Progressive Messaging for the Health Care Debate

1. Health Care for America Now! Progressive Messaging for the Health Care Debate Prepared by Lake Research Partners for Health Care for America Now! info@healthcareforamericanow.org September 2008 1825 K Street NW – 4th Floor Washington, DC 20005 1726 M Street, NW, Suite 500 Washington, DC 20036 tel. 202/776-9066 fax 202/776-9074

2. Voters and Health Insurance • As a reminder, 94% of voters in 2006 had some members of their household covered, 79% had everyone covered.* *SEIU/AHC polling by Lake Research Partners, November 2006.

3. Voters are becoming more comfortable with a government role in health care reform, possibly as a result of the current presidential campaigns. 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? Do you feel strongly or not strongly about that choice? Oppose Favor 28% 66% September 2007 February 2008 23% 69%

4. Voters strongly identify the health insurance industry with negative traits of putting profits ahead of people and being greedy, not caring, and bureaucratic. Terms like reliable and unreliable are more middling.

5. Text of Candidate A’s Progressive Plan Americans would be guaranteed to have a choice of health plans they can afford, either from a private insurer, or from a public plan. Everyone would pay on a sliding scale based on income. To maintain quality and allow fair cost comparisons, health insurance companies and the public plan would be required to provide at least a standard, comprehensive package of benefits including preventive care and all needed medical care. Employers and individuals could choose to keep their current health plans. The public plan would be paid for through a modest payroll tax on employees and employers and by rolling back tax breaks for those who make over $200,000 a year. Small businesses would pay a lower rate. No insurer could deny coverage or charge higher premiums to people with pre-existing conditions.

6. Nearly two-thirds of voters rate Candidate A’s plan (the progressive plan) a six or higher. 34% 65%

7. When asked head-to-head, voters prefer Guaranteed Affordable Choice over health savings accounts, tax credits, or a single payer plan by about three-to-one. 67% 20% 65% 20% 64% 22% Even among the health care base, intense support for single-payer is far lower than for GAC. LRP Poll on behalf of The Herndon Alliance. N=1000, 9/15-27/2007.

8. Text of GAC, HSA, Tax Credits, and Single Payer plan. Guaranteed Affordable Choice language: An approach that would guarantee affordable health insurance coverage for every American with a choice of private or public plans that cover all necessary medical services, paid for by employers and individuals on a sliding scale. Health Savings Account language: A Health Savings Account program that would provide tax-deductible savings accounts to all Americans if they purchase a private insurance plan with at least a thousand dollar deductible. Tax Credits language: An approach that would provide tax credits that will reimburse individuals and families for 25 to 50 percent of the cost of their private health insurance policies. Single Payer language: A single government-financed health insurance plan for all Americans financed by tax dollars that would pay private health care providers for a comprehensive set of medical services.

9. Focus group participants liked that under Candidate A’s plan they would have choices in their health care and that they would not have to fear being denied.

10. Text of Candidate B’s Plan The proposal would level the financial playing field for all health purchasers, so individuals and families can purchase their own health insurance with a universal refundable tax credit of 2,500 to 5,000 dollars in place of the current employer sponsored health insurance tax exclusion. Access to Health Savings Accounts would be expanded and improved by streamlining rules and regulations, allowing families to maximize the value of health services tailored to their needs. Families would be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will reduce overhead, administrative, and excessive compensation costs from the system. Low-income families would receive supplemental aid through their state's Medicaid funds and states could choose to allow the use of private insurance in Medicaid.

11. Voters are less favorable toward Candidate B’s plan (the free market approach) with a majority rating it a five or less. 51% 47%

12. When asked to choose between the two plans, a majority opt for Candidate A’s progressive plan including 2-in-5 who say they strongly support it. 55% 28%

13. Support for candidate A’s plan is strong across urban, suburban, and rural counties. Based on these two health care reform proposals, which candidate would you prefer?

14. Republican men and independent men are the most likely to support Candidate B, but both groups are still net supportive of Candidate A. Margin for Candidate A Candidate B Candidate A +51 +36 +11 +37 0 +23

15. Voters in all regions support Candidate A’s plan, most strongly in the South Atlantic and with the smallest margin in the West North Central. Margin for Candidate A Candidate B Candidate A +21 +28 +7 +40 +15 +30 +29

16. Region Definitions Mid-Atlantic Respondents who live in New Jersey, New York, or Pennsylvania. East North Central Respondents who live Ohio, Indiana, Illinois, Michigan or Wisconsin. West North Central Respondents who live in Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, or Kansas. South Atlantic Respondents who live in Delaware, Maryland, District of Columbia, West Virginia, Virginia, North Carolina, South Carolina, Georgia or Florida. West South Central Respondents who live in Arkansas, Louisiana, Oklahoma, or Texas. Mountain Respondents who live in Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah or Nevada. Pacific Respondents who live in Washington, Oregon, or California.

17. A “Big Government” attack on Candidate A’s plan raises doubts among 65% of voters. Candidate A’s plan sounds good, but it just won’t work. It will be just another big government bureaucracy like the IRS and the DMV, operating inefficiently and costing taxpayers hundreds of billions of dollars. We will end up paying higher taxes and getting low quality health care with long waiting lines to get treatment and lots of red tape and paperwork. Instead of a big government program to bring socialized medicine to America, we need to give consumers more of their own money back, and more options to choose the health insurance plan that’s right for them. 65% Doubt Does that raise SERIOUS doubts, SOME doubts, MINOR doubts, or NO real doubts in your mind about the health care proposal from Candidate A?

18. The attack on Candidate B’s plan is farther reaching, raising doubts among over three quarters of voters. Candidate B’s plan is misleading. Candidate B doesn’t tell you that with those Health Savings Accounts you will need to buy a health care plan with deductibles of 11 hundred to 11 thousand dollars. He doesn’t tell you that even if you do manage to get a tax deduction or credit it will pay for only a quarter to a half of your cost of health insurance. And his plan doesn’t do anything to regulate insurance company practices, like not covering pre-existing conditions, denying claims or restricting your choice of doctors. And there’s nothing in the plan to control skyrocketing premiums or insurance company profits. We don’t need a plan that leaves us on our own with the insurance industry. We need a guarantee of quality affordable health care for all of us. 77% Doubt Does that raise SERIOUS doubts, SOME doubts, MINOR doubts, or NO real doubts in your mind about the health care proposal from Candidate A?

19. After attacks on both sides, voters continue to favor Candidate A’s plan and the margin increases from +27 to +32. 55% 23%

20. All messages generated solid ratings, with the strongest response to the “Guarantee” message.

21. Similar messages test well with swing voters1, but they are even more supportive of government involvement.

22. The best messages in the poll centered on the guarantee of health care and criticize the harsh and unfair insurance industry and affordability contrasting rising insurance premiums to wages. • Guarantee: We need an alternative to the harsh and unfair practices of the health insurance industry. The right approach recognizes that we are all part of the solution. 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 be able to keep the health care that we have and we need the choice of a public plan, so we’re not left at the mercy of the same private insurance companies that have gotten us into this mess. • Guarantee with government: We need an alternative to the harsh and unfair practices of the health insurance industry. The right approach recognizes that we are all part of the solution. We need a guarantee of quality, affordable health care for all of us. We need government to be an advocate for us and set and enforce the rules so insurance companies put our health care before their profits. We need to be able to keep the health care that we have and we need the choice of a public plan, so we’re not left at the mercy of the same private insurance companies that have gotten us into this mess.

23. Can’t keep up – rules: If you work hard, pay taxes, and play by the rules, you ought to have access to quality, affordable health care, but it’s getting tougher and tougher today to make ends meet and afford good health care. Health insurance premiums are going up three times faster than workers’ wages or inflation. None of us should be left behind. As Americans we can and must provide a real solution. Candidate A’s proposal is a common sense plan to make sure we all have access to the highest quality health care in the world. • Can’t keep up – struggle: No matter how hard we work and struggle to make ends meet, it’s getting tougher to get good affordable health care. Health insurance premiums are going up three times faster than workers’ wages or inflation. None of us should be left behind. As Americans we can and must provide a real solution. Candidate A’s proposal is a common sense plan to make sure we all have access to the highest quality health care in the world.

24. Attacks on Candidate B’s plan are consistently effective, though no message is a silver bullet.

25. Voters are most convinced by messages noting that Candidate B’s plan costs consumers, helps insurance companies, and fails to rein in their greedy and unfair practices. Helping insurance companies: Candidate B’s plan is designed to help the insurance companies, not us. That’s why the insurance companies like it so much. They get to keep charging us whatever they want no matter how many people they deny coverage to or how much profit they make. They can keep excluding people with pre-existing conditions from getting any health coverage at all. And they get even more tax subsidies to keep treating people this way. That’s a bad deal for people who need good affordable health care. (68% convincing, 40% very) Misleading w/ tax credits: The proposal from Candidate B is misleading. It doesn’t tell you that the health plans you need to buy in combination with those Health Savings Accounts are actually plans with deductibles of 11 hundred to 11 thousand dollars. It doesn’t tell you that even if you do manage to get a tax deduction or credit it will pay for only a quarter to a half of your cost of health insurance. It leaves us on our own to fend for ourselves in a complicated health insurance market. Tax credits don’t guarantee health care. (67% convincing, 38% very) Huge tax increase: The proposal from Candidate B is really a huge tax increase on working families. Under his plan, workers would get hit with a brand-new tax on the premiums that businesses pay for employee health insurance. Being taxed on the value of our health care benefits doesn’t do anything to solve the health care mess and it makes health care more expensive for working people, not less. (67% convincing, 37% very) *Split sampled question

26. Also convincing are messages that accuse Candidate B of being misleading and not regulating the insurance industry. Misleading: The proposal from Candidate B is misleading. It doesn’t tell you that the health plans you need to buy in combination with those Health Savings Accounts are actually plans with deductibles of 11 hundred to 11 thousand dollars. It doesn’t tell you that even if you do manage to get a tax deduction or credit it will pay for only a quarter to a half of your cost of health insurance. It leaves us on our own to fend for ourselves in a complicated health insurance market. (66% convincing, 35% very) On our own: The proposal from Candidate B doesn’t do anything to regulate insurance company practices, like requiring coverage of pre-existing conditions, ending wrongful denial of claims and restricting your choice of doctors. And there’s nothing in the plan to control premiums or insurance company profits. This proposal leaves us out on our own with the insurance companies with no guarantees. (66% convincing, 35% very) Big business: Candidate B’s plan is all about letting big business off the hook for providing health insurance to workers. It gives them an excuse to let people buy their own insurance. And since insurance companies can set the terms, it helps the insurers as well. That’s why they like it so much. Working people will pay more and will get less. (62% convincing, 35% very)

27. Voters are most convinced by messages noting that Candidate B’s plan costs consumers, helps insurance companies, and fails to rein in their greedy and unfair practices. • Also convincing are messages that accuse Candidate B of being misleading and not regulating the insurance industry.

28. Following all messages, support for Candidate A’s plan increases slightly and the margin expands to +38. 59% 21%

29. As voters learn more through the survey, Candidate A gains some additional support and Candidate B’s support slowly erodes – margins grow from 27% to 32% to 38%. Margin for Candidate A Candidate B Candidate A +27 Initial Post-Attack +32 Final Post-Messaging +38