By Rob Stein and Alexi Mostrous
Washington Post Staff Writers
Tuesday, July 28, 2009
With the Obama administration's top domestic priority struggling in Congress, supporters and opponents of the health-care proposals are focusing on the constituency that both sides agree has become pivotal to the debate: the majority of Americans who have health insurance and are generally satisfied with their care.
Although polls have consistently shown that just over half of Americans think the health-care system is in need of reform, a substantial majority say they are satisfied with their own insurance and care. Any hope of change will require their support, according to experts and advocates across the ideological spectrum.
"They are critical," said Drew E. Altman, president and chief executive of the Kaiser Family Foundation, a nonpartisan health research organization. "This debate will turn on people like this trying to answer the question 'Will this benefit my family?' "
Sharon Williams, for example, said she voted for President Obama, believes millions of uninsured Americans deserve health care and is convinced the system needs to be fixed. But the proposals being debated in Washington make her nervous.
"Something needs to be done, especially to help the kids and the elderly," said Williams, 48, who works for the school district in Forsyth County, Ga. "But if the reforms affect the insurance I have now, I would have a deep issue with it."
Proposals to change the system must allay concerns like Williams's, which seem to have increased since the debate began.
"It's a huge barrier," said Robert J. Blendon, a professor of health-care policy and political analysis at Harvard University. He cited a Washington Post-ABC News poll of 1,001 adults in June that found that 83 percent were either "somewhat" or "very" satisfied with the care they receive and 81 percent felt the same way about their insurance. "These people have something to lose. If they think reform is going to actually make it worse for them, they get really scared."
But that does not mean that most Americans necessarily oppose change. In fact, polls also show that a majority of Americans think the health-care system needs alteration.
" 'Satisfied' means they like their doctor and have insurance to go to that doctor," said Stan Greenberg, a Democratic pollster. "Maybe they think their policy is better than what most people have. But it doesn't mean they don't want reform."
A Kaiser poll conducted this month, for example, found that 56 percent of Americans think health-care reform is particularly important, given the state of the economy, and most say the country will be better off if reform happens. But that poll found far less agreement about what changes might mean to individual families.
The reason for the apparent paradox is that even though most people are satisfied with their insurance, they harbor deep concerns about losing their coverage or their ability to afford it and medical care if costs continue rising.
"There's a lot of anxiety about what the future holds," said Anne Kim, who directs the economics program at the think-tank Third Way, which is working to find political compromises on various issues.
"It places a limit on how much risk people are willing to accept," Blendon said.
Williams, who participated in the Post-ABC poll, said she would not support plans that increased her insurance premiums substantially or limited her health-care choices.
"Obama says we will not be affected, but I'm not entirely sure I believe him," she said during a telephone interview last week after a presidential news conference that was dominated by health-care reform. "What the average person gets out of this plan needs to be clarified a lot more."
Williams is concerned that her employer could replace her current insurance with a public plan, offering less choice. The price tag for the plan also concerns her.
"The entire cost -- trillions of dollars -- is eventually going to fall on all of us, it has to," she said. "And although the president says it won't, I'm worried we're not hearing the whole story."
In the Post-ABC poll, 84 percent of respondents said they were very or somewhat concerned that reform would increase their health-care costs, 82 percent worried that it would reduce their health insurance coverage, and 81 percent fretted about it hurting the quality of their care.
Jonathan Smith, 29, of Buchanan, Va., a poll respondent who works as a health inspector for the mining company Consol Energy, fears the plans would limit his choices and increase his premiums.
"I have coverage through my employer myself, and my health insurance is really good. I don't have to pay anything. I can choose what kind of coverage I want," he said.
But many experts say people remain receptive to change if they see benefits. "They're open to it, but they are in the 'show me' category," Kim said. " 'Show me what's in it for me.' "
That is the case for Tim Bigelow, 48, a retired Marine and registered Republican from Shiawassee, Mich., who supports health-care reform.
"As it stands right now with the economy, the premiums may go up. I would assume that they probably would, and that's significant. I'm very concerned about it," he said.
Keeping costs down appears to be a crucial factor for most people, Blendon said. A Quinnipiac University poll in June found that 54 percent thought reducing costs was the most important goal, compared with 38 percent who thought insuring those without coverage was key.
"We are in a serious recession," Blendon said. "People are having a hard time paying for things. If reform looks like it's going to be cheaper for them, it will be unbelievably popular. If it looks like all it's going to do is cover the uninsured, then people will say, 'Leave me alone.' "
But Greenberg, the Democratic pollster, said guaranteeing that people will not lose their insurance and regulating the insurance industry more tightly are also important selling points.
"There's a real power in telling people, 'We're going to do something to make sure you don't lose your insurance if you lose your job,' " he said.
Recognizing the need to appeal to individual self-interest was part of the motivation for the new ad campaign featuring the fictional couple Harry and Louise, which was used to scuttle the Clinton administration's attempt to change health care and has been brought back by the pro-reform group Families USA and the Pharmaceutical Research and Manufacturers of America.
"Containing costs is very important, but I'm not sure how much the American public will understand that when we talk about 'decelerating the costs' and saving the government money. That's important, but I'm not sure how much people will appreciate what that will do for their own pocketbooks," said Ron Pollack, executive director of Families USA.
Ed Goeas, a Republican strategist and pollster, said he noticed that Obama started talking more about health-insurance reform instead of health-care reform, a change he thought was calculated to appeal to the satisfied majority.
"Basically what they are trying to do is get the message to the majority that everything that they are doing is focused on them. In reality, it's focused on the uninsured, but they're trying to convince people that's not the case," Goeas said.
Williams remains hopeful that a plan she finds palatable will emerge.
"I don't want to be selfish," she said, "but I would not want to give up the quality of health care."
Polling director Jon Cohen and polling analyst Jennifer Agiesta contributed to this report.