23 March 2012
Lake Research Partners
National Survey on Health Insurance Exchanges
To: Interested Parties
From: Lake Research Partners
Re: Findings From A Survey of 805 Likely Voters Nationwide
Date: March 21, 2012
We outline below the key findings from our recent nationwide polling on voters’ attitudes toward health insurance exchanges.1
Most voters have health insurance coverage and are generally satisfied with it. At the same time, many are worried about losing that coverage and not having affordable options: half (51%) are concerned a great deal about getting or keeping affordable health insurance. Thus, security and communicating that the exchange will be there when you need it is highly salient.
Voters are divided and unsure about the Affordable Care Act. There is a sharp partisan divide on the ACA. Given the choice, a majority (56%) of voters would have their state wait until the Supreme Court has reviewed the Affordable Care Act before implementing its provisions.
On the other hand, when given a choice between state and federal action, a majority (55%) want their state to move ahead now with the exchange instead of waiting for the federal government’s plan.
Health Insurance Exchanges
At the start, a plurality of voters (43%) supports the exchanges/marketplaces after hearing a description.2 Another 42% of voters are unsure. This very high level of uncertainty makes defining exchanges all the more important.
1. Lake Research Partners designed and administered this survey that was conducted by telephone using professional interviewers between February 2-6, 2012. The survey reached a total of 805 likely 2012 general election voters nationwide. Telephone numbers for the sample were drawn from a voter file. The margin of error for this survey is +/- 3.5%. MOE for sub-samples is greater.
2. In 2014, there will be a new way for people to buy health insurance called health insurance [exchanges/marketplaces]. An exchange is a program for small businesses and people who don’t already have health insurance through their employer. It will provide information to compare benefits between competing plans through a website, phone or in-person help. Do you generally favor or oppose health insurance exchanges, or aren’t you sure?
As voters learn about the exchanges, they move toward favoring them. After hearing features, opposition messages, and positive messages, a majority of voters (57%) favor the exchanges. Most of this shift comes from those who were initially undecided.
The exchanges pick up support across a broad range of voters, particularly Latinos, independent men, older non-college men, and older Democrats.
Voters end the survey with increased interest in using the exchanges themselves if they were to need insurance. The original group of 14% who were extremely interested grows to a quarter (24%) of respondents.
In the end, the strongest interest in using an exchange is among liberal, Democratic, and non-college women. We also pick up interest among people of color and the 50-64 age group.
The biggest challenge is that voters do not know what exchanges are at all. The exchanges have to be set up and sold.
Exchanges are vulnerable to the same attacks as those used against ACA: big bureaucracy, loss of coverage, and linking the exchange to “Obamacare.” A big new bureaucracy coming between them and their provider is scary to voters: this attack raises doubts about the exchanges among 67% of voters (45% serious doubts).
Hearing a battery of features, many of which voters find very appealing, did not fully inoculate against attacks. Therefore, we shouldn’t just sell exchanges on their components, we must use values-based messages.
Voters are divided on the argument of choice versus regulation. However, they strongly desire protection for consumers from misleading information and hidden costs. An independent board is slightly more popular than a “public agency” as the watchdog. The task is to connect the dots between the features that voters like and a regulated exchange.
Voters respond more strongly to what the exchange would do for them compared to how it is structured.
Guarantees of coverage, including keeping your current doctor, are the strongest testing features of an exchange. Fifty-three percent of voters rate that “the exchange will offer health insurance plans that allow you to keep your current doctor” as a 10 (on a zero to 10 scale) and “by law, all insurance plans must have basic benefits that will cover things like doctor visits, hospitalizations, preventive care, and prescriptions” is rated a 10 by 50% of voters.
Addressing pre-existing conditions resonates here and in messages. Fifty-two percent give a rating of 10 to knowing that “insurance plans will not be able to deny coverage to people because of pre-existing or chronic conditions like cancer or diabetes.”
A second tier of popular elements focus on preventing discrimination against women, having somewhere to turn if you lose your employer-provided coverage, oversights and consumer protections, and getting purchasing power. Reassuring voters of the voluntary nature of the exchanges is very important.
While voters care more about what the exchange does than how it is operated, they do have concerns about the insurance industry serving on the oversight board: half (54%) would prohibit it. These concerns are building blocks for communicating the need for rules and oversight.
The strongest themes for messages are security and fairness. Voters see coverage for preexisting conditions in terms of core values, not just policy provisions. The top message emphasizes quality of affordable choices and highlights that coverage won’t be denied for pre-existing conditions. A message focused on security and peace of mind also tests strongly.
It is reassuring and persuasive to voters to be told that members of Congress will be using these same exchanges.