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Section 2: Views of Health Care Legislation

The public remains, on balance, skeptical about the health care legislation before Congress. Just less than half (48%) say they generally oppose the bills currently under debate, while 39% are generally in favor. This is comparable to the balance of opinion in most previous Pew Research polls back through the summer of 2009.

And opposition to the legislation continues to be more intense as well. Fully three-quarters (75%) of those who are against the legislation say they oppose it very strongly – this represents 36% of Americans overall.

By comparison, about six-in-ten (59%) supporters of the bill say they favor it very strongly, representing 23% of Americans overall. This imbalance is consistent with previous survey results from August, September and October.

Not only are 79% of Republicans against the health bills before Congress, but roughly two-thirds (65%) oppose the legislation very strongly. Backing for the legislation among Democrats is more tepid – 63% favor the bills, but fewer than half (39%) back them very strongly. Roughly half (51%) of independents oppose the health legislation, compared with roughly a third (34%) who support it.

Few See Personal Upside from Legislation

In assessing the personal impact of the legislation, relatively few say they expect their own insurance coverage and health care to improve should the measure become law. Just 21% think it would reduce their out-of-pocket costs, while 18% see the quality of care they receive improving and 16% say the same about their choice of doctors and hospitals. On all three issues, roughly twice as many Americans believe these health reform bills would make things worse for them personally if passed into law. About four-in-ten say their quality of care (41%) and choice of doctors (40%) would not change if the legislation passes.

Yet even when it comes to the insurance reforms that have a broader reach, most Americans see no potential benefit to themselves. Just 33% say their ability to get health insurance if they changed or lost a job would improve, with the rest saying this would get worse (26%) or not change (26%). A slim plurality (39%) say it would be easier for them to get coverage with a pre-existing condition if health reform passes, but half say this would not change (29%) or get worse (21%).

Opponents of the legislation widely see the bill as potentially detrimental to them personally. Majorities of opponents say the bill would lengthen their wait times (63%), raise their out of pocket costs (62%), lower the quality of care they receive (56%) and limit their choice of doctors and hospitals (56%). By nearly two-to-one, more opponents believe the bills would make it harder (38%) not easier (20%) for them to get health insurance if they change or lose a job. And nearly a third (31%) believes that it would be harder to get coverage with pre-existing conditions if the legislation passes.

In general, supporters of the legislation see the law having less impact on their own health care if it passes. Most say it would not affect the quality of care they receive (53%), their choice of doctors and hospitals (54%) or the length of time they wait for appointments (52%). But most supporters register the benefits of insurance reform if it passes: 58% say their ability to get coverage with a pre-existing condition would be improved, and 52% say the same about getting coverage if they change or lose a job.

Many Say Law Would Increase Their Costs

By two-to-one (40% vs. 21%) more Americans believe the health legislation, if passed, would increase, not decrease their out-of-pocket costs, and this concern spans demographic groups. Among those 65 and older, 46% believe their costs would rise, as do 44% of Americans 50 to 64. People younger than 30 are most likely to say that their out-of-pocket costs would get better, but just 33% express this view while about as many (34%) say their costs would get worse.

Similarly, 31% of people with family incomes of less than $30,000 annually expect the legislation would lower their out-of-pocket health care costs, but at least as many (34%) think they would end up paying more. In both middle-income households ($30,000-$74,999) nearly half (47%) expect their out-of-pocket costs to rise, while just 18% believe they would pay less, and the balance is similar among those with higher incomes.

Even among the 17% of Americans who are currently without health insurance – expected to be the main beneficiaries of health care legislation – about as many believe their out-of-pocket health care costs would get worse (33%) as believe they would benefit financially (37%).

More Trust Insurance Companies than Government

More Americans trust private insurance companies rather than the government to make decisions about what kinds of medical procedures should be covered by health insurance. A 45% plurality is more confident in insurance companies, 31% are more confident in the government, with 16% volunteering that they do not trust either.

Not surprisingly, there is a substantial partisan gap – by a 65% to 10% margin Republicans trust private insurance companies rather than the government when it comes to making insurance decisions. The balance of opinion is less lopsided among Democrats, with 47% trusting the government more and 32% trusting insurance companies more.

Lower-income and younger Americans are substantially more likely to trust the government more when it comes to health care decisions. Among people with household incomes of less than $30,000 annually, 40% express greater confidence in the government rather than insurance companies, compared with 26% of people earning $75,000 or more. But even among the lower income Americans, as many trust insurance companies (43%) as the government (40%).

Those 65 and older – the majority of whom receive their health insurance from the government – are the least likely to be confident in government decision making. Just 20% say they trust the government over private insurers, while 52% say private insurance companies do the better job. Fully 68% of seniors report Medicare as their main source of health insurance, and another 5% cite other government insurance sources.

Americans younger than 30 are the most likely of all age groups to express confidence in government health care decision making: 40% have more confidence in the government than private insurers. But even in this age range, at least as many (48%) say they trust private insurers more than the government.

Overall, there is little relationship between the source of a person’s health insurance and whether he or she has more confidence in government or private insurers. Among the 54% of Americans who say they have insurance through a private insurance company, more trust private insurers (45%) than the government (29%). Among the 24% who say their main source of insurance is a government program, 47% trust private insurers more, while 27% trust the government more. Only those who are currently without insurance – 17% of the public – is the balance of opinion different, with roughly equal numbers expressing greater confidence in private insurers (40%) as government (45%).

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