As Health Care Costs Take a Toll, Some Changes Win Broad Backing

Such a mandate would have an impact: In this survey, nine percent of Americans who hold full-time jobs report that they currently have no health insurance, and it's 14 percent among those who are employed part-time. (Note, estimates of the uninsured population vary somewhat in different surveys. One factor is the time period specified --e.g., uninsured currently vs. ever uninsured in the last year.)

Given the current, employer-based system, lack of insurance soars among unemployed Americans (excluding retirees). And there the public favors changes as well. Eighty-two percent support expanding state-run health programs for low-income people, such as Medicaid and the Children's Health Insurance Program. Alternatively, about as many support tax credits or other aid to help the poor buy private health insurance.

In another approach, three-quarters like the idea of expanding Medicare, the government program that covers retirees, to cover people as young as age 55 who lack other health insurance; 55 percent strongly back this proposal. (Support is lower among seniors, who may fear that expanding the popular program could endanger it.)

Another notion -- requiring all Americans to obtain health insurance, with tax credits to help the poor pay for it -- gets two-thirds support. But strong support for this, the most sweeping of these proposals, is lowest -- just 35 percent. Again it seems the most-preferred approaches are not the most systemic ones.

This poll measures baseline support for all these measures; each would likely be heavily debated, and various lines of criticism (for example, negative assessments of their impact on jobs or taxes) could potentially impact their popularity.

In one example of movable attitudes, while 65 percent in general favor requiring all Americans to have health insurance, there's less support specifically for a mandatory plan like the one in Massachusetts, which carries penalties for being uninsured. That plan gets 52 percent support; the drop occurs overwhelmingly among conservatives, possibly given Massachusetts' reputation as a liberal state.

Consumer-Directed Plans -- In another direction, nearly eight in 10 Americans think that allowing people to shop around for their own medical care would be an effective way to control costs. But the idea of consumer-driven care looks less popular if it's accompanied by the risk of higher out-of-pocket expenses.

Making consumers more aware of the cost of care is a motivating force behind proposals such as "health savings accounts." In these people would be insured only for major medical needs; for routine care they'd have an annual pool of money to spend as they chose, but once depleted, further routine care would come from their own pocket. This poll finds that two-thirds oppose the idea, including as many conservatives as liberals, and six in 10 Republicans along with 73 percent of Democrats.

Such proposals are complex; other aspects could enhance their appeal in some groups, such as tax breaks on contributions made by employers and individuals; lower premiums; and the accumulation of unspent health care funds in the accounts, which can be rolled over from year to year and job to job. Still, the risk associated with these arrangements appears to be a significant hurdle for consumer-driven health plans to overcome.

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