Support for Massachusetts landmark health reform law rises in 2011, poll finds

Despite a difficult financial environment in the state, the poll found that 74% want the law to continue, with 51% favoring continuing it with some changes and 23% continuing it as is. Only 9% of state residents favored repealing the health reform law. There has been virtually no change in those wanting to repeal the legislation since the 2009 poll (10%).

A central piece of the legislation is a mandate for all uninsured Massachusetts residents to purchase health insurance or pay a fine, with some exemptions and financial support for low-income residents. Support is lower for the mandate provision than for the overall law. About half (51%) of Massachusetts residents say they support this mandate, while 44% oppose it.

"The picture of how the Massachusetts health care law is working out is different than many national commentators suggest. Most people in Massachusetts approve of this law, and it hasn't negatively affected them," said Robert Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.

Impact of the Law on Individuals

The principal intent of the Massachusetts legislation was to provide health coverage for nearly all of the state's residents, and Massachusetts now is the only state where nearly all of the population has health insurance coverage. The poll found that 68% of residents thought the health reform law was successful in reducing the number of uninsured in the state, 14% thought it was not successful, and 8% were unsure.

The poll asked respondents about the impact of the health reform law on their own health care in terms of costs, quality of care, their ability to pay medical bills if they were to get sick, and the amount of time it takes them to get an appointment with a physician. On the latter three measures -- quality of care, ability to pay medical bills, and amount of time it takes to get an appointment -- a majority or near majority felt the law did not have much of an impact on them. Looking at those who reported an impact, more thought it helped than thought it hurt their quality of care (22% vs. 14%) and their ability to pay their medical bills (27% vs. 13%). There was no statistical difference between those who thought it was helping versus hurting the amount of time it takes to get an appointment with a doctor (13% helping vs. 17% hurting). The public felt somewhat differently about the law's impact on the cost of their care -- only 33% said it did not have much of an impact on the cost of their own care, while roughly half said the law had an impact on those other aspects of their care. Looking at those who thought the law did have an impact on the cost of their care, 30% said it hurt while 23% said it helped; this difference was not statistically significant.

Impact of the Law on Health Care Costs Across the State

Health care costs in Massachusetts have risen in recent years for many people. When asked about the main factors that are influencing rising costs in Massachusetts, only 20% of residents said rising costs were due mainly to the health insurance law, while 72% thought rising costs were due to other factors. The Massachusetts public is split on whether the state can afford to continue with this law as it currently stands. Forty-two percent said it could afford to continue, 38% said it could not, and 9% were unsure.

"Massachusetts is a high health care-cost state, but most residents do not blame the health care law for rising costs," says Gillian SteelFisher, Assistant Director of the Harvard Opinion Research Program and Research Scientist at the Harvard School of Public Health.

Views on National Health Care Legislation

Some analysts have suggested that the Massachusetts law served as a model for national health care legislation passed by the U.S. Congress in March 2010, and the poll asked residents about their overall support for that national legislation. More Massachusetts residents support the national health care legislation of 2010 than oppose it (40% vs. 27%), while 24% say they neither support nor oppose it. Comparing these results to the most recent national polling data using the same question wording (AP-GfK Poll conducted by GfK Roper Public Affairs & Corporate Communications; March 24-28, 2011), Massachusetts residents appear to be more favorable toward the national legislation than the nation as a whole. The AP-GfK poll found that fewer adults in the U.S. supported the legislation of 2010 than opposed it (35% vs. 45%), while 17% neither supported nor opposed it.

The Massachusetts poll also asked residents' for their views on whether or not the Massachusetts law should have been used as a model for the national health care legislation, as former Massachusetts Governor Mitt Romney has taken the position publicly that it should not have been. The Massachusetts public is nearly evenly divided as to whether or not they agree with former Governor Romney; 43% say the Massachusetts law should have been used as a model for national law while 47% say it should not have been and 8% are not sure.

Methodology

The Massachusetts Health Reform Poll was conducted by the Harvard School of Public Health and The Boston Globe. Representatives of the two organizations worked closely to develop the survey questionnaire and analyze the results of the poll. The Boston Globe and the Harvard School of Public Health are publishing independent summaries of the poll's findings, and each organization bears sole responsibility for the work that appears under its name. The Harvard School of Public Health and The Boston Globe paid for the survey and related expenses.

The project team was led by Robert J. Blendon, a professor who holds joint appointments at the Harvard School of Public Health and the Harvard Kennedy School, and Gideon Gil, Health and Science editor of The Boston Globe. The Harvard research team also included Gillian SteelFisher, Johanna Mailhot and Kathleen Weldon.

Interviews were conducted with 537 randomly selected Massachusetts state residents, ages 18 and older, via telephone (including cell phones and landlines) by Social Science Research Solutions of Media, Pennsylvania. Interviews were conducted in English and Spanish. The interviewing period was May 24-26, 2011. The data were weighted to reflect the demographics of the state's 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 Massachusetts adult population had been interviewed. The sampling error for this survey for questions asked of the whole population is ±5.32 percentage points at the 95% confidence level. The size of this error varies with the number of persons surveyed and the magnitude of difference in responses to each question.