Leave No American Uninsured
By Sean McElwee and John Ray
Americans are fine with the continued existence of health insurance companies, but they clearly want drastic reforms to healthcare.
The question of what sort of healthcare plan each candidate supports has been at the forefront of the Democratic presidential primary. However, while Medicare for All has faced immense scrutiny, “public option” plans have faced very little. To see how a public option might stand up after facing attacks from the right, we tested a few possible messages for and against the public option.
Our public-option battery focused on the potential consequences of healthcare reform. We wanted to know whether voters would support or oppose new healthcare reform (specifically a public option) and if it might have certain consequences. We asked voters:
Some members of Congress have proposed a “public option” that would allow individuals to buy into a government-run plan. Would you favor or oppose a public option if you heard that it would do the following?
Let private health insurance companies continue to exist
Left some Americans uninsured
Did not require tax hikes
Continue to require out-of-pocket costs so individuals must cover some care
Continue to limit the choice of doctors and hospitals to those in a particular network
Allow doctors and hospitals to continue to raise their rates
After being shown each possible consequence of the policy, voters could report whether they supported, opposed, or were unsure how they felt about a public option. Voters saw each item in a randomized order.
Our results suggest voters are ready to do anything to curb the rising costs of healthcare. By an overwhelming margin (73 percent to 16 percent), voters say they would oppose any new healthcare policy that allowed costs to continue to rise. By a similarly strong margin (71 percent to 17 percent), voters also say they would oppose reforms that continued to limit choices to particular networks—a limitation that is also the defining feature of the current healthcare system.
Additionally, voters oppose the mere idea of out-of-pocket costs, which form the basis of the deductibles system. Voters would oppose a public plan that continued to require these out-of-pocket costs, 47 percent to 38 percent.
At the same time, however, voters would also support a new healthcare policy that allowed private health insurance companies to continue to exist. Voters would support a public option if private health insurers stuck around with it, 66 percent to 24 percent. This is roughly the same amount of voters as those who would reject a public option that left some Americans uninsured and is higher than the share who would reject a public option if out-of-pocket costs continued to survive.
Voters don’t want to pay taxes. Across the board—and even controlling for potential differences due to party identification—voters would support a public option that did not require tax hikes. As it turns out, by a 43-percentage-point margin, voters would support a public option if they did not face the possibility of having to pay for it.
Surprisingly, the pattern of support for and opposition to a public option is roughly stable across the partisan divide. By a 37-point margin, Democratic voters would support a public option if it let private health insurance companies continue to exist. By a 68-point margin, they would also oppose a public option if it left some Americans uninsured. Democrats would by a 50-point margin prefer a public option that did not include tax hikes. By a 19-point margin, Democrats would oppose a public option if it did not also eliminate out-of-pocket costs. By a 52-point margin, they would also oppose a public option if it continued to limit doctor and hospital choice, and by a 61-point margin, they would oppose a public option if it did not end rising costs.
On net, independent and Republican voters agree with Democrats on virtually everything with respect to what they would accept or reject about a public option. Voters of all partisan identities would prefer allowing insurance companies to continue to exist. Each group of voters opposes leaving Americans uninsured, including 50 percent of Republicans and 57 percent of independents. No one of any partisan affiliation would like to pay for a public option with tax hikes.
Independents would clearly oppose a public option of it continued to require out-of-pocket costs, while Republicans would narrowly support a public option that continued to require these costs, with 47 percent supporting it and 38 percent opposing it. But even Republicans are ready to ditch network limitations and want to cap rising rates, and Democrats and independents clearly agree. By a 52-point margin, independents would oppose a public option if it continued to limit choices of doctors and hospitals to particular networks, as would Republicans, by a 58-point margin. (Note, however, that this is in line with the fact that Republicans would generally don’t want a public option at all).
Independents would overwhelmingly prefer to curb rising prices for accessing healthcare services. About 68 percent of independents would reject a public option that allowed rates to continue to rise, compared to just 13 percent who would support it. About 69 percent of Republicans would also reject such a plan, compared to just 17 percent who would support it.
Data for Progress has previously shown that Americans are ready for healthcare reform. And now we’ve seen that a public option must accomplish many things to be politically palatable to voters. Prices must stop rising, choices must be expanded, and the cost of access for users must be low or zero (i.e., out-of-pocket costs are deeply unpopular, except among Republicans). At the same time, voters would accept a public option if it was just that—an option, rather than a government monopoly.
Sean McElwee (@SeanMcElwee) is co-founder and Executive Director of Data for Progress.
John Ray John Ray (@johnlray) is a Senior Political Analyst at YouGov Blue.
On behalf of Data for Progress, YouGov Blue fielded a survey of US registered voters as part of its Registered Voter Omnibus. The sample included 1,062 US voters and was weighted to be representative of the population of voters by age, race/ethnicity, sex, education, US Census region, and 2016 presidential vote choice. Here we focus on the results of a battery of items centered around a public option for healthcare.