Today is the bridge day between The Battle of the Democratic Primary Candidates Debate #2 Part 1 and tonight, Part 2. So it’s a good time to take stock of U.S. voters’ views on health care, through the lens of the Kaiser Family Foundation’s Health Tracking Poll for July 2019 published yesterday.

Health care is the top issue Democrats want to hear about in the debates, well ahead of climate change, women’s issues, immigration and gun policy.

Let’s start with an overall context statistic from this poll: that is that 86% of insured U.S. adults like their health insurance plan rating it “excellent” (39%) or “good” (47%).

Among Democrats and people leaning Dem, the most popular health reform “form” is to expand coverage further building on the Affordable Care Act (ACA) (55%) versus replacing it with a Medicare-For-All plan (39%) for which Bernie Sanders and Elizabeth Warren passionately argued in last night’s debate.

In fact, enthusiasm for a Medicare-for-All plan fell in this month’s KFF poll from 56% favoring M4A in April 2019 dropping to 51% in July.

There is greater support for including a public option along with private plans for health coverage, the combination which 65% of Americans favor.

However, there are nuances about a mix of public/private plans: the KFF poll found people have different responses depending which kind of “public” plan would be baked with private insurance options. The most favored public plan is Medicare, beloved by 83% of Americans, where Medicaid is favored by 75% of people.

Note that most Republicans have favorable views on Medicare, employer-sponsored insurance, Medicaid and private health insurance purchased by individuals. Most Democrats favor all four health plan types except for self-paid private health insurance.

Now here’s where things get complicated: only 48% of U.S. adults have a favorable view of the ACA in July 2019. This percentage has ranged from a low of 35% favorability in September 2014 to a high of 54% in February 2018 — a month after President Trump took office.

So only one-half of Americans think favorably about the ACA. But wait! there’s more to consider.

Check out the second bar chart which details ACA provisions that Americans believe are “very important” to be kept in place if the law is found unconstitutional by the court. These favorite ACA line items are:

  • Assuring that people with pre-existing conditions are guaranteed insurance coverage (72%)
  • Assuring that pregnant women aren’t denied coverage (71%)
  • Assuring that sicker people don’t pay more for health insurance coverage (64%)
  • Requiring coverage of preventive service (62%)
  • Assuring that health insurance companies do not set a lifetime limit for coverage (62%), among other popular provisions.

KFF’s bottom line is that, “With the ACA and its various provisions under legal threat from an ongoing federal court case, this month’s KFF Health Tracking Poll probes the public on how important it is for different ACA provisions to remain in effect if the law is ruled unconstitutional. Most Americans say it is “very important” to them that each of the provisions included in this month’s survey are kept in place.”

Health Populi’s Hot Points:  U.S. health citizens who have health insurance are holding tight to their plans — even with the sticker-shock of surprise billings, the price of prescription drugs, and administrative hassles. Health care continues to be the #1 election issue and it will drive people to the primary and Presidential polls over the coming months.

Even with warts-and-all, Americans who are insured know having health insurance is better than not having it in the current costly environment and payment regime. Ezra Klein wrote a timely post in Vox two days ago here on how Medicare-for-All proponents could do a better job explaining why they support that flavor of universal health care. Ezra writes,

“Private health insurance isn’t theoretical. More than 150 million Americans get insurance through their employers right now. They live in the world that pundits and think-tankers are arguing over. So if the private insurance market as it exists is such a nightmare, then why are people so loath to see it replaced?”

After a long discussion about health insurance “churn” and failed policy attempts to reform health care, Ezra concludes that,

“Risk aversion here is real, and it’s dangerous. Health reformers don’t tiptoe around it because they wouldn’t prefer to imagine bigger, more ambitious plans. They tiptoe around it because they have seen its power to destroy even modest plans. There may be a better strategy than that. I hope there is. But it starts with taking the public’s fear of dramatic change seriously, not trying to deny its power.”

We’ll tune in to the debate tonight to see how the next group of Democratic presidential candidates will deal with the nuances of universal care, from public options and “Medicare for Those Who Want It,” to Medicare For All. For now, the KFF July 2019 poll tells us Americans who are insured cleave tightly to their health plans — sub-optimal as the experience, coverage and cost might be.

2 Comments on Love ACA Provisions, Not the ACA – KFF Poll Reveals American Voters’ Views on Health Care Reform

David Nickelson said : Guest Report 3 months ago

I came away from the last two nights fearing the same...and similar to above, a recent Marist poll found the same...that risk aversion and status quo bias are enormous challenges here. When you add in the fear of unknown or unpredictable health problems, the emotional valence of "losing a glass half full" becomes an even bigger and real human blocker to support, change and adoption. There is perfect policy, and then there is realistic transformation...the broader public is as best ready only for the latter. - Dr D

Mike McGraw said : Guest Report 3 months ago

While many millions of people have medical insurance through their jobs, even more folks are not so lucky. Their jobs offer no insurance, they don’t/can’t work, despite all they can’t afford even the barest plan. Medicare For All will cover everyone, equally. Plus, dental and vision care will be included (these are now almost-entirely separate extra-cost plans). Of course, people will be defensive about changes to what they (we) have. Remember the Republican lies about ACA having “death panels”? But now ACA is accepted and relatively popular. Medicare for All will be another step forward in health care for America.

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