Tag: public opinion

Poll: The ACA’s Pre-existing Condition Regulations Lose Support When the Public Learns the Cost

Days before the 2018 midterms, 68% of voters say that health care is very or extremely important to how they plan to vote in this year’s elections, according to a new Cato 2018 Health Care Survey of 2,498 Americans. These numbers are driven primarily by Democratic voters with 86% who say this issue is especially important to them—in fact, 56% say the issue is “extremely important” to them. Independent (33%) and Republican voters (21%) are far less likely to say this is an “extremely” crucial issue for their vote this Tuesday.

 FIND FULL POLL RESULTS HERE

These results are consistent with analysis of 2018 campaign ads, which finds Democrats have made healthcare the centerpiece of their case to voters. About half of Democratic ads have featured health care issues compared to less than a third of Republican ads. At the core of the debate is what to do with pre-existing condition regulations embedded in the Affordable Care Act (ACA) that prevent health insurers from denying coverage or charging higher premiums to people with pre-existing conditions. Much of the public debate centered on pre-existing condition protections assume that these regulations enjoy widespread public support. However, these protections lose public support when voters learn about their costs, finds the Cato 2018 Health Care Survey.

The survey first replicated the results from myriad other surveys finding a majority (65%) of Americans favor regulations that prohibit insurance companies from refusing to cover, or charging higher premiums to, people with pre-existing conditions, while 32% oppose. However, support plummets when Americans are faced with likely consequences of these regulations. 

Support drops 20 points to 44% in favor and 51% opposed if pre-existing condition protections limited people’s access to medical tests and treatments. Similarly, 44% would favor and 50% would oppose if these regulations harmed the delivery of high-quality health care. Support drops 18 points to 47% in favor and 48% opposed if these regulations limited people’s access to top-rated medical facilities and treatment centers. Some may dismiss these potential costs as improbable; however, research finds these are likely consequences from the incentives these regulations create for the health care industry. It is for this reason that we investigate how the public evaluates these costs.

Compared to quality reductions, Americans are more prepared to pay higher taxes or premiums in exchange for keeping regulations that prevent insurers from denying coverage or charger higher premiums to people with pre-existing conditions. About half (51%) would favor and 44% oppose if these regulations raised taxes and 49% would favor and 47% would oppose if they drove up premiums. 

These results follow a familiar pattern identified in the Cato 2017 Health Care Survey that asked about each of these pre-existing condition protections separately. However, in this year’s survey we improve the desirability of these regulations by offering them as a bundle. Even still, when faced with the realistic costs of these mandates, public support plummets. 

Taking a look among partisans, we find that without any mention of costs, 83% of Democrats, 55% of independents, and 52% of Republicans initially support pre-existing condition protections. However, independents and Republicans turn against these regulations if they increase the cost of health insurance (66%, 55%), reduce access to medical tests and treatments (59%, 58%), harm the quality of health care people receive (57%, 55%), reduce access to top-rated medical facilities and treatment centers (57%, 55%), or increase taxes (57%, 57%). Democrats are less swayed by these trade-offs; however, they are least willing to sacrifice the quality of health care in exchange for keeping the pre-existing condition regulations (42%). Instead, majorities of Democrats are willing to have less access to medical tests (57%), or top-rated medical facilities (61%), or pay higher premiums (67%) or taxes (72%). Some differences in how partisans answer these questions may depend, perhaps, on how believable these costs seem to respondents rather than how acceptable they are. For instance, since Democrats are most enthusiastic about these regulations, they may be less likely to believe that they could harm the quality of care.

Higher-income Americans are more willing than low-income Americans to make trade-offs, such as shouldering higher premiums or having less access to top-rated medical facilities, to keep the pre-existing condition regulations. For instance, 61% of Americans earning more than $80,000 a year say they’d pay higher premiums to keep these regulations. In contrast, about a third (38%) of Americans earning less than $40,000 a year agree; instead, 56% oppose paying higher premiums for this reason. Nearly 6 in 10 (57%) of people earning more than $80,000 a year say they’d accept having less access to top-rated medical facilities compared to 35% of Americans earning less than $20,000 a year.

Short Term Plans

The survey also asked Americans about new federal rules that allow consumers to purchase alternative health insurance plans that don’t comply with ACA-mandates. The survey finds that majorities support new federal rules that allow consumers to purchase alternative plans, like short-term plans, even when confronted with likely trade-offs.

First, the survey presented respondents with only the anticipated benefits of the new federal rules. Doing so finds that 77% of Americans support new federal rules that allow consumers to purchase health insurance plans that cost 50% less and offer greater choices of hospitals and doctors than current plans and would cover 2 million more uninsured people. 

Support drops to 64% in favor and 31% opposed if these rules meant that some people would purchase insurance policies that cover fewer services than current plans. For instance, these new plans would not be required to cover services like mental health and prescription drugs. 

One reason why such plans have lower premiums is they do not have to comply with ACA pre-existing condition regulations and thus may exclude people, or offer limited services to people, with expensive medical conditions. These lower premiums could draw people who use fewer medical services out of the ACA-compliant plans and thus increase premiums for those who remain in those plans and are not eligible for subsidies. Nevertheless, the survey finds that 59% would continue to favor while 35% would oppose these new rules if they caused premiums to rise for some people who purchase insurance plans in the individual market.

These rule changes are popular among partisans with 77% of Democrats and 86% of Republicans in support. Majorities of Democrats and Republicans continue to favor allowing people to purchase non-ACA compliant plans even if doing so means people would not have as many services covered (58% and 71%) or if doing so increased premiums for unsubsidized people in the individual market (63% and 65%).

The Path Forward

The survey also asked Americans how they felt policymakers should approach health care reform going forward. A majority (55%) of Americans believe that the “better way” to sustainably provide high-quality affordable health care is through expanding free-market competition among insurance companies, doctors, and hospitals. Thirty-nine percent (39%) think that more government regulation of insurance companies, doctors, and hospitals is more likely to provide affordable coverage. These numbers are virtually unchanged from last year’s health care survey.

Independents (54%) and Republicans (79%) agree that more free-market competition rather than more government management of health care is more likely to lead to affordable coverage. However, a majority (60%) of Democrats think more government management is the key. Despite these partisan differences, majorities or slim majorities of whites (58%), African Americans (53%) and Hispanics (51%) believe more free market competition can better provide affordable health care than more government control.

Implications

These results do not support the widespread misperception among the political punditry that pre-existing condition regulations are necessarily and universally supported by voters across the political spectrum. Voters like benefits but not costs. And some costs are more acceptable to voters than others. Democratic accountability demands that we understand if voters are willing to bear the necessary trade-offs and costs in exchange for establishing a new policy, regulatory protection, or social program. But first, pollsters have to ask.

 
 
The Cato Institute 2018 Health Care Survey was designed and conducted by the Cato Institute in collaboration with YouGov. YouGov collected responses online October 26-30, 2018 from a representative national sample of 2,498 Americans 18 years of age and older. The margin of error for the survey is +/- 2.66 percentage points at the 95% level of confidence.

 

Results from the 2018 Libertarianism vs. Conservatism Post-Debate Survey

As part of a yearly summer tradition, the Heritage Foundation and Cato Institute co-host a debate in which interns at both think tanks debate whether conservatism or libertarianism is a better ideology. Following this year’s debate, the Cato Institute conducted a post-debate survey of attendees to ask who they thought won the debate and what they believe about a variety of public policy and philosophical issues. The post-debate survey offers a unique opportunity to examine how young leaders in the conservative and libertarian movements approach deep philosophical questions that may be inaccessible to a general audience.

2018 Intern Debate Survey

Despite agreement on domestic economic issues and free trade, the survey finds striking differences between conservative and libertarian  attitudes about Donald Trump, immigration, transgender pronouns, government’s response to opioid addiction, police, defense spending and national security, domestic surveillance, and religion. The survey also went further than just asking about policy and used Jordan Peterson’s 12 principles for a 21st century conservatism to examine the underlying philosophical differences between libertarian and conservative millennials. 

Will Trump’s Foreign Policy Matter for the Midterms?

In a recent piece at The Hill, I argue that Trump’s terrible approval ratings for his handling of foreign policy will matter more than most people think.

The basic argument consists of four points:

1. Trump has made foreign policy more important to Americans today thanks to his “America First” approach:

The genius of Trump’s “America First” slogan was the way it allowed Trump to connect foreign and domestic politics under a single populist and nationalist banner. When Trump says he’s protecting American workers, he could be talking about tax cuts, illegal immigration, “horrible trade deals,” or terrorism. Trump’s America First strategy has blurred much of the historical difference between foreign policy and domestic policy. All of this makes foreign policy more important moving forward.

2. Trump’s foreign policy has been historically unpopular:

Not only does Trump suffer lower approval for his handling of foreign policy than all presidents back to Ronald Reagan, but majorities of Americans oppose Trump’s calling card issues. Fifty-eight percent oppose building a wall along the Mexican border and 67% think that illegal immigrants currently living in the United States should eventually be allowed to apply for citizenship. Twice as many Americans (49%) think raising tariffs will hurt the economy as think it will help (25%)…

3. Foreign policy approval feeds into overall presidential approval:

… even though the impact of foreign policy is most obvious during a war or international crisis, it plays a key role in shaping the general narrative of a president’s performance while in office. One analysis, for example, found that public approval of the president’s handling of foreign policy has a larger impact on his overall approval rating than does his handling of the economy.

4. Trump’s net-negative presidential approval ratings signal big trouble for Republicans at the midterms:

Research suggests that Trump’s current 41% approval rating historically would typically result in about an 8-point national advantage in voting for Democrats…. Looking at data from each president’s first midterm elections going back to 1946, the four presidents who did not enjoy a net-positive approval rating saw their party lose an average of 49 seats in the House and 6.5 seats in the Senate.

The bottom line is that Trump’s handling of foreign policy hasn’t done Republicans any favors this year and is likely to be an even bigger problem for Trump himself in 2020.

Thanks to Hannah Kanter for the background research and contributing to the writing of the original commentary.

The Rising Popularity of Increasing Immigration

The most fascinating phenomena of American politics is the increasingly anti-immigration opinions of politicians like Donald Trump that contrasts with an increasingly pro-immigrant public opinion.  Gallup has asked the same poll question on immigration since 1965: “In your view, should immigration be kept at its present level, increased, or decreased?”  Gallup’s question does not separate legal from illegal immigration, likely meaning that answers to this question undercount support for increasing legal immigration.  They recently released their 2018 poll results.  The support for increasing legal immigration is at 28 percent – the highest point ever (Figure 1).  Support for increasing immigration is just one point below support for decreasing immigration – well within the 3-point margin of error (95% CI). 

Figure 1

Gallup: Should Immigration Be Kept at Its Present Level, Increased, or Decreased?

Gallup

Sources: Gallup.

The Gallup trend is the clearest and best for those of us who support increasing immigration but the General Social Survey shows a similar directional trend – although not nearly so dramatic (Figure 2).

Figure 2

GSS: Should Immigration Be Kept at Its Present Level, Increased, or Decreased?

GSS

Source: General Social Survey.

If the public is increasingly pro-immigration, why is the GOP so opposed to immigration?  It can’t be radically divergent opinions across partisan lines. According to the Gallup poll, 65 percent of Republicans think immigration is good for the country compared to 85 percent of Democrats.

Another possibility is that anti-immigration voters care a lot more about the issue than pro-immigration voters and are willing to change their votes based on it.  For pro-immigration voters, immigration just isn’t their biggest issue.  The Gallup poll hints at this as 55 percent of those who are dissatisfied with the current immigration levels want to cut the numbers while only 22 percent who are dissatisfied want to increase the numbers.

Another issue is causality as anti-immigration politicians could be pushing moderate Americans into a more pro-immigration position.  The crude language used by nativists, such as President Trump’s description of illegal immigrants as an infestation, can turn off a lot of voters in the same way that the Prop 187 campaign in California in the mid-1990s convinced a lot of white voters to not support the GOP.  This is the exact worry that Reihan Salam, a moderate restrictionist, voiced. The spokesman for political issues matters and Trump is not a very good one.

Another potential explanation is the “locus of brutality,” a riff on the locus of control literature that says voters are more supportive of liberalized immigration when they perceive it to be controlled.  Under that theory, border chaos, illegal immigration, refugee surges, and the perception of immigrant-induced chaos increases support for restriction.  Thus, countries with open immigration are mostly able to maintain those policies so long as it appears orderly.  Since disorder usually arises from poor government laws, this means that more regulation can make it more chaotic and create demand for more legislation in an endless cycle.  That locus of control pattern could be countered by the brutality of immigration enforcement such that voters become more pro-immigration when they are confronted with the government’s brutal enforcement of immigration laws.  Prison camps for immigrant children thus create support for liberalization.

My final theory is that this is the last gasp of nativism.  Lots of dying political movements that are terminally ill due to shifting public opinion go all out as it is their last chance to get elected.  Think George Wallace and segregation.  During the 2016 campaign, then-Senator Jeff Sessions said that that was the “last chance for Americans to get control of their government.”  When it comes to changes in the public trends and support for cutting immigration, he is probably correct.

The public is becoming increasingly pro-immigration.  The Democratic Party is increasingly reflecting that changing public opinion while the Republican Party is getting an increasing percentage of that shrinking but sizable anti-immigration minority.  There will come a point, should public opinion continue to support increasing immigration, where both parties will adopt this position.

The Trump Doctrine and Public Opinion at One Year

In advance of the January 30 conference here at Cato—The Trump Doctrine at One Year—I review public attitudes toward Trump’s “America First” vision and his foreign policy handling over his first year in office. Join us for a what will undoubtedly be a spirited conversation with a fantastic group of experts.

Donald Trump’s America First rhetoric during the 2016 presidential campaign marked a sharp departure from the fundamental tenets of liberal internationalism that have guided U.S. foreign policy since World War II. Trump’s tirades against free trade, NATO allies, immigrants (legal and otherwise), and his general disinterest in engaging with the world unless there was money in it for the United States horrified the foreign policy establishment of both parties.

Beyond concerns about Trump, many observers worried that his success reflected the demise of public support for internationalism. Though the public supported robust internationalist policies after World War II and during the Cold War, Trump’s emergence coincided with rising economic insecurity and inequality, intense political polarization, and dropping confidence in government to solve the problems facing the nation. Had the public perhaps decided that internationalism’s time had come and gone? Would Trump’s presidency usher in rising support for nativist and protectionist policies and calls to turn inward, away from the international arena?

A wide array of poll data from Trump’s first year in office strongly suggests the answer is no. A large majority of Americans disapprove of Trump’s handling of foreign policy and his America First policies are among the most unpopular elements of his foreign policy.

Trump’s fiery attacks on unfair trading practices by China and Japan and his criticism of NAFTA as “the worst deal ever made” may have energized his base during the campaign, but since taking office Trump’s course on trade has not been a popular one. Though Trump pulled the United States out of the Trans-Pacific Partnership as soon as he took office and appears likely to pull out of the North American Free Trade Agreement, Americans remain committed to free trade. A June 2017 survey from the Chicago Council on Global Affairs found that 72% of the public thinks international trade is good for the United States. An October 2017 poll from the Pew Research Center echoed this result, finding that Americans are more likely to believe NAFTA is good for the United States by 56-33%. 

America’s Foreign Policy Attention Deficit

We Washingtonians rightly get criticized for being hyper focused on politics. While D.C. natives gossip about the ups and downs of the powerful elite, most Americans are worrying about their marriages and mortgages. The disjuncture is even greater when it comes to foreign policy, an area in which public interest and knowledge are particularly limited. As many scholars have pointed out, to some degree this dynamic is the result of “rational ignorance” on the part of the public. Given the many other priorities citizens have in their private lives, the benefits of following policy debates closely is quite limited so long as people are generally confident that more knowledgeable people are paying attention. 

Taken too far, however, public apathy toward foreign affairs could become a problem for a democratic system. A central pillar of democratic politics is the ability of the marketplace of ideas to foster debate and produce sound policy. Without a certain level of public engagement, the marketplace of ideas cannot function effectively. If no one is paying attention, how can we have a meaningful debate over U.S. military operations in the Middle East and Africa, or what to do about North Korea’s nuclear arsenal, or China’s growing power? 

The traditional method for criticizing the public’s attentiveness to foreign policy is to note Americans’ astonishing lack of knowledge about the world. The June 2017 Pew Research “News IQ” survey finds, as usual, that most Americans know little even about events and people that have appeared regularly in the news. On the four questions most closely related to foreign policy, 60% of those surveyed knew that Britain is leaving the European Union, 47% could identify Robert Mueller as the person leading the investigation into Russian interference in the 2016 election, 44% could name Rex Tillerson as the Secretary of State, and just 37% could identify Emmanuel Macron as the president of France.

The public also typically lacks key facts informing specific foreign policy issues. Even as the Trump administration calls for new kinds of nuclear warheads, polls have routinely found that few Americans are aware that the United States already possesses thousands of nuclear weapons. And though 67% of Americans in 2014 knew that the Islamic State controlled territory in Syria, only half could identify the nation of Syria when it was highlighted on a map. In 2009, fewer than 30% knew that the United States had 70,000 troops in Afghanistan.

Thanks to Google we have another way to measure America’s foreign policy attention deficit. Google Trends gives us the ability to track how often people searched for a given term over a particular time period. If public ignorance is due to lack of interest, search activity on the Internet is a good way to measure that.

82% Say It’s Hard to Ban Hate Speech Because People Can’t Agree What Speech Is Hateful

An overwhelming majority (82%) of Americans agree that “it would be hard to ban hate speech because people can’t agree what speech is hateful,” the Cato 2017 Free Speech and Tolerance Survey finds. Seventeen percent (17%) disagree. Majorities across partisan and demographic groups alike agree that hate speech is hard to define and thus may be hard to regulate.

Full survey results and report found here.

How Do Americans Define Hate Speech?

When presented with specific statements and ideas, Americans can’t agree on what speech is hateful, offensive, or simply a political opinion

Besides slurs and biological racism, Americans are strikingly at odds over what speech and ideas constitute hate.[1] For instance, a majority of Democrats (52%) believe saying that transgender people have a mental disorder is hate speech. Only 17% of Republicans agree. On the other hand, 42% of Republicans believe it’s hateful to say that the police are racist, while only 19% of Democrats agree.

Among all Americans, majorities agree that calling a racial minority a racial slur (61%), saying one race is genetically superior to another (57%), or calling gays and lesbians vulgar names (56%) is not just offensive, but is hate speech. Interestingly a majority do not think calling a woman a vulgar name is hateful (43%), but most would say it’s offensive (51%). Less than half believe it’s hateful to say that all white people are racist (40%), transgender people have a mental disorder (35%), America is an evil country (34%), homosexuality is a sin (28%), the police are racist (27%), or illegal immigrants should be deported (24%). Less than a fifth believe it’s hateful to say Islam is taking over Europe (18%) or that women should not fight in military combat roles (15%).

Pages