Field Research Corporati on 601 California Street San Francisco, CA 94108-2814 (415) 392-5763 FAX: (415) 434-2541 EMAIL: fieldpoll@field.com www.field.com/fieldpollonline Field Research Corporation is an Equal Opportunity Employer THE FIELD POLL
Release #2477 Embargoed for Print Publication: Tuesday, August 19, 2014
2014 TCWF-Field Health Policy Poll - Part 1 Increase in California Voter Support for Affordable Care Act Most Say the State's Implementation of the Law Has Been Successful Growing Proportions Satisfied with the Way California's Health Care System Is Working By Mark DiCamillo and Mervin Field Following its first year of full implementation in California, the Affordable Care Act (ACA) is now receiving greater support from this state's voters than at any time since its introduction in 2010. At present, 56% of registered voters say they support the law, while 35% are opposed. This twenty-one point margin in support is up from 15 points last year. By a two-to-one margin (60% to 30%) voters think the state of California has been successful in implementing the ACA. This contrasts with their much more divided assessment of the way the federal government has implemented the law (49% successful vs. 46% not successful). Many more voters say the state has been successful than feel it has been unsuccessful in achieving six of seven goals that California set out to achieve when it began implementing the law. This includes encouraging uninsured residents to get coverage, expanding Medi-Cal, providing consumers with more insurance choices, obtaining the federal funds needed to implement the law, providing better consumer protections, and establishing a one-stop place where consumers can go to shop for health insurance online. The one area where more voters think the state has not been successful in its implementation of the law relates to limiting the rate increases that insurance companies charge to their customers. Statewide, 46% feel California has been unsuccessful in meeting this goal, while 37% think it has been successful. Another 17% aren't sure. Related to this is the finding that 46% of voters say they have difficulty paying the costs of their health care, including 17% who say it's very difficult. However, the proportion reporting that their health care costs are very difficult to afford declined four points from 21% who said this last year. These generally positive evaluations of the ACA and its implementation in California appear to be impacting voters' overall views of the way the state's health care system is performing. Currently, 56% say they are satisfied with the way the state's health care system is working, while 34% are dissatisfied. This is a significant improvement from prior TCWF-Field Health Policy Surveys. The Field Poll #2477 Tuesday, August 19, 2014 Page 2 The poll also finds two-thirds of California voters (66%) in support of the ACA's requirement that private health insurance plans cover the full cost of birth control. In addition, most disagree (56%) with the recent U.S. Supreme Court ruling allowing certain employers, whose owners object to birth control on religious grounds, to be exempt from this requirement. These are the findings from Part One of the 2014 TCWF-Field Health Policy Survey conducted J une 26-J uly 19, 2014 by The Field Poll among 1,535 California registered voters in seven languages and dialects, under a grant from The California Wellness Foundation. Part Two, for publication tomorrow, will examine voter visits to and views of the Covered California health insurance exchange website, the expansion of the state's Medi-Cal system under the ACA, and proposals aimed at improving the state's health care system, including the proposal to extend Medi- Cal to the state's undocumented immigrants and likely voter preferences regarding Proposition 45, the "Approval of Healthcare Insurance Rate Changes" initiative on the upcoming November election ballot. "For those monitoring the implementation of the Affordable Care Act, it was clear that the experience in California would be critical to the national success of this important reform," said J udy Belk, president and CEO of The California Wellness Foundation. "The poll's findings related to increased satisfaction among voters with the performance of the health care system in our state indicate that the hard work of policymakers, advocates and others is paying off. More Californians are now insured and able to access health care." Voter support for the ACA moves higher in California This most recent assessment of California voters' overall opinion of the ACA shows 56% in support (35% strongly and 21% somewhat). This compares to 35% who are opposed (26% strongly and 9% somewhat). The current 21 percentage-point plurality in favor is up from 15 points last year and is the largest margin of support for the law in annual TCWF-Field Health Policy Surveys dating back to 2010. Like other Americans, Californians' views of the ACA are highly partisan. While California Democrats support the law greater than five to one, Republicans oppose it greater than three to one. However, compared to last year, Republican opposition in the state has moderated some, from greater than four-to-one opposition last year. Support for the law continues to be stronger in the nine-county San Francisco Bay Area and in Los Angeles County than in other regions. However, most of this year's increase in regional support is derived from somewhat greater support for the law among voters in the Central Valley and in areas of Southern California outside of Los Angeles County. While the state's ethnic voter population continues to be overwhelmingly supportive of the law, a plurality of the state's white non-Hispanic voters now favors the law (50% to 44%). When asked what further actions Congress should take with regard to the law, the proportion of voters who favor expanding the law has grown from 38% last year to 43% this year. Another 12% believes Congress should leave the law as is, while 36% of Californians favor repealing all or parts of the law. The Field Poll #2477 Tuesday, August 19, 2014 Page 3 The state of California's implementation of the ACA viewed much more favorably than the federal government's efforts By a two-to-one margin (60% to 30%) voters believe the state of California has been successful in implementing the ACA. This contrasts to a much more divided assessment of the way the federal government has implemented the law. Statewide, 49% of Californians believe the federal government's implementation of the law has been successful, while 46% say it has not. Many more voters believe that the state has been successful than feel it has been unsuccessful in achieving six of seven specific goals that California set out to achieve when it began implementing the law. This includes encouraging more previously uninsured residents to get coverage, expanding Medi-Cal to extend health insurance to more low-income residents, providing consumers with more insurance choices, obtaining the federal funds needed to implement the law, providing insurance buyers with better consumer protections, and establishing a one-stop place where consumers can go to shop for health insurance online. However, a plurality believes the state has not been successful in limiting the rate increases that insurance companies charge to their customers. Statewide 46% of voters feel California has not been successful in meeting this goal, while 37% feel it has, and 17% aren't sure. Growing proportions of voters say they're satisfied with the way the health care system is working in California By a 56% to 34% margin, more voters now say they're satisfied than dissatisfied with the way the health care system is working in California. This represents a significant improvement in voter assessments of the state's health care system from prior measures. For example, in 2008 50% were satisfied and 46% dissatisfied. Overall satisfaction with the state's health care system is related to household income. By a greater than two to one margin, voters with annual incomes of less than $40,000 now report being satisfied with the way the state's health care system is working, a much more positive assessment than was observed two years ago. Nearly half report some difficulty paying for health care Nearly half of voters statewide (46%) say they have difficulty paying the costs of their health care, while 52% do not. About one in six voters (17%) say it's "very difficult." However, this is less than the 21% of voters who felt it was very difficult for them to pay their health care costs in 2013. Most likely to report that health care costs are very difficult to afford are the uninsured (46%). In addition, 47% of voters say the total amount they are paying for health care increased over the past year. Higher income Californians are more likely to say this than lower income Californians. The Field Poll #2477 Tuesday, August 19, 2014 Page 4 Californians support ACA's requirement that private health plans cover the full cost of birth control; most disagree with recent Supreme Court ruling on the matter Two-thirds of California voters (66%) support the health care law's requirement that private health insurance plans cover the full cost of birth control, while 25% are opposed. However, opinions about this divide sharply along party lines, with 83% of Democrats supporting it, compared to 39% among Republicans. Most Californians disagree with the recent U.S. Supreme Court ruling allowing certain employers, whose owners object to birth control on religious grounds, to be exempt from this requirement. A 56% majority of voters who were interviewed after the High Court ruled on this issue on J une 30 say they disagreed with the decision, while 36% agreed. There were big differences in views of the ruling by party, with 72% of Democrats disagreeing with it, compared to 31% among Republicans.
-30- About the Survey The 2014 TCWF-Field Health Policy Survey is the eighth in an annual series of health policy surveys conducted among random samples of California registered voters by The Field Poll through a grant from The California Wellness Foundation. This year's findings are based on a survey of 1,535 California registered voters interviewed by telephone in seven languages and dialects English, Spanish, Cantonese, Mandarin, Korean, Vietnamese and Tagalog. Interviews were completed on either a voter's landline phone or a cell phone. In this survey 859 voters were contacted on their cell phone, while 676 were reached on a regular landline or other phone. In order to enable the survey to more closely examine the opinions of the state's growing ethnic voter populations the survey included additional interviews with Asian American voters. A total of 1,167 of the interviews were conducted in English and 368 in non-English languages. Interviewing was conducted J une 26 J uly 19, 2014 from Field Research Corporation's central location call center. Up to six attempts were made to reach and interview each randomly selected voter on different days and times of day during the interviewing period. After the completion of interviewing, the overall sample was weighted to align it to the proper statewide distribution of voters by race/ethnicity and by other demographic, geographic and political characteristics of the California registered voter population. Sampling error estimates applicable to any probability-based survey depend upon its sample size. According to statistical theory, 95% of the time results from the overall sample are subject to a maximum sampling error of +/- 2.6 percentage points. The maximum sampling error is based on percentages in the middle of the sampling distribution (percentages around 50%). Percentages at either end of the distribution have a smaller margin of error. Sampling error will be larger for analyses based on subgroups of the overall sample.
About The California Wellness Foundation The California Wellness Foundation is a private, independent foundation created in 1992, with a mission to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention. Since its founding in 1992, the Foundation has awarded 7,338 grants totaling more than $890 million. For more information, visit the Foundation's website, www.calwellness.org, or contact Cecilia Laich, communications officer, at (818) 702-1900. Updating Voter Views of the Affordable Care Act and the Health Care System in California Conducted by The Field Poll
for The California Wellness Foundation
for release Tuesday, August 19, 2014 2014 TCWF-Field Health Policy Survey
Part 1 The Field Poll The California Wellness Foundation 1
About the Survey Population surveyed: California registered voters. Number of interviews: 1,535 interviews completed including an augmented sample of Asian American voters. Data collection: June 26-July 19, 2014 by cell and landline telephone using live interviewers from Field Researchs central location call center. Languages of English, Spanish, Cantonese, Mandarin, administration: Tagalog, Korean and Vietnamese. 1,169 completed in English and 368 in non-English languages. Sampling error: Overall findings have a sampling error of +/- 2.6 percentage points at the 95% confidence level. The Field Poll The California Wellness Foundation 2 Graph 1 Current public opinion of California voters toward the Affordable Care Act (July 2014) Support strongly 35% Support somewhat 21% Oppose somewhat 9% Oppose strongly 26% No opinion 9%
Since 2013
-3
Since 2013
+4
Since 2013
+0
Since 2013
-1 The Field Poll The California Wellness Foundation 3 52% 52% 54% 53% 56% 38% 39% 37% 38% 35% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2010 2011 2012 2013 2014 Support Graph 2 Trend of California voter opinions of the Affordable Care Act Oppose The Field Poll The California Wellness Foundation 4 Graph 3a Current voter opinions of the Affordable Care Act by region and party registration 56% 22% 79% 53% 67% 50% 48% 49% 62% 56% Support 33% 69% 15% 41% 28% 40% 42% 41% 30% 35% Oppose Total Region Los Angeles County South Coast Other Southern CA Central Valley San Francisco Bay Area Other Northern CA* Party registration Democrat No party preference/other Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion. * Small sample base. Republican +3 -2 +4 +9 +8 +1 +6 +5 +2
Since 2013 +2 -3 +2 -7 -9 -9 +3 -9 -6 -4
Since 2013 0 The Field Poll The California Wellness Foundation 5 Graph 3b Current voter opinions of the Affordable Care Act by race/ethnicity and age 54% 57% 56% 55% 61% 66% 82% 62% 50% 56% Support 36% 36% 37% 35% 32% 19% 10% 27% 44% 35% Oppose Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.
+3 +6 -4 0 +3 +4 -2 0 +7
Since 2013 +9 -3 -5 +1 -2 -4 +5 -1 -7
Since 2013 -9 -5 Total Race/ethnicity White non-Hispanic African American Age 1829 3039 4049 5064 65 or older Latino Asian/Pacific Islander The Field Poll The California Wellness Foundation 6 Graph 3c Current voter opinions of the Affordable Care Act by insurance status and type 68% 60% 57% 55% 57% 42% 56% Support 18% 35% 31% 40% 35% 44% 35% Oppose Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.
+3 -10 +4 +2 +9 +4 +5
Since 2013 -3 +13 -4 -2 -10 -7
Since 2013 -4 Total Insurance status and type Uninsured Through employer/union Medi-Cal Individual market Insured (total) Medicare The Field Poll The California Wellness Foundation 7 Graph 4 What further actions should Congress take with regard to the Affordable Care Act
Since 2013 +1
Since 2013 +5
Since 2013 -3
Since 2013 -1 Keep as is 12% Repeal it completely 23% Expand the law 43% No opinion 9% Repeal parts of it 13%
Since 2013 -2 The Field Poll The California Wellness Foundation 8 Graph 5 California voter views about ACAs requirement that private health insurance plans cover the full cost of birth control Oppose 25% Support 66% No opinion 9% 68% 39% 83% 66% No party preference/other Republican Democrat Total registered voters % Support Party registration The Field Poll The California Wellness Foundation 9 Graph 6 California voters views about the U.S. Supreme Court ruling allowing certain employers (whose owners object to birth control on religious grounds) to be exempt from the ACAs requirement to cover costs of prescription birth control in their companys health plans Disagree 56% Agree 36% No opinion 8% 58% 31% 72% 56% No party preference/other Republican Democrat Total registered voters % Disagree Party registration Note: Question added to the poll immediately after the U.S. Supreme Court issued its ruling on this case and was asked of 1,302 registered voters statewide. The Field Poll The California Wellness Foundation 10 Graph 7 Opinions of how successful the federal government and the state of California have been in implementing the Affordable Care Act Very successful Not at all successful 22% Not too successful 24% Somewhat successful 41% 8% No opinion 5% Federal Government Not at all successful 12% Not too successful 18% Somewhat successful 45% No opinion 10% Very successful 15% State of California The Field Poll The California Wellness Foundation 11 Graph 8a Voter opinions about how successful California has been in achieving specific goals of the ACA (1 of 2) 24% 31% 21% 24% 51% 57% 63% 64% Obtaining the federal funds needed to implement the law Providing California consumers with more insurance choices Expanding Medi-Cal to extend health insurance to more low-income Californians Encouraging more previously uninsured residents to get coverage Successful Not successful California has been Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion. The Field Poll The California Wellness Foundation 12 Graph 8b Voter opinions about how successful California has been in achieving specific goals of the ACA (2 of 2) 46% 32% 28% 37% 50% 50% Limiting the rate increases that insurance companies charge to their customers each year Establishing a one-stop place where it will be easy for consumers to shop for health insurance online Providing health insurance buyers with better consumer protections Successful Not successful California has been Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion. The Field Poll The California Wellness Foundation 13 Graph 9 Voters reported difficulty in paying for health care
Since 2013 0
Since 2013 -4
Since 2013 +5
Since 2013 0 Very difficult 17% Somewhat difficult 29% No opinion 2% Not too difficult 29% Not at all difficult 23%
Since 2013 -1 The Field Poll The California Wellness Foundation 14 23 20 16 12 15 46 17 27 32 27 29 29 27 29 50% 52% 43% 41% 44% 73% 46% Medi-Cal Individual market Medicare Through employer/ union Insured (total) Uninsured Total registered voters Very Somewhat Graph 10 Difficulty in paying for health care by insurance status and type % Difficult Insurance status/coverage type -4 +1 0 -8 -13
Since 2013 -3 -2 The Field Poll The California Wellness Foundation 15 Graph 11 Perceived changes in amount paid for health care over the past year
Since 2013 -1
Since 2013 -3 Increased 47% No opinion 4% About the same 40% Decreased 9%
Since 2013 +4 The Field Poll The California Wellness Foundation 16 Graph 12 Perceived changes in amount paid for health care over the past year by household income 63% 52% 51% 38% 33% 47% % Increased 6% 7% 10% 14% 13% 9% % Decreased 40% 52% 39% 37% 47% % About the same 54% Total registered voters Household income Less than $20,000 $40,000 $59,999 $100,000 or more $20,000 $39,999 $60,000 $99,999 The Field Poll The California Wellness Foundation 17 51% 50% 50% 52% 56% 44% 46% 42% 40% 34% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2006 2008 2010 2012 2014 Satisfied Graph 13 Trend of voter satisfaction with the way the health care system is working in California (2006 2014 ) Dissatisfied Note: Differences between 100% and the sum of each years percentages equal proportion with no opinion. The Field Poll The California Wellness Foundation 18 Total registered voters Race/ethnicity White non-Hispanic African American Latino Asian/Pacific Islander Household income Less than $20,000 $40,000 $59,999 $100,000 or more $20,000 $39,999 $60,000 $99,999 63% 67% 61% 52% 50% 53% 50% 62% 67% 56% % Satisfied 24% 26% 27% 40% 42% 37% 39% 29% 24% 34% % Dissatisfied Note: Differences between 100% and the sum of each subgroups percentages equal proportion with no opinion.
+4 +13 +10 +1 +1 +3 -4 +3 +3
From 2012 +7 -6 -15 -11 -4 -5 +4 -5 -2
From 2012 -13 -3 Graph 14 Satisfaction with the way the health care system in California is working by household income and race/ethnicity H:\600046\Report\Rls2477 Topline Findings.docx 1 Field Research Corporation 600-046 San Francisco, California 94108 081914
Topline Findings 2014 TCWF-Field Health Policy Poll Part 1 Updating Voter Views of the Affordable Care Act and the Health Care System in California
1. How satisfied are you with the way the health care system is working in California? Are you very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied? VERY SATISFIED .................................. 22% SOMEWHAT SATISFIED ........................ 34 SOMEWHAT DISSATISFIED ................... 16 VERY DISSATISFIED ............................. 18 NO OPINION ......................................... 10
As you know, about four years ago the Congress passed and President Obama signed into law the Affordable Care Act, to reform the nations health care system and it is now being enacted.
2. Generally speaking, do you support or oppose the health care reform law? (IF SUPPORT OR OPPOSE, ASK:) Do you feel that way strongly or somewhat? SUPPORT STRONGLY ........................... 35% SUPPORT SOMEWHAT ......................... 21 OPPOSE SOMEWHAT ............................. 9 OPPOSE STRONGLY ............................ 26 NO OPINION ........................................... 9
3. What would you like to see Congress do when it comes to the health care law leave it as is, expand it so the law does more, repeal parts of it so the law does less, or repeal it completely? KEEP AS IT........................................... 12 EXPAND IT ........................................... 43 REPEAL PARTS TO DO LESS ................. 13 REPEAL IT COMPLETELY ...................... 23 NO OPINION ........................................... 9
4. In general, do you support or oppose the health care laws requirement that private health insurance plans cover the full cost of birth control? SUPPORT ............................................ 66% OPPOSE .............................................. 25 NO OPINION ........................................... 9
5. (ASKED FOLLOWING JUNE 30 SUPREME COURT RULING) The U.S. Supreme Court recently ruled that certain employers whose owners object to birth control on religious grounds should not be required to cover the cost of prescription birth control in their companies health plans, even if this means their female employees will have to pay the cost of birth control themselves. Do you agree or disagree with the Supreme Courts ruling in this case? AGREE ................................................ 36% DISAGREE ........................................... 56 NO OPINION ........................................... 8
6. Regardless of whether you support or oppose the health care law, how successful do you think the federal government has been in implementing the law very successful, somewhat successful, not too successful or not at all successful? VERY SUCCESSFUL ............................... 8% SOMEWHAT SUCCESSFUL .................... 41 NOT TOO SUCCESSFUL ........................ 24 NOT AT ALL SUCCESSFUL .................... 22 NO OPINION ........................................... 5
7. How successful do you think the state of California has been in implementing the law very successful, somewhat successful, not too successful or not at all successful? VERY SUCCESSFUL ............................. 15% SOMEWHAT SUCCESSFUL .................... 45 NOT TOO SUCCESSFUL ........................ 18 NOT AT ALL SUCCESSFUL .................... 12 NO OPINION ......................................... 10
H:\600046\Report\Rls2477 Topline Findings.docx 2 8. I am going to read some of the goals that California initially set out to achieve when it began implementing the health care law. For each, please tell me how successful you think the state has been in achieving each goal. (ITEMS IN RANDOM ORDER) How successful do you think California has been in achieving this goal very successful, somewhat successful, not too successful, or not at all successful? VERY SOMEWHAT NOT TOO NOT AT ALL NO SUCCESSFUL SUCCESSFUL SUCCESSFUL SUCCESSFUL OPIN ( ) a. encouraging more previously uninsured residents to get health insurance coverage ..................19% ........... 45 ........... 17 .............. 7 .........12 ( ) b. providing health insurance buyers with better consumer protections ....................................................... 8% ........... 42 ........... 18 ............ 10 .........22 ( ) c. obtaining the federal funding needed to implement the law ..........................................................12% ........... 39 ........... 15 .............. 9 .........25 ( ) d. providing California consumers with more health insurance choices ..........................................................15% ........... 42 ........... 18 ............ 13 .........12 ( ) e. limiting the rate increases that health insurance companies charge to their customers each year ............ 6% ........... 31 ........... 26 ............ 20 .........17
Think for a moment about the total amount of money you now pay out-of-pocket for health care. This includes any costs you pay for insurance coverage, for paying any portion of your health care bills that you pay out of pocket when you use health care services, such as deductibles and co-pays, as well as the amount you pay for any health care services you receive that are not paid for by insurance.
9. Overall, how difficult would you say it is to pay for the costs of your health care very difficult, somewhat difficult, not too difficult or not at all difficult? VERY DIFFICULT .................................. 17% SOMEWHAT DIFFICULT ......................... 29 NOT TOO DIFFICULT ............................. 29 NOT AT ALL DIFFICULT ......................... 23 NO OPINION ........................................... 2
10. In the past year, has the total amount you pay for you and your family's health care increased, decreased, or remained the same? INCREASED ......................................... 47% DECREASED .......................................... 9 REMAINED THE SAME .......................... 40 NO OPINION ........................................... 4
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