Two years after the implementation of a health care reform law aimed at providing health coverage for nearly all Massachusetts residents, public support for the law remains high. According to a new poll by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, over two-thirds (69%) of Massachusetts residents support the law. Just over one in five (22%) oppose the law and approximately one in ten (9%) say they do not know enough about it to give an opinion. Since the law's passage in 2006, public support has increased slightly (69% in 2008 compared to 67% in 2007 and 61% in 2006). The poll was conducted June 10-23, 2008.
Other signs of public support for the law include the following:
- 77% support providing subsidized coverage
- 58% support requiring individuals to have insurance
- 71% say the law has been successful at reducing the number of uninsured in Massachusetts
"The poll was taken during a time of much public discussion by legislators and policymakers about the high costs of the plan due to greater-than-expected enrollment numbers," said Jarrett T. Barrios, president of the Blue Cross Blue Cross Blue Shield of Massachusetts Foundation. "We think this shows the public's strong support for the law."
In the two years since the law's passage, approximately 350,000 Massachusetts residents have gained health insurance coverage.
A key component of the law is a mandate requiring all Massachusetts residents to have health insurance or pay a fine. A majority of the public support this individual mandate (58%) while slightly over one-third oppose it (35%). Support for the mandate has also increased slightly since the law was passed (58% in 2008 compared to 57% in 2007 and 52% in 2006).
The law requires businesses that employ more than 10 people to provide health insurance for their employees or pay a fine of up to $295 per employee per year. The public is highly supportive of this provision with three out of four expressing support (75%) and one in five opposition (21%). Support for this business requirement has also risen slightly since 2006 (75% support in 2008 compared to 70% in 2006).
Another key component of the law is providing free or subsidized coverage for Massachusetts residents whose incomes fall below 300% of the Federal Poverty Level ($63,600 for a family of four or $31,200 for an individual). Over three-quarters (77%) of the public support this subsidized insurance program while 18% oppose it.
Perceptions of Success of the Law
The poll finds that the public is aware of the law's success at reducing the number of uninsured in the state with 14% saying the law has been very successful and 57% somewhat successful. Fifteen percent say the law has been not very successful at reducing the number of uninsured while 4% say it has been not successful at all. Nine percent say they did not know enough to give an answer.
"These findings have implications for the national debate on guaranteeing health insurance for all Americans," said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health. "The poll shows that it is possible to cover most citizens and maintain public support. In most past cases of health reform, the public has become less supportive as it gained understanding of the trade offs involved. Massachusetts shows that this may no longer be true."
Perceptions of Who the Law is Helping and Hurting
The public is divided on whether the law is helping the uninsured. A little less than half feel the law is helping the uninsured (45%) while one-third (33%) feel the law is hurting them. Fourteen percent say the law is not having much impact on the uninsured. The poll finds a similar split between those who feel that poor people are being helped by the law (44%) versus those who believe the poor are being hurt (31%) or not being affected (14%).
The poll also asked about the impact of the law on other groups such as the middle class, young adults and large corporations. A majority of the public feel that these groups are not being affected by the law or are being helped. Small businesses are the only group that a majority of Massachusetts residents feel are being hurt (56%). This compares to 13% who feel small businesses are being helped or not impacted (19%).
Many Massachusetts residents report that the law has had a limited impact on them personally. Just over two-thirds (67%) say the law is not having much impact on them personally compared to 14% who feel they are being helped and 18% being hurt. In addition, most people do not believe that the law has caused their health care costs to increase. Just over a majority (54%) say that the law has not had an impact on what they pay for health care while 6% say their costs have gone down. One in three (33%) say their costs have gone up as a result of the law.
Perceptions of the Law Among Those Affected
The law is most likely to have directly affected people who lacked health insurance at some point during the past 12 months and those who have gotten insurance or changed their insurance due to the law. Among this group, the law in general and the mandate in particular receive less support (52% law, 37% mandate) compared to the total population (69% law, 58% mandate). Respondents directly affected by the law are also more likely to say the uninsured and themselves personally are being hurt by the law (50% uninsured, 44% you personally) compared to the total population (33% uninsured, 18% you personally).
Challenges for the Future
The success of the law at reducing the number of uninsured in Massachusetts has created financial challenges. More people than projected signed up for subsidized coverage through the state causing the program to be over budget. When asked about a number of ways to cover this budget shortfall, several funding options receive support from a majority of Massachusetts residents. Nearly three of four (74%) favor charging businesses that have numerous part-time employees receiving subsidized coverage. Seventy percent favor increasing the cigarette tax, while 61% favor requiring insurers to contribute to a fund for subsidized coverage. Just over a majority (53%) favor increasing the $295 penalty for businesses with more than 10 employees that do not provide insurance.
Several policy options for covering the budget shortfall would face strong public opposition including increasing the state sales tax (75% oppose). Two out of three Massachusetts residents (66%) are opposed to limiting the number of people who qualify for subsidized insurance and creating a waiting list. Just over a majority (56%) are opposed to cutting other government programs as well. A majority of the public (55%, with 33% strongly opposing and 22% somewhat opposing) oppose increasing premiums, co-pays, and deductibles for subsidized care. Forty percent (16% strongly favor and 24% somewhat favor) support such increases on consumers.
Despite these financing challenges, the poll finds that Massachusetts residents want the law to continue. When asked if they would like the law to be repealed, continued as it currently stands or continued but with changes made, almost three-quarters want the law to continue though most want changes made (70% continued with changes, 14% continued as is). The poll did not ask about how the public would like to see the law changed. Only 12% want the law repealed. This is true even among the 22% of Massachusetts residents who say they do not support the law (56% continued with changes, 39% repealed, and 4% continued as is).
Methodology
The Massachusetts Health Reform Survey was conducted by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation. The survey was designed and analyzed by a team of researchers at the Harvard School of Public Health with input and review from the Foundation. This is the third survey in a series of surveys designed to measure the attitudes of Massachusetts residents towards the health reform law passed in 2006. The second survey also included the Kaiser Family Foundation as a research partner.
The instrument was approximately 15 minutes in length. Interviews were conducted with 1,015 randomly selected Massachusetts state residents, age 18 and older, via telephone by International Communications Research of Media, Pennsylvania. The interviewing period was June 10 to 23, 2008. The data were weighted to accurately reflect the demographics of the state's adult population as described by the U.S. Census.
When interpreting these findings, one should recognize that all surveys are subject to sampling error. Results may differ from what would be obtained if the whole Massachusetts adult population had been interviewed. The size of this error varies with the number of persons surveyed and the magnitude of difference in responses to each question. The sampling error is ±3.93 percentage points at the 95% confidence level.
About the Harvard School of Public Health
Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu.
About the Blue Cross Blue Shield of Massachusetts Foundation
The mission of the Blue Cross Blue Shield of Massachusetts Foundation is to expand access to health care. Through grants and policy initiatives, the Foundation works with public and private organizations to broaden health coverage and reduce barriers to care. It focuses on developing measurable and sustainable solutions that benefit uninsured, vulnerable and low-income individuals and families in the Commonwealth, and served as a catalyst for the pioneering Massachusetts health care reform law passed in 2006. The Foundation was founded in 2001 with an initial endowment of $55 million from Blue Cross Blue Shield of Massachusetts; the endowment has since grown to $108 million. The Foundation operates separately from the company and is governed by its own 18-member Board of Directors. It is one of the largest private health philanthropies in New England and in 2007 was awarded the Paul Ylvisaker Award for Public Policy Engagement by the Council on Foundations.
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