Californians Want Major Change in Health Care and Favor Elements of Schwarzenegger and Democratic Plans

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Health Moves Up to Tie as Most Important Issue with Perennial Favorite Immigration

The Public Policy Institute of California (PPIC) has released a new poll that shows that health care has catapulted into a virtual tie with immigration as the most important issue to likely California voters and that an overwhelming 69% of Californians and 72% of likely voters want “major change” in the health care system.

The 34 page survey, which can be read or downloaded directly from the PPIC was taken of 2003 California adult residents, a very large sampling between September 4 and 11, and has a margin of error of 2% as to Californians and 3% as to likely voters. This is a very large sample and the PPIC is highly respected. It includes many other issues and quesitons besides health which will be dealt with in separate articles.

When given a relatively short description of both the Schwarzenegger and Democratic health plans, there is support for both, but likely voters are split on the Democratic plan as described. There was no question about the single payer plan being advanced by Senator Sheila Kuehl.

The Most Important Issue in California

Immigration has long polled as the most important issue facing California. It still is the most important issue to all Californians by a margin of 18% to 14% over health care, followed by 13% for jobs and the economy and smaller percentages for education and housing. This is a much lower overall figure for immigration which has by a wide margin been the single largest issue identified in polls as the most important issue to Californians. When it comes to likely voters, immigration at 19% and health care at 18% are within the margin of error of the poll–statistically tied.

In fact immigration ranks third amongst California Democrats as the most important issue at 10% (compared with 21% of Democrats who identify health and 13% who indicate jobs and the economy) and 20% of the state’s independent (decline to state and other party members) rank health as the single most important issue and drop immigration to a tie with jobs and the economy. The state’s Republicans consider immigration as the most important issue by a 29% to 10% margin over health.

How Closely Are Californians Really Following the Health Care Proposals?

When asked “How closely are you following news about the governor’s and legislature’s efforts to reform the California health care system?” almost half–47%–of Californians indicate they are following the issue closely. 10% describe their following this as “very closely” and another 37% as “fairly” closely. 52% say they are not closely following the health care the governor and legislature on health –“not too closely” (37%) and “not at all closely” (15%).

It is interesting to compare these numbers with the Field Poll released in August near the height of the California budget impasse where 12% of registered voters said they were giving the budget “a lot of attention” followed by 37% at “some attention,” 34% “little attention” and 17% none at all. At the time, many newspapers and commentators interpreted this as a lack of interest in the budget situation of a large number of voters.

Given the relatively low level that most Californians follow the news about most state government issues, I find the level of interest in the health plans to be significantly high, as I did with the budget before.

On the other hand, given findings of recent polls that the numbers of California voters who can identify the Speaker of the California Assembly or President pro Tem of the California State Senate, it would be interesting to find out how much those being surveyed really know about the important aspects of the competing health plans.

Half (52%) of California residents have seen of or heard of Michael Moore’s film documentary about health “Sicko” according to this survey, while 48% have not. Out of the 52% who have seen or heard of the movie, by 17% to 3% it has made them more likely rather than less likely to think there is a need to reform the US health care system. Another 29% indicate is has not changed their opinion and 3% just plain “don’t know.”

Similarly, 46 percent have seen, heard or read ads about the California health care reform, and by a margin of 20% to 2% they are more likely to think there is a need to reform the California health care system.

Californians Overwhelmingly Want Major Changes in the Health Care System

When asked the question “Do you think California’s health care system is in need of major changes or minor changes or that is is basically fine the way it is?” the numbers are off the charts for major changes, any way you slice it-, including by party .

69% of Californians want major changes, 19% minor changes, and only 10% describe the system as “fine the way it is.” The numbers are even more pronounced when it comes to likely voters–72% want major changes, 17% minor changes and 8 percent the way it is now. That’s about 90% of both Californians and likely voters who want changes.

There are partisan differences, with Democrats being more strongly in favor or major changes–77% with only 4% saying it is fine as it is. Republicans at 63% wanting major changes, 20% minor changes, and 13% liking it as it is, are still overwhelmingly in favor of major changes. The “independent” voter is also strongly in support–68%– of major changes and only 8% think what we have now is fine with them.

What Plan Do They Favor?

Here, as it is in many polls, the devil is in the detail of the questions. As many of those involved in the crafting of the health care plans and bills know, both the Schwarzenegger and the Perata/Nunez proposals are complex and a welter of numbers with various cut offs, payments, and financial underpinnings.

Here is the question asked survey respondents as to what the survey reports as the Schwarzenegger plan:

“Would you favor or oppose a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers, and individuals?”

72% of Californians favored this and 23% were opposed. Only 5% said they didn’t know. Of likely voters, it was favored 63% to 31% with 6% expressing no opnion.

The numbers are very interesting when broken down by party–with Democrats being the most strongly in support 79% to 16% and Republicans more even in their support at 50% to 44%. Independents favor it by 70% to 24%. It receives 89% Latino support as compared to 43% of whites.

Here is the question asked about the Democratic (AB 8) approach:

“Would you favor or oppose a plan that requires employers to provide health insurance to their employees or pay a fee to the state to cover all working Californians, and that also guarantees health insurance for all children regardless of immigration status?”

By a margin of 61% to 36%, this is favored by all Californian–but with likely voters it comes in at 47% approval and 49% opposed–at the margin of the poll and basically split.

Here, there is strong Democratic support 72% to 25%, as well as independent support at 58% to 39%. Republicans, however, are strongly opposed by 68% to 29%, and that is what makes the numbers close when it comes to likely voters.

Note that the question asked on AB 8 references immigration whereas there is no mention of immigration in the Schwarzenegger question, even though the governor’s plan would include all immigrants employed in the state regardless of their status. Neither of these plans include all Californians as one might think from the descriptions of both.

The Bottom Line–Where Does All of this Shake Out?

Californians of all stripes are dissatisfied with the current health care arrangement, want major reform and not just minor reform of the system, and are following health more closely than most California issues and have moved it up the agenda as one of the major issues facing the state.

It would have been nice to have seen the single payer plan polled–as the recent Field Poll showed, like the PPIC here, major dissatisfaction with the insurance based system we have now. In polling on single payer, Field found increasing support for this.

In the special session, and for the foreseeable future, especially in light of Arnold Schwarzenegger’s veto of SB 840 Kuehl), a single payer plan, last year and his continued opposition to it, the battle is between AB 8 and the Schwarzenegger plan, and the differences between the Governor and the Democrats is narrowing, according to their own account. You can read the comments by Anthony Wright about the convergence of both plans and other health reform articles that describe these proposals in detail.

Both Governor Schwarzenegger and Speaker Nunez have issued statements that the PPIC poll supports their proposals. In point of fact, the Nunez plan has elements of the Schwarzenegger approach as framed in the PPIC question and the Schwarzenegger plan, as apparently modified in negotiations with the Speaker has elements of AB 8 in it. What we don’t have in the PPIC survey is the kind of follow up questions about the individual differences in the plans being put forth–the “what if it included this” or “had this cut off level” kind of questions that would give more of an understanding of the opinions expressed. For instance, does the inclusion of the immigration issue in the AB 8 question change the results, in particular with likely voters? In point of fact, the Schwarzenegger plan would cover immigrant workers with questionable status who are employed in the state–unless part of the underground economy.

Given the length and breadth of the non health issues and attitudes of Californians covered by this PPIC poll, the questions on health have been telescoped down to very short descriptions of competing plans. So the results need to be read and interpreted along with other polling data. But it is clear from this survey that Californians want big things done and not tinkering around the edges and that is in accord with other polls..

If any agreement is reached between the legislature and the Governor, there will be parts of it that the public will have to be sold on–in the details about affordability in particular. There will be parts that the public will like. There will be those who think it does not go far enough and those who feel it does too much in one direction or another. And there will probably be a ballot proposition for the voters to weigh in on at least part of the plan and possibly a referendum. That is when the voters will be paying much more closer attention to the specifics.

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