Survey: Americans want Congressional focus on health care

A poll timed to coincide with the shift in the nation's political winds as Democrats take control of Congress found Americans believe access to health care should be the top domestic priority of the new Congress. The poll was sponsored by America's Health Insurance Plans (AHIP), which released the results as part of a campaign for its proposal to expand access to health insurance to every American.

While Americans expressed broad support for a stronger health care safety net, AHIP said, a commanding majority favored reforms building on the current public-private system rather than implementing a new government-run system.

"Americans across the political spectrum are saying that government should take action to improve access to health care coverage, but they do not support a one-size-fits-all approach," said pollster Whitfield Ayres, president of Ayres, McHenry & Associates. "Promoting access to health care coverage is an issue Americans agree on regardless of party or ideology."

The AHIP plan would provide access to affordable health insurance coverage for more than 40 million uninsured Americans by expanding eligibility for public programs, enabling all consumers to purchase health insurance with pre-tax dollars, providing financial assistance to help working families afford coverage, and encouraging states to develop and implement access proposals.

AHIP officials said the plan is designed to expand access to health insurance coverage to all children within three years and 95% of adults within 10 years. AHIP estimated full implementation of the proposal would cost the federal government some $300 billion over 10 years.

"The access crisis causes millions of Americans to forgo the preventive care and treatment for chronic illness that they need," said AHIP chairman-elect George Halvorson, Kaiser Permanente chairman and CEO. "By ensuring everyone has access to coverage, we can make families more secure, workers more productive and, ultimately, make this a healthier nation."

The plan calls for enacting federal legislation to provide significant financial incentives to states and make changes to federal tax policy to make health coverage more affordable. Key plan elements include:

  • expanding SCHIP to make eligible all uninsured children from families with incomes under 200% of the federal poverty level;
  • improving and expanding Medicaid to make eligible all uninsured adults, including single adults, with incomes under 100% of the federal poverty level;

establishing a Universal Health Account to allow all individuals to purchase any type of health care coverage and pay for qualified medical expenses with pre-tax dollars, with federal matching grants for contributions made by families to the Universal Health Account;

  • establishing a health tax credit of up to $500 for low-income families who secure health insurance for their children;
  • establishing a new $50 billion federal performance grant to assist states in expanding access to coverage.

In the poll results that AHIP said support its proposal, 77% of Americans said they back increasing funding for a health insurance program for children from low-income families that would be paid for by the federal and state governments. Also, 69% support expanding Medicaid to cover all adults, including single adults, who make less than the federal poverty level.

The public (65%) also strongly supports establishing a new tax-free health account for all Americans, which could be used to buy any type of private health insurance, and supports giving a federal tax deduction for money paid by individuals to purchase private health insurance (69%).

A very large 85% said they support giving a tax credit to any low- and moderate-income parents who can show that their children are covered by health insurance. Some 71% support providing incentive grants from the federal government to encourage states to develop programs to provide health insurance coverage for the uninsured, while 63% support modifying the current system rather than replacing it with a government-run health system.

Responding to the AHIP plan, National Association of Community Health Centers vice president for federal, state, and public affairs Dan Hawkins said the nation's health centers "know all too well that ending the huge gap between health care's 'haves' and 'have-nots' is a crucially important step toward fixing our seriously broken health care system."

But Mr. Hawkins said it will be equally important to ensure that every American has a health care home. "Today," he said, "there are 35 million people across the country who do not have a personal doctor or health care home, and half of them already have health insurance. These people often end up in hospital emergency rooms or, worse, in hospital wards, because they couldn't get the care they need to keep them healthy or treat illness early and less expensively. Importantly, providing a health care home for each American will help to both improve people's health and lower health care costs, making care more affordable for everyone."

And the Association for Community Affiliated Plans (ACAP), representing safety net managed care organizations, echoed support for AHIP's proposal. "ACAP applauds AHIP in its efforts to stimulate comprehensive action to solve our country's uninsurance problem," said Margaret Murray, ACAP Executive Director. "In particular, ACAP agrees that the expansion of Medicaid and SCHIP to cover all low-income adults and children is a logical, efficient solution to persistent uninsurance among these populations."

Darnell Dent, CEO of the Community Health Plan of Washington (State) and ACAP board chairman, said the AHIP plan means that the concept of universal coverage will remain at the forefront of critical national issues. "We hope that other stakeholders, including health plans, the federal and state governments, providers and consumers will participate in what promises to be an ongoing national discussion. ACAP will certainly be on board as this work to cover all people moves forward."

Meanwhile, a poll conducted by the University of Chicago and reported in a Health Affairs Web exclusive found that consumers want more coverage and choice, but don't want to pay for them through higher health insurance costs. The pollsters also reported the uninsured are more likely to reject policies that would mandate purchase of health insurance, and that more than 25% of Americans are comfortable with charging obese people higher premiums for their benefits.

They said that Americans have difficulty making trade-offs to reform the health system and make coverage more broadly available, preferring to insist that government and employers address the issues. "Overall, Americans seem to be hoping for a better deal: there is little evidence of self-sacrifice," said coauthor Daniel Gaylin. "They want employers and the government to do more to help pay for coverage, but they still want the right to choose from different policies."

More information on the AHIP proposal and the survey findings is on-line at www.ahipbelieves.com. Information on the National Association of Community Health Centers' position is available at www.nachc.com. More information on the Association for Community Affiliated Plans is available at www.acap.org. The Health Affairs report is on-line at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w596.