Poll: On Eve of Senate Vote, More Than Two-Thirds of Republicans Want Congress to Enact An Alternative to the ACA

BOSTON, Sept. 22 -- Harvard University's T.H. Chan School of Public Health issued the following news release:

According to a new POLITICO/Harvard T.H. Chan School of Public Health poll, more than two-thirds (71%) of Republicans want Congress to try again to enact an alternative to the Affordable Care Act (ACA). In contrast, a majority of Democrats (57%) believe Congress should move on to other issues (Chart 1).

The poll also shows that for Republicans, repealing and replacing the ACA tops the list of domestic priorities for Congress to work on during the rest of 2017 (53% saying it is an "extremely important priority").

"What many missed is how important it is to Republicans to try one more time to repeal and replace the ACA," said Robert Blendon, co-director of the poll and professor of health policy and political analysis at Harvard Chan School. "The consequence is a willingness on the part of congressional Republicans to vote on Graham-Cassidy, which is the remaining alternative plan."

One other plan of interest to Democrats is replacing the current health insurance system in the U.S. with a single-payer system, in which all Americans would get their health insurance from one national government plan. The public is evenly divided on this plan, with most Republicans opposing it (62%) and most Democrats favoring it (60%).

Of significance for the future debate, when the term in the poll is changed from "single-payer" to "Medicare for all Americans," public support increases substantially from 45% to 66%.

The caveat that may prove critical in the years ahead is the resistance by a share of the public to paying additional taxes for these alternative health plans, he said. As shown in Chart 2, when asked if they would still favor these alternative plans if it meant their own taxes would increase, support falls to less than a majority in both descriptions - 31% for a single-payer system vs. 44% for a national plan like Medicare.

Among other alternative options to the current legislation is allowing people between the ages of 55 and 64 to have the choice of purchasing Medicare coverage. This is supported by eight in ten (81%) of the public, including 79% of Republicans and 80% of Democrats.

Overall, the poll showed the top domestic priority for the public as a whole is for Congress to take action to lower prescription drug prices, an item not currently being debated in Congress.

An overwhelming majority of the public (88%) favors the federal government negotiating with pharmaceutical companies to lower the prices of prescription drugs for seniors on Medicare.

However, support substantially declines if it means that because of these government-negotiated lower prices, some pharmaceutical companies might choose to not sell certain prescription drugs to seniors through Medicare. This is a consequence that has been raised in prior national debates. When given this scenario, only 38% of the public favors government negotiations of prescription drug prices for those on Medicare.

Another possible way of reducing prescription drug costs and giving consumers more choices is allowing importation of prescription drugs and medical devices that have been approved by countries with different standards such as Canada and European countries, but have not been approved for safety and effectiveness by the U.S. Food and Drug Administration, or FDA.

Americans are divided on this potential solution to lowering prescription drug prices, with more favoring (51%) than opposing (42%).

Another health issue addressed in the poll is the controversial question of taxing soda and sugary beverages to raise money for pre-school and children's health programs and to help address the problem of obesity. A majority of the public (57%), including 63% of Democrats, support this tax measure. More than half of Republicans (53%) are opposed.

View the complete poll findings (PDF) (https://cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2017/09/POLITICO-Harvard-Poll-September-2017-Tax-Reform-and-Other-Domestic-Issues.pdf).

Methodology

These polls are part of an on-going series of surveys developed by researchers at the Harvard Opinion Research Program (HORP) at Harvard T.H. Chan School of Public Health in partnership with POLITICO.

The research team at Harvard T.H. Chan School of Public Health consists of: Robert J. Blendon, Professor of Health Policy and Political Analysis and Executive Director of HORP; John M. Benson, Senior Research Scientist and Managing Director; Logan S. Casey, Research Associate in Public Opinion; and Justin M. Sayde, Administrative and Research Manager. The research team at POLITICO was led by Joanne Kenen, Executive Editor, Health Care at Politico/Politico Pro.

Interviews were conducted with a nationally representative sample of 1,016 randomly selected adults, ages 18 and older, via telephone (including cell phones and landlines) by SSRS of Glen Mills, Pennsylvania. The interviewing period was August 30 - September 3, 2017. The data were weighted to reflect the demographics of the national adult population as described by the U.S. Census.

When interpreting these findings, one should recognize that all surveys are subject to sampling error. Results may differ from what would be obtained if the whole U.S. adult population had been interviewed. The margin of error for the full sample is a3.8 percentage points. For questions asked of half-samples, the margin of error is a5.3 percentage points.

Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases and for variations in probability of selection within and across households, sample data are weighted by household size, cell phone/landline use and demographics (sex, age, race/ethnicity, education, and region) to reflect the true population. Other techniques, including random-digit dialing, replicate subsamples, and systematic respondent selection within households, are used to ensure that the sample is representative.