Americans (78%) favor requiring health insurance companies to cover anyone who applies, even if they have a pre-existing condition.

This support remains high (72%) even when the public is given the argument often made that such a change may raise health insurance costs for healthier people even as it lowers them for the less healthy.

Support is bipartisan: a clear majority of Democrats (77%), political independents (78%) and Republicans (58%) support eliminating exclusions for preexisting conditions.

Similarly, over six in ten Americans strongly or somewhat favor limiting the administrative expenses health insurance companies can claim (65%) and even the profits these companies can earn (62%).

These proposals garner support across party identification as well, with majorities of Democrats (71%), political independents (59%) and Republicans (55%) backing government limits on health insurance company profits.

Roughly half the public believes there is not enough government regulation of health care costs (51%) or the price of prescription drugs (52%).

When examined by political identification, a majority of Democrats (61%) and political independents (52%) think there is not enough regulation of health care costs, while just under four in ten (37%) Republicans think similarly.

"We can see the framework of a winning package of health reform proposals from the public's perspective," said Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health.

"But the reality is that there are some key distinct differences among partisans that will pose a challenge to policymakers," he added.

The Devil is in the Details ...and the Financing... and the Partisan Divide

One of the key questions of health care reform is how to pay for it.

The survey suggests that, as has long been the case, the public is split down the middle in its willingness to sacrifice financially in order to cover more individuals: roughly half (49%) say they are not willing to pay higher insurance premiums or taxes, while a similar percentage (47%) say they are.

There are big partisan differences here, with most Democrats (59%) saying they are willing to pay, most Republicans unwilling to pay (67%), and independents divided (49% willing, 47% unwilling).

When offered a list of potential taxes that could be used to pay for expanding health insurance for the uninsured, the only options with majority support were those likely to impact the fewest people, in particular, smokers and the wealthy.

 Roughly seven in ten (72%) strongly or somewhat favor increasing the cigarette tax, increasing taxes for people from families earning more than $250,000 per year (70%), or repealing current income tax cuts for those earning more than $250,000 per year (61%).

The survey also suggests that as in the past early support for a number of reform proposals could fade in the face of arguments that opponents might raise in a public debate.

For example, seven in ten Americans (71%) say they favor the idea of employer mandates. But when given the argument often made by critics that this may cause some employers to lay off some workers support falls dramatically, to just under three in ten (29%).

The same pattern holds on the topic of individual mandates. Roughly two in three (67%) favor requiring all Americans to have health insurance with help for those who could not afford it.

When given the criticism that some people may be required to buy health insurance they find too expensive or do not want, support falls to two in ten (19%).

Americans seem most concerned that any health care plan not raise their costs or involve government limiting or dictating their choices. According to the survey, nearly two-thirds (65%) say they would be less likely to support a plan that would get the government get too involved in personal health care decisions, more than six in ten (61%) would be less likely to support a plan that increases people's insurance premiums or out-of-pocket costs, and more than half (56%) would be less supportive of a plan that limits an individual's choice in doctors.

"As we have learned from past debates, public support looms for health reform largest at the beginning of the debate, but it's relatively easy to chip away at that support with arguments about tradeoffs," said Mollyann Brodie, Kaiser vice president and director for Public Opinion and Survey Research.

Any debate over health reform options will also involve negotiating the very different views of rank and file Democrats and Republicans.

 Democrats are significantly more likely to place a priority on action on health care, which ranks second on their priority agenda (61% say it is a top priority), compared to Republicans, who rank it eighth (23%).

More than three-quarters (77%) of Democrats think health reform "is more important than ever" due to the economy, while six in ten (62%) Republicans believe the nation "cannot afford to take on health reform now."

 Democrats are more likely to favor a big push on coverage, and as noted above, more willing to pay for it. The partisan divide on spending also extends to SCHIP: more than six in ten (62%) Democrats and a majority (55%) of political independents want to see the Congress and President-elect Obama increase spending on the program, while less than three in ten (29%) Republicans would agree.

Public's Other Favored Health Policy Priorities

While reforming the nation's health care system is on the mind of Americans, they also approve of other ideas to alter federal health care policy or spending.

Allowing the federal government to use its buying power to negotiate lower prescription prices with drug companies is the most popular proposal in the survey - supported by nine in ten (90%).

Eight in ten (79%) favor filling the Medicare prescription drug coverage gap known as the "doughnut hole." Nearly two-thirds (64%) of the public support spending more on medical care for veterans.