Monday, November 25, 2019

The Kaiser Family Foundation is shaping (or showing the shape of) our healthcare debate

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There is a subtext to Abby Goodnough's excellent overview of voters' preference for a public option or Medicare buy-in over Medicare for All:  the extent to which the Kaiser Family Foundation and its tracking poll of voters' healthcare concerns and perceptions are shaping the debate.

Voters cited in Goodnough's piece reflect the concerns about M4A flagged in Kaiser polls:
About two-thirds of voters like the idea of a public option or Medicare buy-in, according to several recent national polls. This month, the Kaiser Family Foundation tracking poll, which has asked voters about the plan four times since July, found that 65 percent of the public favors the idea, compared with 53 percent who support “Medicare for all.” Large majorities of Democrats and independents favored a public option in Kaiser’s November poll, as did 41 percent of Republicans — roughly the same level as earlier Kaiser polls found but down from an unusual spike of 58 percent in October....

Polls suggest that some voters have become unnerved by the price tags of the Warren and Sanders’ “Medicare for all” plans and the fact that they would abolish private health insurance. Support for such an approach has narrowed in recent months, as people have begun to understand what it would involve. A new Kaiser Family Foundation poll of voters in four battleground states — Michigan, Minnesota, Pennsylvania and Wisconsin — found that 62 percent of those who are undecided or are still persuadable believe that “a national Medicare-for-all plan that would eliminate private health insurance” is a bad idea.
You could say with some justice that Kaiser is showing the shape of the debate rather than shaping it. But the two are hard to separate.  At least since January, both the polling itself and Foundation president Drew Altman's commentary on that polling have been throwing up red flags suggesting that Medicare for All is a political loser  -- or at least a political risk. Some points along the way:

  • Kaiser's January tracking poll found that while 56% of Americans supported the idea of Medicare-for-all, support collapsed to 37% when respondents were asked if they'd support the plan if it required most Americans to pay more in taxes or eliminated private insurance companies*. Support for various Medicare/Medicaid buy-ins ranged from 74-77%.

  • Kaiser's April tracking poll found that "far more Americans saying targeted actions on prescription drug costs (68 percent), protections for pre-existing conditions (64 percent), and surprise medical bills (50 percent) are the “top priority” for Congress compared to broader reforms like implementing a national Medicare-for-all plan (31 percent), or repealing and replacing the ACA (27 percent)." Drew Altman's takeaway: "The winning health care message will be about out-of-pocket costs" (leading me to wonder, What if candidates took voters' stated healthcare priorities literally?).

  • In the wake of Kaiser's October poll, Altman warned that Medicare for All's popularity may have peaked and that while there was still a majority in favor, "it's narrow and headed in the wrong direction." And, foreshadowing Goodnough's snapshot today, "A public option, Medicare buy-in and other more incremental, voluntary and less expensive plans that are more difficult to make look threatening are more popular than Medicare for All."  Note the built-in acknowledgement that opposition to M4A will be fierce -- cf. Adam Cancryn's deep dive today into the healthcare industry coalition Partnership for America's Future, devoted to shooting down all expansions of government healthcare, including a public option. M4A advocates likely consider Kaiser a softer force pushing against single payer -- though Kaiser can fairly claim to be simply reporting pubic opinion data.


Caveats: Kaiser also notes a) M4A has strong support among Democrats, b) it still has narrow majority support, c) while healthcare remains Democrats' leading policy concern, getting rid of Trump is the top concern among swing voters in swing states (far outstripping any single policy issue), and d) voters trust Democrats more than Republicans to deal with healthcare. Kaiser is not hostile to Medicare for All.  But leadership -- Drew Altman and scrupulously even-handed EVP for health care policy Larry Levitt -- are clearly worried about its potential impact on the 2020 election.

P.S. Recalling too that Kaiser's June poll highlighted that most people expected "Medicare for all" to look more like current Medicare than like the Sanders/Jayapal bills, and that a national health program would leave employer-sponsored insurance in place -- leading me to conclude, Voters understand Medicare-for-all better than Bernie does.

Related:
Medicare for all (who want or need it): A path for presidential candidates?
What if candidates took voters' stated healthcare priorities literally?)

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*Kaiser's consistent polling practice is to add qualifiers like this to polling questions. Pre-ACA polling about the "individual mandate" -- the requirement to obtain insurance or pay a penalty -- showed a similar (and even more pronounced) pattern:  support fell from 69% to 28 when respondents were asked, "What if you heard that this could mean that some people would be required to buy health insurance that they find too expensive or did not want?"



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