Health Reform Challenge: Seniors and their Medicare

Sep 24, 2009 2:40pm

Fresh controversy over the impact of health care reform on Medicare underscores one of the Obama administration’s steepest challenges in promoting its plan: Getting seniors on the bus.

Americans 65 and over long have been among those most critical of the reform proposals. One factor may be their general skepticism about Barack Obama; seniors were the only age group clearly to favor John McCain last November. But another, far more specifically, is their concern about the impact of health care reform on Medicare.

We tested it in our latest ABC/Post poll: Fifty-six percent of seniors thought reform would weaken the Medicare program, far more than the 37 percent of under-65s who shared that concern. It’s a powerful reason seniors are so much more likely to oppose reform overall, and a public option in particular; and likewise are so much more apt than others to think reform would “do more harm than good” – and to say the more they hear about it, the less they like it.

News this week may give seniors’ concerns some traction. The Congressional Budget Office told senators marking up the reform bill that cuts in federal payments to the pricier, private-insurance form of Medicare, called Medicare Advantage, could force a cut in that program’s “extra benefits” (beyond those provided in regular Medicare). Medicare Advantage covers about a quarter of all Medicare enrollees.

That spells trouble for the administration for a simple reason: Seniors like their Medicare – a lot. In a poll we did in June, 71 percent of seniors were “very” satisfied with their quality of care, 65 percent with their coverage – vastly outstripping that level of satisfaction among younger adults, 44 and 36 percent, respectively. And that’s not just satisfied – it’s “very” satisfied.

If seniors strongly like the health care and coverage they have, and broadly think health care reform will weaken Medicare, you have a recipe for opposition. And that’s what the president’s gotten. Consider:

-Overall opposition to reform jumps to 61 percent among seniors, vs. 45 percent among younger adults. On one contentious element, 59 percent of seniors oppose a public option, compared with 39 percent of those under 65. (Not all doors are closed, though: As we reported last week, support for a public option nearly doubles among seniors if it’s limited to people who cannot get private insurance – a step that presumably would limit the option’s impact.)

-Sixty-two percent of seniors think reform will do more harm than good, and 60 percent think it’ll create too much government involvement in the health care system. Among younger adults these drop sharply, to 41 percent and 43 percent, respectively.

-Sixty-six percent of seniors say the more they hear about reform, the less they like it. That compares with 52 percent among younger adults – not insubstantial, but considerably lower.

At first blush it may seem odd for most seniors to oppose a public option and to be concerned about too much government involvement in health care, yet to love their own Medicare. But regard again their fears about reform’s impact on Medicare. The two are linked, as you might suspect; among seniors who think reform would weaken Medicare, 82 percent oppose it.

We’ve further sussed this out with a regression analysis testing the predictive strength of views about the impacts of reform, and basic demographic variables, on opinions about reform overall. Result: Among seniors, the single strongest independent predictor of opposition to reform overall, and to a public option in particular, is the sense it’ll weaken Medicare.

There is, in all this, a strong impetus for Congress members facing re-election to take notice. Under-65s split about evenly on whether a vote for reform would help or hurt at the polls in 2010. But seniors – a particularly reliable voting group – say by 2-1 they’d be less likely, rather than more likely, to support a congressional candidate who’d backed health care reform.

5 p.m. update: A couple of comments I’ve gotten on this post encourage me to add a slightly dorky but interesting further point: It looks like what we’re seeing does not represent pure self-interest, but rather broader interest, albeit specific to seniors. In other words what drives attitudes about reform isn’t seniors’ fears that they personally will lose out, but rather their sense that seniors as a group will suffer.

I say this because in our model self-interest measures on the impact of reform (whether it’ll hurt your own care, coverage and costs) are not significant in terms of predicting support for reform among seniors, while the Medicare measure is. Wandering beyond the data, seniors may sense that their age group worked a lifetime for these benefits, and now should be entitled to them.

Concerns about Medicare also significantly predict views on reform among younger adults, but less powerfully, and as part of a broader mix of factors.


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