Two Polls Does Not Make a Debate

This week Utah politicos were served two distinct statewide polls on the Healthy Utah Plan.

The first poll, published by UtahPolicy.com with surveying by Dan Jones & Associates, indicated that 67% of Utahns support the plan after it was explained to them. Not surprisingly, the poll also found that 44% of respondents had not heard of the Healthy Utah Plan. In addition, 79% of self-described Republicans said they support the governor’s proposal.

The second poll, published by Sutherland Institute, with surveying and analysis by Louisville, CO-based Magellan Strategies, uncovered a completely different reaction. Public support for Healthy Utah Plan registered a dismal 17%, with 20% of voters responding “unsure or don’t know” and a plurality of 31% saying “do not expand Medicaid right now.”

Both polls were conducted in early September (September 9-11; September 8-9) and counted a similar number of Utah voters (407; 500).

So what accounts for the dramatic difference?

We can explain it in one word: Obamacare.

The script for the Sutherland poll included 24 references to “Obamacare,” and only four references to the “Affordable Care Act.”

The Sutherland script describing the Healthy Utah Plan included the sentence, “This proposal would expand Utah's Medicaid program by using Medicaid funding to subsidize the purchase of private health insurance for individuals who do not currently qualify for Medicaid and make less than 138 percent of the federal poverty level, as required by Obamacare.” (link, page 25, table 7.1)

Now we at UHPP don’t claim to be experts in survey methodology, and our regression analysis is a little rusty since that college statistics course that sunk our GPA.

But we do know something about words. Especially words like Obamacare and the “throwing gasoline on a fire” effect it has on Utah audiences.

UHPP has conducted over 150 “Health Reform 101” presentations to public audiences across the state—from St. George to American Fork, and from Logan to Vernal. We understand the visceral reaction that Utahns have to the O-word.

So we use it all the time, along with “Affordable Care Act” and ACA.

We want audiences to be comfortable talking about health reform using which ever term they prefer., so we use all three term interchangeably. Along the way, we’ve noticed that public impressions about “Obamacare” and the “Affordable Care Act” differ considerably. People believe Obamacare authorized a nameless death panel to kill granny and raise their taxes, while the ACA is making their well-child checks free and helping their friend who survived cancer get health insurance.

But don’t take our word for it.

Last September a CNBC poll found a nine percentage point swing in perceptions about the healthcare law depending on whether respondents were asked about “Obamacare” or the “Affordable Care Act.” Can you guess which descriptor generated the highest negative opinions? Hint: It started with “O.”

And then there’s Jimmy Kimmel’s hilarious “person on the street” interviews that showed how regular people (just like Utah voters) favored the ACA over Obamacare, with one woman explaining “I don’t like anything that has to be forced for everybody to buy.” Kimmel’s video has 4 million views, so this “Obamacare-effect” must also be entertaining as well as reproducible.

Which brings us back to the two surveys in Utah.

Here’s how the UtahPolicy.com survey described the Healthy Utah Plan.

“Governor Herbert’s Healthy Utah plan utilizes the private insurance market to provide health insurance for Utahns living at or near the federal poverty line.  If implemented, the plan would return to Utah nearly 250 million dollars paid by Utahns to the federal government each year.  Under the Healthy Utah plan, this money would be used to assist more than 55,000 low-income Utahns who currently lack access to affordable health insurance.  Funds would either purchase insurance from the private insurance market or support participation in current state health insurance programs.”

Notice no mention of Obamacare, or even the Affordable Care Act.

We believe that UtahPolicy’s description could have been more accurate. For instance, mentioning the eventual cost to the state budget (approx. $40 million) after the federal match rate decreases from 100% to 90% in 2020. Or they could have said that close to 100,000 Utahans could eventually be coveted by Healthy Utah insurance—not just the 55,000 currently in the coverage gap. But we view those omissions as logical (Healthy Utah is only a 3-year pilot and could end before the federal match rate decreases), or for brevity’s sake.

After all, UtahPolicy’s description of the Healthy Utah Plan is 89 words, compared to the 219 words deployed by the Sutherland survey. We don’t own a Ph.D. in economics, but we do know that survey or respondent fatigue is a well-documented bias in data collection that leads to a higher selection of “don’t know” or the simplest answer.

Given the proven negative impact of the word “Obamacare” on perceptions of healthcare reform, it seems strange that the Sutherland Institute would deploy it 24 times in their survey script. It’s even stranger they would tag the Healthy Utah Plan’s expansion of coverage with the description, “as required by Obamacare," when the plan's use of private insurance isn’t even mentioned in the ACA, and after the 2012 Supreme Court decision made the expansion optional for all states.

But in the end,  this week’s poll disparity was best summarized by Salt Lake Tribune reporter Robert Gehrke, who tweeted on Monday: “Takeaway from today’s health care polls: When you ask people about a topic they don’t get, they’ll agree with what you tell them”

Additional Resources

UtahPolicy.com Survey Description of Healthy Utah Plan

“Governor Herbert’s Healthy Utah plan utilizes the private insurance market to provide health insurance for Utahns living at or near the federal poverty line.  If implemented, the plan would return to Utah nearly 250 million dollars paid by Utahns to the federal government each year.  Under the Healthy Utah plan, this money would be used to assist more than 55,000 low-income Utahns who currently lack access to affordable health insurance.  Funds would either purchase insurance from the private insurance market or support participation in current state health insurance programs.”

(link)

Sutherland Institute Survey Description of Healthy Utah Plan

“T7. One proposal is referred to as THE HEALTHY UTAH proposal. This proposal would expand Utah's Medicaid program by using Medicaid funding to subsidize the purchase of private health insurance for individuals who do not currently qualify for Medicaid and make less than 138 percent of the federal poverty level, as required by Obamacare. It would subsidize health insurance premiums for more than 160,000 individuals, whose insurance would cover similar health services as traditional Medicaid. The actual number of qualifying individuals may be significantly higher based on unexpectedly high enrollment in other states that have expanded Medicaid. Some of these individuals currently have private insurance, while others do not. It is estimated that just over 63 percent of working age adults in this group are single, and 61 percent of them are without children. By 2021, this plan is estimated to cost $40 million in state tax dollars, with the remaining cost of approximately $360 million paid for with funding from the federal government. If federal funding was cut in the future, Utah lawmakers would have to decide whether to pay more state tax dollars to continue insurance subsidies or cut Medicaid health benefits. After hearing information about this proposal, would you say you strongly favor, somewhat favor, somewhat oppose, strongly oppose or are you undecided about this proposal?”

(link)

More Resources:

UtahPolicy.com Poll

Survey conducted September 9-11 among 407 registered Utah voters. The margin of error is +/- 4.9%.

Exclusive Poll: Utahns Don't Know Much About Healthy Utah, But They Prefer It Over Medicaid Expansion (link)

Poll: Once Republicans Understand Herbert's Healthy Utah Plan, They Support It (link)

Survey Details (link)

Sutherland Poll

Utah Medicaid Expansion Survey, September 8th - 9th, 2014, 500N, 4.38% MoE, Weighted Results
New poll shows Utahns reluctant about Medicaid expansion proposals (link)

Survey Summary (link)

Survey details (link)

Media Coverage

Provo Herald (link)

Salt Lake Tribune (link)

KVNU's "For the People" (link)