202.776.9066 | | November 6, 2008 Health Care and The 2008 Elections Celinda Lake.

202.776.9066 | www.lakeresearch.com | November 6, 2008

Health Care and The 2008 ElectionsHealth Care and The 2008 Elections

Celinda Lake

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Key PointsKey Points

• The 2008 election delivered a substantial mandate for real change. Barack Obama’s central argument in the closing days of the campaign was that it was time to turn to the page on the last 8 years and try something new. The margin of victory underscores that the voters are ready for change.

• The results of the presidential and congressional elections completes the wave that started in 2006. Four years ago, voters wanted change, but felt cross-pressured by the 9/11 dynamic. In 2006, terrorism was not enough to offset weak job approval rating for President Bush and the Congress. And in 2007 voters completed their repudiation of conservative Republican ideas.

• Health care reform is a key element of the change that voters demand. Consistently over the past year and a half, voters have expressed concern over rising costs and limited access and expressed an appetite for a larger government role.

• The economy dominated this election as a voting issue. All other issues took a back seat to the economic crisis. The health care issue was the top personal economic issue.

• The weak state of the economy presents a challenge to health care reform, but also an opportunity. While many politicians will instinctively seek to pull back on spending, health care is one of the key components of voters’ economic anxiety. Advocates need to drive this point home to policy makers.

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The vast majority of voters are insured. However, The vast majority of voters are insured. However, some key constituencies viewed health care as a some key constituencies viewed health care as a voting issue. voting issue.

• 90% of voters in 2008 had some members of their household covered, 79% had everyone covered.* Of those, 79% were swing voters. Currently, 91% of voters report having some sort of insurance coverage, and 66% had coverage for every member of their families in the last 3 years.**

• Core health care voters supporting progressive reforms include Democrats, Democratic women, and African-Americans.

• Older women and seniors are the most attentive voters on this issue. They need to be reassured that reforms will not adversely affect the quality of their health care.

*SEIU/AHC polling by Lake Research Partners, November 2006.

** LRP Poll for The Partnership to Fight Chronic Disease. October 4-9, 2008. 1500 Likely Voters (795 Women).

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The economy dominated this election. Obama won The economy dominated this election. Obama won by being the most trusted voice on the economy. He by being the most trusted voice on the economy. He also appealed to voters specifically concerned about also appealed to voters specifically concerned about health care. health care.

7%

9%

9%

10%

63%

0% 10% 20% 30% 40% 50% 60% 70%

Energy Policy

Terrorism

Health Care

Iraq

Economy

Issue (%) Obama McCain

Economy (63%) 53% 44%

Iraq (10%) 59% 39%

Health Care (9%) 73% 26%

Terrorism (9%) 13% 86%

Energy Policy (7%) 50% 46%

Source: CNN 2008 Exit Polls. 17,836 Interviews

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Even after the collapse of Bear Stearns, Lehman Brothers Even after the collapse of Bear Stearns, Lehman Brothers and AIG, health care was the top personal economic and AIG, health care was the top personal economic concern in voters’ everyday lives for both men and concern in voters’ everyday lives for both men and women.women.

LRP Poll for The Partnership to Fight Chronic Disease. October 4-9, 2008. 1500 Likely Voters (795 Women).

33%

24%

17%

17%

13%

11%

10%

9%

7%

3%

3%

1%

1%

35%

22%

17%

17%

12%

8%

12%

11%

6%

6%

3%

3%

2%

1%

38%

8%

39%Health care

Rising costs of gas and food

Jobs

Schools and education

Retirement savings

Affordable housing

The stock market

Being able to live on a fixed income

Medicare

Fear of another terrorist attack

Crime, drugs, and gangs

Getting government assistance like food stamps or Medicaid

Credit card debt

Nursing home care

(don't know)

Total

Women

Now I’m going to read you some problems you and your family may face. Please listen carefully, then tell me which ONE of these you personally worry the most about? … Now from the same list, please tell me which ONE of these you personally worry about second most?

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Leading up to the election, eighty-two percent of Leading up to the election, eighty-two percent of voters viewed health care as extremely or very voters viewed health care as extremely or very important to their vote for president.important to their vote for president.

49%

33%

15%

3%

0%

20%

40%

60%

ExtremelyImportant

Very Important SomewhatImportant

Not at allimportant

Source: Fox News Poll. 10/20-21/2008. 1,100 Registered Voters.

(How important will each of the following issues be to your vote for president (in 2008)?...Extremely important, very important, somewhat important, not at all important)...Health care

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44%

50%

49%

23%

18%

17%

-40% -20% 0% 20% 40% 60%

Strongly Favor Not strongly favor Strongly oppose Not strongly oppose

For the past year leading up to the election, we saw For the past year leading up to the election, we saw no lessening in the public appetite for progressive no lessening in the public appetite for progressive reform—even if it meant raising taxes.reform—even if it meant raising taxes.

FavorOppose

September 2007

February 2008 64%27%

69%28%

Do you favor or oppose providing access to affordable, quality health care for all Americans even if it mean raising your taxes? Do you feel strongly or not strongly about that choice?*

October 2008 31% 64%

* Asked of half of sample.

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51%

57%

46%17%

18%

22%

-30% -10% 10% 30% 50% 70%

Strongly Favor Not strongly favor Strongly oppose Not strongly oppose

Similarly, voters have consistently been more than Similarly, voters have consistently been more than willing to accept a strong federal government role in willing to accept a strong federal government role in making sure all Americans have access to making sure all Americans have access to affordable, quality health care.affordable, quality health care.

FavorOppose

September 2007

February 2008 69%

66%28%

23%

Do you favor or oppose providing access to affordable, quality health care for all Americans even if it mean a major role for the federal government? Do you feel strongly or not strongly about that choice?

30% 64%October 2008

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The week before the election, Obama had The week before the election, Obama had established clear advantages on health care, jobs, established clear advantages on health care, jobs, and the economy.and the economy.

24

14

13

31%

37%

37%

55%

51%

50%

Handle healthcare

Handle Jobs

Handle theeconomy

McCain ObamaObama - McCain

ALL VOTERS

GWU Battleground Tracking. October 23,26-29, 2008.

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Both Obama and McCain voters believe that reducing Both Obama and McCain voters believe that reducing the cost of health care is the top priority for reform. the cost of health care is the top priority for reform. However, Obama voters are much more likely to be However, Obama voters are much more likely to be concerned about access as well.concerned about access as well.

Health Care Priorities

13%

15%

14%

10%

44%

2%

8%

9%

33%

46%

7%

11%

11%

22%

45%

0% 10% 20% 30% 40% 50%

Reduce spending on gov't healthprograms like Medicare and Medicaid

Improve quality of care and reducemedical errors

Improve Medicare and Rx drugprogram

Expand health insurance coverage forthe uninsured

Make health insurance more affordable

Total

Obamasupporters

McCainsupporters

Source: Kaiser Family Foundation Poll. N=1622 Registered Voters. 9/2008.

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The fundamental disagreement between the two The fundamental disagreement between the two camps comes in who is most responsible for making camps comes in who is most responsible for making sure that Americans have access to quality, sure that Americans have access to quality, affordable health care.affordable health care.

30%

47%

20%

23%

18%

54%

25%

31%

38%

0% 10% 20% 30% 40% 50% 60%

Employers andbusinesses

Individual persons

The Federalgovernment

Total

Obama supporters

McCain supporters

Source: Kaiser Family Foundation Poll. N=1622 Registered Voters. 9/2008.

Who should have the most responsibility for making sure Americans receive health insurance coverage?

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Two thirds of all voters were worried about Two thirds of all voters were worried about health care costs, and these voters broke health care costs, and these voters broke hard for Obama. hard for Obama.

Presidential Vote by Concern About Health Care Costs

60%

42%

56%

38%

Obama McCain Obama McCain

Source: CNN 2008 Exit Polls. 17,836 Interviews

Worried About Health Care (66%)

Not Worried about Health Care (33%)

202.776.9066 | www.lakeresearch.com | November 6, 2008

Health Care and The 2008 ElectionsHealth Care and The 2008 Elections

Celinda Lake