Wednesday, November 19, 2008

The Massachusetts Model? 

Only if you discount those most effected

By Greg Scandlen

Filed As:  Health Care

Harvard’s Robert Blendon continues his superlative work in measuring public opinion around health care issues in a new study of the attitudes of Massachusetts residents about that state’s health reforms. The study, published in Health Affairs, looks not only at current opinions, but tracks attitudes through the debate and consideration of the plan.

One of the findings is how opinion changes once people are made aware of the costs and consequences of a reform proposal. Mr. Blendon tested attitudes towards various reform ideas in 2003. He found that 82% or respondents favored “expanding existing state programs,” but when told that “these programs would require raising taxes to pay for the cost” support dropped to 55%. Similarly with other ideas –
•    76% supported an employer mandate, but that dropped to 35% when told that employers might have to pay off workers
•    70% supported tax credits and deductions for the uninsured, but that dropped to 36% when people were told it might not cover the full cost of the coverage.
•    56% supported an individual mandate, but that dropped to 22% were told it will cause financial hardship for the people affected.
•    50% supported single payer, but that dropped to 30% when people were told that might have to wait longer for hospital and specialist care.

This is part of the reason Massachussetts developed its approach that included a little bit of everything -- there was no consensus on a single best approach. Of these various approaches, the one with the least support once the trade-offs are made clear was the mandate on individuals. Mr. Blendon’s article notes that the mandate was the “most politically controversial” part of the legislation, gaining only 52% support.

That level of support has increased since the law was enacted and implemented, to 57% in 2007 and 58% in 2008. But that population-wide number hides some alarming trends. Mr. Blendon writes of his 2007 survey, “Upon hearing descriptions and costs of subsidized and unsubsidized plans for an average uninsured person, 62 percent thought that it was unfair to require an uninsured person to sign up and pay for an unsubsidized plan like this. Forty-four percent thought that it was unfair to require an uninsured person to sign up and pay for a subsidized plan.”

Today, the people most supportive of the individual mandate are the people least affected by it – 69&% of people making $75,000 or more per year support it while only 49% of those making between $25,000 and $50,000 do. 69% of people with college degrees support it, but only 45% of those with high school or less do.

There is a growing concern among all residents that the law is hurting, rather than helping, the uninsured, with the percentage saying it is hurting growing from 15% in 2006 to 33% in 2008. The percentage saying it is helping the uninsured has dropped from 67% in 2006 to 45% in 2008.

The survey digs deeper into this trend. It breaks out the population that is directly affected by the law from those who are not. Of those directly affected by the law, 60% say it is hurting them personally and only 22% say it is helping. 51% say that health care costs have gone up and only 14% say the have gone down. As a result only 37% of those directly affected now support the mandate, as opposed to 62% of those not affected.

Mr. Blendon cautions that these developments could presage a backlash against the law, especially if “more people report increasing costs.”

• posted by Greg Scandlen
• 12:45 pm
• 0 comment