Californians Support Universal Health Care, Cost Sharing Plan In State, and Single Payer at Least at the Federal Level: Interpreting the New PPIC Poll

This poll is based on the responses of a large sample--over 2,000 Californians. It was taken January 11 to 18, 2007, shortly after the State of the State Address by Governor Schwarzenegger on January 9, and at a time when the Governor's proposal had just recently been laid out and a number of competing bills were just being introduced. It is accurate to within 3 points as to the opinions of "all adults" in the state and to within 2 points as to "likely voters." So, it is an accurate snapshot of opinions as of the time it was taken. Like all polls, the questions and the order in which they were asked, may be significant in the responses elicited.

The "Governor's Health Plan"

Californians were asked, as question 20, "Overall, do you have a favorable or an unfavorable impression of the plans and policies for California that Governor Schwarzenegger presented in his most recent State of the State speech?" 47% responded "favorable," 24% "unfavorable," and 20% volunteered that they "haven't heard about the speech," with another 9% stating they "don't know." I have a real question as to whether 81% of Californians really have an opinion about the plans outlined in the speech. Mind you, this is of all residents of the state, whether registered to vote or not. Even if it is Arnold Schwarzenegger, who is followed more than most politicians and Governors of this state, I would think the true numbers of those who haven't formed an opinion about the policies in the speech are, in fact, higher. But these are the responses given.

Then it is stated: "Next, please tell me if you favor or oppose the following plans and policies that the governor presented in his speech." This means that the health care questions which were rotated with one other question and asked immediately following the statement were answered in the context of them being part of the governor's plan.

Notwithstanding the above caveats, the responses are overwhelmingly in support of "a plan requiring all Californians to have health insurance, with costs shared by employers, health care providers, and individuals." Every subset supported that general proposition: All adults by a margin of 71% to 23%, Democrats by 79% to 15%, even Republicans by the lowest margin of any group of 55% to 39%, "Independents" by 66% to 27%, and likely voters by 65% to 28%.

Even higher, but similar numbers approved "A plan to guarantee medical coverage for children of low-income families, that is a family of four earning under $60,000 a year." The overall support for this was 79% to 18% and includes all subsets.

When asked immediately afterwards "What if this plan covered children of low-income families regardless of their immigration status?" the numbers dropped to 56% in support and 40% opposed, with likely voters at 46% in support and 50% in opposition. Democrats still supported this by a 2 to 1 margin, but Republican support slipped even more decidedly against this idea by 27% to 68%. "Independents" were split 47% in support and 48% opposed, well within the margin of error of the poll.

Single Payer, the "Medicare" Type Program

In contradiction to the support of the "shared" costs proposal in the "Governor's plan," by 61% to 31% all Californians support for "a universal health insurance program, in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers" to "the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no health insurance." All subsets support this, except for Republicans who oppose it by a 56% to 36% margin. Democrats are overwhelmingly in support by 73% to 18%. Independents support this by 59% to 32%. 54% of "likely voters" are in support with only 37% preferring the existing system.

Even if one considers that the respondents were given only a choice here between the current system and single payer, and were asked as part of the questions about United States policies, the results unmistakably point to Californians supporting single payer. The numbers are not close, and this shows Californians are open to the idea.

The numbers are even more surprising, and even a bit higher for "the U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes." 63%, even higher, supported this and only 34% opposed it. All subsets except, you guessed it, the Republicans, supported this by margins as high as 76% to 20% amongst Democrats, 64% to 32% of "Independents," and especially significant, likely voters overall by a solid 59% to 38%.

Conclusions to be Drawn?

There's a battle of ideas going on here, and at least from this survey's different results, the hearts and minds of Californians can be won by the two major approaches being advocated: shared costs or single payer. Those surveyed were not given the details of the proposals, and it is in those trenches that we will be spending our time this year.

The approaches of the Governor, State Senate President pro Tem Perata, and Speaker of the Assembly Nunez all have differing formulae for shared costs. When voters learn of the important details of these, support levels can shift. The Chair of the Senate Health Committee, Sheila Kuehl, has a competing vision of single payer. When it is described as "Medicare like," it too may have strong support. The legislature passed Senator Kuehl's SB 840 last year for single payer and it was vetoed by the Governor. It was attacked as "government run medicine" and there are many details in SB 840 that ran to over 50 pages and provide targets for those opposed to single payer.

There will be intense negotiations and if a bill is passed and signed into law this year, it will probably not look like any of the proposals--at least substantial amendments and tinkering for most of the year is to be expected. The final sausage has not been ground yet and spices and sweeteners will be added.

If a two-thirds vote is required (because this is considered a tax) , it does not seem likely we will have a final legislative product that the Governor can sign. California legislative Republicans appear to be dead set against either a shared cost proposal or a single payer plan. There may be other obstructions including federal preemption under ERISA (jokingly referred to as Every Ridiculous Idea Since Adam) that deals with employer provided benefits including health insurance.

If a bill isn't passed this year, or looks likely to be stalled, we may have competing measures on one of the 2008 ballots. Even if one passes, there may be ballot measures next year. This will be a big issue. Gird your loins.