Health reform polls don't tell the whole story

Washington -- Many Republicans in Congress have repeatedly stated that most Americans oppose the national health system reform law and want it repealed, but polling experts say public opinion on the law is divided and more complicated than it seems at first glance.

In a recent example of a key talking point, Senate Minority Leader Mitch McConnell (R, Ky.) said Feb. 1: "Most Americans opposed the health care bill that Democrats jammed through Congress last March." GOP members have used poll results to justify their efforts to repeal the law or cut off its funding.

If given an up-or-down choice, slightly more Americans support scrapping the entire health reform law than keeping it exactly intact, according to several recent polls. For example, 50% of Americans would rather repeal the law entirely, compared with 42% who want to keep the law unchanged, according to a CNN poll of more than 1,000 adults from Jan. 14-16.

But not all Americans who oppose the health reform law do so because they think it goes too far. Of the 50% of people who said they oppose the law in a Jan. 13-16 Washington Post-ABC News poll, nearly a quarter said the law does not change the health system enough.

If given a third option -- expanding the health reform law -- support shrinks both for repealing it and keeping it the same. About a third of Americans would choose to repeal the law, a third would expand it, and 20% would keep it the same, according to a Pew Research Center poll of more than 1,500 Americans from Jan. 5-9.

Most pollsters are producing technically adequate polls, but they're not asking the right health policy questions, said Lawrence R. Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota. That gives GOP leaders an edge in the debate, he said.

For example, Jacobs said, most provisions of the health reform law are at least moderately popular, except for the requirement for individuals to buy health insurance or pay a penalty. But many polls don't inform respondents about other individual parts of the law, such as the subsidies that will be available to help pay for insurance for many of those required to buy it. This knowledge could affect poll results.

The result is "a one-sided and inaccurate view of where Americans stand on health reform, and the pollsters are aiding and abetting [the law's opponents] by doing such a terrible job," Jacobs said.

A Kaiser Family Foundation survey of Americans' knowledge about the health system reform law released Feb. 2 found that many people have more to learn about the law. When asked 10 true-or-false questions about the law, only 25% of Americans answered seven or more questions correctly. An additional 40% answered five or six correctly, and 36% answered four or fewer accurately.

Trench warfare

The health reform law is not popular compared with other historic legislation, such as the enactment of Social Security and Medicare, said Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health in Boston. But neither those who oppose the law nor those who support it have a clear majority, he said.

News about changes in Americans' opinion of the health reform law is overblown, said Drew Altman, PhD, president and CEO of the Kaiser Family Foundation. Kaiser's January health tracking poll found that 50% of Americans oppose the law -- an increase of nine percentage points in one month -- but Altman said campaigns for and against the bill have been stuck in a kind of trench warfare for months.

"It's like World War I. The lines are fixed," Altman said.

Republican voters clearly don't like the health reform law, which is why GOP members of Congress are carrying out a campaign against it, Blendon said. Congressional Republicans are paying more attention to the opinions of people who voted for them than of the public as a whole. In addition, people who oppose the bill feel much more strongly about their position than people who support it, Blendon said.

"The passion is on the side of those who want to repeal," said Brian Darling, director of government relations for the Heritage Foundation, a conservative think tank based in Washington, D.C. "Nobody is in love with this law."

However, congressional Republicans' plans to attack the health reform law by restricting funding for it may stand on somewhat shaky ground, even with members of their own party, according to the January Kaiser poll. Overall, 62% of those surveyed opposed cutting off funding as a way to stop the law from going into effect, while 33% approved. A slight majority of Republicans and repeal supporters want to cut off funding, but 38% of both groups do not support doing so.