Findings From A Survey of 800 Likely Voters Nationwide

Voter Attitudes on a Public Health Care Plan Findings From A Survey of 800 Likely Voters Nationwide 202.776.9066 www.lakeresearch.com January 26, 2009

Methodology Lake Research Partners designed and administered this survey that was conducted by telephone using professional interviewers between January 8-13, 2009. The survey reached a total of 800 likely voters nationwide. Telephone numbers for the sample were generated by random digit dial (RDD) methodology. The margin of error for this survey is +/- 3.5%. 2

Key Findings 7 in 10 voters overwhelmingly support a public health insurance plan as part of national health care reform. Voters always prefer having a choice of public or private insurance over having either option alone. Even after hearing multiple attacks against a public plan option, voter support remains overwhelming. Attacks against a public plan do not work well. In paired statements supporting and attacking a public plan, a solid majority supports a public plan every time, and the response beats the attack by double digit margins. Conservative attacks that a public plan will increase costs, contribute to unfair competition, cause rationing, and that employers will drop their private insurance are not believable to most voters. 3

Key Findings Despite voters economic concerns, a majority support reform to provide quality, affordable health care for all, even if it means raising taxes. Voters also support reform even if it means a large federal government role. Voters believe a public plan option will increase competition, contain costs, and help control the cost of health care. They believe it will give private insurers incentives to control their costs and become more efficient, not less. Voters favor the principle of having guaranteed health coverage and having a choice. A public plan increases their peace of mind. These principles resonate most strongly with women. 4

Key Findings Referring to Obama s health care proposal further intensifies support for a public plan. Referring to Obama is effective with Democrats and Independents but cuts support with Republicans. Using Medicare as an analogy for a public plan helps most when referring to Medicare as a guarantee and providing peace of mind, especially with women, seniors, and minority voters. Medicare is less effective with men, especially men under 55 and college-educated men. When referring to the plan, call it a public health insurance plan. Emphasize choice of public and private plans. 5

Overwhelming support for a public plan choice over 7 in 10 voters prefer having a choice of a public or private health insurance plan. Which of the following three approaches to health care reform do you prefer: one, everyone getting health insurance through private health insurance plans; two, everyone getting health insurance through a public health insurance plan; or three, everyone having a choice of private health insurance or a public health insurance plan? 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 15% 9% 73% Private only Public only Choice of private or public 2% Don't know 6

Support for a public plan is strong across the board, and solid majorities support it. % Prefer Choice of Private or Public Plan TOTAL Women Men Age 55+ Under 55 Democrats Independents 73% 75% 71% 72% 74% 77% 79% Republicans 63% 7

The broad consensus in support of a choice of public or private plan remains overwhelming even after hearing a battery of arguments against a public plan. Sometimes in a survey like this people change their minds. Which of the following three approaches to health care reform do you prefer: one, everyone getting health insurance through private health insurance plans; two, everyone getting health insurance through a public health insurance plan; or three, everyone having a choice of private health insurance or a public health insurance plan? 90% 80% 70% Final Ballot 72% Initial Ballot 15% 9% 73% 2% 60% 50% 40% Private only Public only Choice of private or public Don't know 30% 20% 10% 16% 9% 3% 0% Private only Public only Choice of private or public Don't know 8

When comparing Obama s plan for reform with the plan supported by the insurance companies, Obama s plan wins by a margin of more than 2-to-1. Support for Obama s Plan 67% +43 points 38% 24% 13% 9% Obama's Plan AHIP Plan Undecided 9 * Asked of half of sample. Darker color indicates intensity

Text of Health Plans [AHIP PLAN] Under Plan A, proposed by the health insurance industry, the government would require all private health insurers to offer at least a set amount of health coverage through a high-deductible plan. Insurance companies would determine how much to charge in premiums. The government would subsidize the cost of health insurance for low income and some middle-income families. Insurance companies would not be allowed to deny people coverage for pre-existing conditions. Everyone would be required to get health insurance. Most people would be covered through private health insurance, with seniors covered by Medicare as they are now. [OBAMA S PLAN] Under Plan B, proposed by President-elect Obama, the government would require all health insurers to offer at least one standard, comprehensive health plan with guaranteed benefits. The cost of coverage would depend on a family s income. Insurance companies would not be allowed to deny people coverage for pre-existing conditions and would have restrictions on how much they can charge. Employers would be required to provide health coverage or contribute to the cost of coverage, with tax credits for small business. Everyone would be able to keep the health insurance they have, or have a choice of private insurance or a public insurance plan, with seniors covered by Medicare as they are now.

Despite some tax sensitivity in a weak economy, a majority of voters favor progressive reform, even if it means raising taxes. Do you favor or oppose providing access to affordable, quality health care for all Americans even if it means raising taxes? IF FAVOR/OPPOSE, ASK: Do you feel strongly or not so strongly about that choice?* Health Care Despite Tax Raise 60% 43% 31% 23% 9% Favor Oppose Undecided 11 Darker color indicates intensity * Asked of half of sample.

Over 7 in 10 voters accept a major government role in health care, the highest level of support in over a year. Do you favor or oppose providing access to affordable, quality health care for all Americans even if it means a major role for the federal government? IF FAVOR/OPPOSE, ASK: Do you feel strongly or not so strongly about that choice?* Major Role For Federal Government 71% % Favor Major Role for Fed Govt 66% 69% 64% 46% 57% 51% 55% Sept. 07 Feb. 08 Oct. 08 21% 16% 9% Favor Oppose Undecided 12 Darker color indicates intensity * Asked of half of sample.

Quality: Voters reject an attack claiming that a public plan will lower quality. Two thirds agree with the response that the public plan will provide an affordable option with a wide choice of doctors. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* QUALITY - COMPREHENSIVE A public health insurance plan will force people into lower quality care including long waiting times and rationing of care. 21% 26% +40 points A public health insurance plan will provide people the choice of an affordable plan that includes a standard, comprehensive package of benefits, including a wide choice of doctors. * Asked of half of sample. 51% 66% The response is strongest with older women, older non-college educated voters, Democrats, and those in the East North Central region. 13

Quality: A response to the same quality attack that mentions the same benefits as members of Congress tests nearly as well. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* QUALITY - CONGRESS A public health insurance plan will force people into lower quality care including long waiting times and rationing of care. 18% 26% +38 points A public health insurance plan will provide people the choice of an affordable plan that includes at least the same benefits as members of Congress get, including a wide choice of doctors. * Asked of half of sample. 51% 64% This response is strongest with African Americans, younger women, older noncollege educated men, and Democrats. 14

Bureaucracy: By over two to one, voters reject an attack on big government bureaucracy, agreeing that the public plan will provide real competition and help lower costs. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* BUREAUCRACY A public health insurance plan will be another big, government bureaucracy that will increase costs to taxpayers. 22% 28% +34 points A public health insurance plan will lower health care costs by providing real competition with private insurance while spending less on administration, marketing, and executive salaries, and it won t have to generate a profit. 50% 62% This response is strongest with older noncollege educated women and Democrats. 15 * Asked of half of sample.

Costs: Most voters don t buy an attack that a public plan will make insurance more expensive due to underpayment and cost shifting. They believe that a public plan will help control health care costs and provide competition. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* UNDERPAYMENT Like Medicare and Medicaid, a new public health insurance plan will reimburse doctors and hospitals at much lower rates, causing many doctors and hospitals to shift higher costs onto people who buy private health insurance. 19% 25% +36 points A public health insurance plan will be able to control overall health care costs for everyone by using its purchasing power to drive competition and lower the prices paid for health care services and prescription drugs. 48% 61% This response is strongest with under 40 and women under 55. 16 * Asked of half of sample.

Using the VA as an example to counter the underpayment attack increases support among seniors, women over 55, and those with a high school education or less. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* UNDERPAYMENT W/ VA Like Medicare and Medicaid, a new public health insurance plan will reimburse doctors and hospitals at much lower rates, causing many doctors and hospitals to shift higher costs onto people who buy private health insurance. 17% 20% +45 points A public health insurance plan will be able to control overall health care costs for everyone by using its purchasing power - like the Veterans Administration does now - to drive competition and lower the prices paid for health care services and prescription drugs. * Asked of half of sample. 46% 65% This response is strongest with seniors, older women, and those high school educated or less. 17

Competition: Voters believe a public plan can help increase competition and set rules. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* UNFAIR ADVANTAGE A public health insurance plan will have an unfair competitive advantage over private insurance because the government will set rules that favor the public plan. 19% 27% +30 points A public health insurance plan option will increase competition and rein in costs because the private and public plans will have to play by the same set of rules. * Asked of half of sample. 45% 57% This response is strongest with older men. 18

Competition: Voters are convinced a public plan will help increase competition and rein in costs. A direct challenge to private insurance plans increases support with older women and voters with a college degree. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* UNFAIR ADVANTAGE W/ EFFICIENCY A public health insurance plan will have an unfair competitive advantage over private insurance because the government will set rules that favor the public plan. 17% 23% +37 points A public health insurance plan option will increase competition and rein in costs. If private insurers are really more efficient than government, then they won t have any trouble competing with a public health insurance plan option. * Asked of half of sample. 48% 60% This response is strongest with older women and those with at least a college degree. 19

The argument that a public plan will promote quality and control costs is strong across the board. Only a small minority of voters believes that competition among private plans is enough. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* COMPETITION The best way to promote quality and control costs is through competition among private health insurers without adding another government plan. 21% 26% +34 points The best way to promote quality and control costs is through competition between public and private health insurance plans. 48% 60% * Asked of half of sample. This response is strongest with Democrats and those in the Middle Atlantic region. 20

Voters are skeptical of private insurers and 6 in 10 believe that a public plan is necessary to control costs, as opposed to simply setting basic rules and regulations. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* RULES AND REGULATIONS W/ NON-PROFIT We don t need a new government health insurance plan. Private health insurance can control costs and provide quality affordable health care if the government sets basic rules and regulations, such as requiring private health insurers to accept people with preexisting conditions. 19% 27% +33 points Private health insurers will always find ways to put profits before people. That s why we need an independent non-profit public health insurance plan that is not driven by making higher profits, in order to control costs and guarantee access to quality affordable health care. 47% This response is strongest with seniors, post-graduates, and Independent men. 60% 21 * Asked of half of sample.

A response that does not use the words independent non- profit is not quite as strong. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* RULES AND REGULATIONS We don t need a new government health insurance plan. Private health insurance can control costs and provide quality affordable health care if the government sets basic rules and regulations, such as requiring private health insurers to accept people with pre-existing conditions. 25% 37% +16 points Private health insurers will always find ways to put profits before people. That s why we need a public health insurance plan that is not driven by making higher profits, in order to control costs and guarantee access to quality affordable health care. 43% 53% 22 * Asked of half of sample.

Attacks claiming a government health insurance plan will cause people to lose their coverage do not hold up well. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* MILLIONS LOSE COVERAGE - GOVT INSURANCE Establishing a government health insurance plan will mean that millions of people will lose their private health insurance coverage because employers will drop their private insurance and dump people in the public plan. 17% 21% +47 points Under the current system, millions of people are already losing their health coverage every year. Having a choice of public or private health insurance plans will make sure that Americans always have an option for quality affordable health care. 54% 68% 23 * Asked of half of sample.

An attack based on the cost of a government plan in a bad economy is ineffective when the cost of private insurance is cited in response. Which statement comes closer to your own view? (FOLLOW-UP) Do you feel STRONGLY about that, or not so strongly?* BAD ECONOMY - GOVT INSURANCE A new government health insurance plan will cost taxpayers a huge amount of money we cannot afford right now during an economic slowdown, and because the government is involved, it will make the health system less efficient and increase costs. 18% 25% +31 points Private insurance companies currently have little incentive to control premiums and deductibles, reaping huge profits while working families struggle to pay the bills. A public health insurance plan that competes directly with private insurers will help. 43% 56% 24 * Asked of half of sample.

Messages in support of a public plan test very strongly, and support is highest when referring to Obama s plan. Voters are also reassured by having a guaranteed backup for peace of mind. Next I m going to read you a few short statements that have been made in favor of including a public health insurance plan option as part of health care reform. For each one, please tell me if the statement is a very convincing, somewhat convincing, not very convincing, or not at all convincing reason to support a public health plan option. % Convincing (intensity in dark) [Obama s plan] 46% 76% -10% [Peace of Mind w/medicare]* 43% 78% -14% [Peace of Mind]* 43% 74% -34% 25

Text of Positive Messages [Obama s plan] President-elect Obama s health care proposal includes the choice of a public health insurance plan. Under Obama s plan, if you lose your job or lose your current health coverage for any reason, you ll always be covered because the public insurance plan option will be a guaranteed backup. Lobbyists for the private insurance industry are using scare tactics to try to get rid of the public plan option, which would cut the heart out of Obama s plan. Congress should listen to the voters, not the insurance companies, and enact Obama s health plan. [Peace of Mind w/medicare] It s just wrong for people who work hard and pay taxes to go without affordable, quality health care. Many hard-working middle class people are finding it harder to afford health care they can count on for themselves and their families. We need a public health insurance option like Medicare as a guaranteed backup that will always be there to ensure quality, affordable health care coverage is available no matter what happens. It would give millions of hard-working families peace of mind. [Peace of Mind] It s just wrong for people who work hard and pay taxes to go without affordable, quality health care. Many hard-working middle class people are finding it harder to afford health care they can count on for themselves and their families. We need a public health insurance option as a guaranteed backup that will always be there to ensure quality affordable health care coverage is available no matter what happens. It would give millions of hard-working families peace of mind. 26

The top message for Democrats, Independents and middle-aged voters is Obama s Plan. For Republicans and seniors, Choice and Quality with Medicare is most effective. Top Among Democrats, Independents, and Middle-Aged Voters: [Obama s plan] President-elect Obama s health care proposal includes the choice of a public health insurance plan. Under Obama s plan, if you lose your job or lose your current health coverage for any reason, you ll always be covered because the public insurance plan option will be a guaranteed backup. Lobbyists for the private insurance industry are using scare tactics to try to get rid of the public plan option, which would cut the heart out of Obama s plan. Congress should listen to the voters, not the insurance companies, and enact Obama s health plan. Top Among Republicans and Seniors: [Choice and Quality w/medicare] We need an alternative to the harsh and unfair practices of the health insurance industry. We need a guarantee of quality affordable health care for all of us. We need to set and enforce the rules so insurance companies put our health care before their profits. We need to have a choice of keeping the health insurance we have, or choosing a public health insurance plan like Medicare, so we re not left at the mercy of the same private insurance companies that have gotten us into this mess. 27

In a test of plan names, 3 in 4 voters like the terms public health insurance plan or national health insurance plan. Rating 5-4 Rating 3 Mean A public health insurance plan like Medicare* 53% 21% 74% 3.4 A national health insurance plan 53% 20% 73% 3.4 A public health insurance plan* 48% 26% 74% 3.3 A public health insurance option* 48% 22% 70% 3.2 A public health insurance option like Medicare* 47% 19% 66% 3.1 Now I m going to read you some different names that could be used to describe the public insurance plan option we have been talking about. For each one, please tell me on a scale of 0 to 5 how favorable you feel toward that name, where a 5 means the name is very favorable, and a zero means the name is very unfavorable, and you can rate it anywhere in between. 28

Referring to government or a federal government sponsored plan is less effective than a public health insurance plan. Rating5-4 Rating 3 Mean A non-profit public health insurance plan* 46% 20% 66% 3.0 A federally sponsored health insurance plan* 41% 25% 66% 3.1 A publicly sponsored health insurance plan* 41% 27% 68% 3.0 A government-backed health insurance plan* 40% 24% 64% 2.9 A public plan* 38% 20% 59% 2.8 A federal health insurance plan* 34% 25% 59% 2.8 Now I m going to read you some different names that could be used to describe the public insurance plan option we have been talking about. For each one, please tell me on a scale of 0 to 5 how favorable you feel toward that name, where a 5 means the name is very favorable, and a zero means the name is very unfavorable, and you can rate it anywhere in between. 29

Key Messaging Points Voters strongly support having a choice of public or private insurance. In messaging, voters respond positively to arguments that a public plan will help contain costs, increase competition, provide choice, and be a guaranteed backup. Referring to Obama s health care proposal sharpens already strong support for a public plan option among Democrats and Independents. Attacks on the public plan claiming increased costs, big government or lower quality do not hold up when effective responses are made. 30

Key Messaging Points Using Medicare as an analogy for a public plan helps most when referring to Medicare as a guarantee and providing peace of mind. Medicare resonates most strongly among women, especially women over 55 and non-college women, as well as with seniors and minority voters. Medicare is less effective with men, especially men under 55 and college-educated men. Naming it a public health insurance plan generates strong support across the board. Key is to mention both public AND health insurance and to emphasize choice. 31

Voter Attitudes on a Public Health Care Plan Findings From A Survey of 800 Likely Voters Nationwide 202.776.9066 www.lakeresearch.com January 26, 2009