Who Supports Health Reform David W Brady Stanford

Who Supports Health Reform? David. W. Brady, Stanford University Daniel P. Kessler, Stanford University PS: Political Science and Politics January 2010.

Health Care Reform Frontline: Lobbyists and Health Care Reform Correlation: Increase in Lobbying activity (money or information) corresponded to changes in health care law (Public Option dropped, Individual Mandate added). Time order: Changes to health care law (Public Option dropped, Individual Mandate added) happened after lobbying activity (money or information). Non-spuriousness: Changes to health care law (Public Option dropped, Individual Mandate added) reflected the publicly stated demands of specific lobbying interests.

Health Care Reform Frontline: Lobbyists and Health Care Reform Why did efforts by the health insurance lobby to redesign President Obama’s health care proposals work? Hypothesis: Legislators are more likely to work (DV: Effect) with lobbying interests, when the lobbying interests are “constructive” (DV: Cause), that is, when they offer to work with rather than attempt to kill the legislation.

Polling Public Opinion on Health Care: Polls reveals that political party, age, education, gender, and other characteristics likely affect people’s views of health reform. …

Polling Public Opinion on Health Care: Limits with the Polling: However carefully these polls are done, though, they suffer from three limitations. 1. Reform? Do not spell out exactly what reform is under consideration. 2. Cost? Few surveys present respondents with any estimates of the costs of reform. 3. Bivariate? Most of the literature’s claims about differences in support across groups are based on simple bivariate comparisons. (Old versus Young, Rich versus Poor: it might be more complex than that). …

Polling Public Opinion on Health Care: Research Design: Contingent Valuation To address these limitations, Brady and Kessler conducted a large, national survey that used contingent valuation (CV) methods from environmental economics to estimate how much Americans are willing to pay to expand health insurance coverage (Kessler and Brady 2009). Analyzing Results: Regression Coefficients as Mean Differences We estimated regression models that are a function of a series of categorical variables describing each respondent’s characteristics. In this framework, coefficient estimates represent the differences in mean support across groups, holding all other respondent characteristics constant. Note: The higher the Mean Difference, the greater potential of Statistically Significant difference.

Polling Public Opinion on Health Care: Research Questions: Policy Support and Tax Increase We asked respondents about their likelihood of supporting two specific reforms: 1. Insurance subsidies for low-income people 2. Medicaid expansions … Income: Calculation of Tax Increase (Baseline) … if they had to pay more income taxes to cover the programs’ costs. (Based on the respondents’ income we told them approximately how much, in dollar terms, their tax increases would be. We also explained the benefits of each reform).

Polling Public Opinion on Health Care: Article Roadmap: The article proceeds as follows. Section I: we present our CV survey methods and questions. Section II: presents our results, and Section III: concludes with some observations for public policy.

Polling Public Opinion on Health Care: Article Roadmap: The article proceeds as follows. In section I, we present our CV survey methods and questions. Section II presents our results, and section III concludes with some observations for public policy.

Polling Public Opinion on Health Care: Contingent Valuation (CV) Survey: From January 8 through January 21, 2009, we conducted an Internet-based CV survey of 3, 344 American adults on their preferences for health insurance and health policy reform through You. Gov/Polimetrix. In addition to the policy-scenario questions, we also obtained information on respondents: ’ Income Age Gender Race Education Party Affiliation

Polling Public Opinion on Health Care: Contingent Valuation (CV) Survey: Questions We then asked respondents, in random order, about their likelihood of supporting two different health reforms, 1. A subsidy to low-income people to buy private Insurance 2. An expansion of government insurance/Medicaid program. Major v. Minor Reform: One-half of the sample was queried about a major version of each reform; one half was queried about a minor version. In each case, the respondent was offered four choices of response: very likely, somewhat likely, not too likely, or not at all likely. (Ordinal/Ranked Data)

Polling Public Opinion on Health Care: Importance of Cost: Survey Two Additional Samples To investigate the sensitivity of respondents’ support for reform to its cost, we replicated our original survey on two additional samples. Test: Impact of Tax Increase (50% and 150%) First Sample: Respondents in the first additional sample were told that their tax increase would be 50% of our baseline estimate. Second Sample: Respondents in the second additional sample were told that their tax increase would be 150% of our baseline estimate.

Polling Public Opinion on Health Care: Results: Party: Self-reported Republicans are the least willing to support reform. Self-reported Democrats are the most likely to support reform. Independents are in the middle. Their support for reform was statistically distinguishable.

Polling Public Opinion on Health Care: Results: Income: Support for Health Care Declines with Rise in Income. The willingness to support reform declines with income (Inverse Relationship) and it starts early (only those making under 25 K support reform). Income Matters Regardless of Party Affiliation Even with Democrats, the wealthier they get (up to a point) the less likely they are to support Health Care Reform.

Polling Public Opinion on Health Care: Results: Age: Older Americans (age 60 or above) are significantly less likely to support either reform than are the young (age 18– 35). The Middle-Aged (age 35– 59) are also less likely to support either reform than the young.

Polling Public Opinion on Health Care: Results: Cost and Scope of Health Care Reform: Inverse Relationship. As the cost and scope of reform rise, support for reform falls.

Polling Public Opinion on Health Care: Results: Major v. Minor Reforms: Party: Self-identified Republicans and independents were less supportive of both major and minor reform than Democrats. Income: High-income households were less supportive of both types of reform than low-income households. Age: Older Americans Support Minor Reform However, the negative effect of age on willingness to support reform was more pronounced for major versus minor reform. Support of middle -aged and older Americans for minor reform was not statistically distinguishable from that of young Americans.