Public Opinion Watch

Covering polls and related articles from the week of February 23–29, 2004

In this edition of Public Opinion Watch:
• Vulnerabilities of the Medicare Prescription Drugs Law
• Public Opinion on the No Child Left Behind Act

Vulnerabilities of the Medicare Prescription Drugs Bill
Ipsos/Associated Press poll of 1,000 adults, released February 25, 2004 (conducted February 16–18, 2004)
Kaiser Family Foundation poll of 1,201 adults, released February 26, 2004 (conducted February 5–8, 2004)

Recent news reports indicate that the Medicare prescription drugs law continues to get a tepid-to-hostile reaction from the public, especially seniors, the intended beneficiaries of the legislation. To understand this poor reception, it’s instructive to review how public opinion evolved on the issue. Such a review shows that the current political problems of the law were foreshadowed every step of the way by public opinion as the bill moved toward passage.

July 2003

In a July Gallup report on attitudes toward Medicare reform, seniors opposed, by 69 percent to 24 percent, an effort to shift most Medicare recipients into managed care plans. And, by 63 percent to 20 percent, seniors believed that the new Medicare bills then being considered by Congress would not do enough to help pay the cost of prescription drugs.

Another Gallup report in the same month showed that Bush’s job approval dropped twelve points among seniors in the second half of June, a period when coverage of the Medicare prescription drug bills was particularly intense.

October 2003

As the Medicare bill continued to move toward passage, an October CBS News/New York Times poll showed that Bush’s approval rating was just 41 percent among those age 65 and older, a fall of 22 points since May of that year.

An October Washington Post poll showed that Bush’s approval rating on prescription drugs for seniors was an abysmal 35 percent and his approval rating on the cost, availability, and coverage of health insurance was a dreadful 31 percent, with 60 percent disapproval.

November 2003

According to a poll taken right before passage of the bill by Peter Hart Research for the AFL-CIO, almost two-thirds of voters age 55 and older thought Congress and the White House should work for a better Medicare prescription drug plan than the one on offer. Just 19 percent wanted Congress to pass the bill under consideration.

The same poll found that 65 percent of these voters viewed the drug plan unfavorably and the same number viewed the subsidies for private HMOs unfavorably. Also, 64 percent opposed the bill’s provisions to ban importation of drugs from Canada and an overwhelming 78 percent said that the bill didn’t do enough to protect retirees now covered by employer-provided prescription drug plans.

Another poll taken around the same time by the University of Pennsylvania’s Annenberg Public Policy Center found that, based on a carefully worded neutral description of the bill, the public as a whole opposed the bill by 42 percent to 40 percent, registered voters opposed it by 44 percent to 39 percent, those over age 50 opposed it by 49 percent to 36 percent, and those over age 65 opposed it by 49 percent to 33 percent. And, interestingly, those holding a favorable opinion of AARP, which of course endorsed the bill, opposed its passage 45 percent to 38 percent.

December 2003

When the ink was barely dry on the law, the Washington Post found that strong pluralities of both seniors (47 percent to 26 percent) and those age 55 to 64 (46 percent to 32 percent) disapproved of the Medicare changes voted by Congress. These findings led nonpartisan pollster Andrew Kohut to say, “This is a surprisingly tepid reaction to this big legislation.”

More evidence of seniors’ dismay was provided by a Gallup poll released about the same time. Seniors just barely said (46 percent to 39 percent) that they favored the new prescription drug benefit for Medicare recipients. That’s amazing for a group that had just received a new benefit.

And, by 44 percent to 38 percent, they said that they opposed the changes made in Medicare coverage. Moreover, 85 percent said that they were very (56 percent) or somewhat (29 percent) concerned that the Medicare changes wouldn’t go far enough in helping seniors pay for their prescriptions; 78 percent said that they were very (58 percent) or somewhat (20 percent) concerned that these changes “benefit prescription drug companies too much”; and 73 percent said that they were very (48 percent) or somewhat (25 percent) concerned that the changes would force some Medicare recipients into HMOs.

Finally, by a lop-sided 59 percent to 28 percent margin, seniors thought that the new Medicare plan would do more to benefit prescription drug companies than Medicare recipients.

January–February 2004

A January Gallup poll found that 62 percent of seniors (compared to 53 percent among the population as a whole) said that the new prescription drug benefit did not go far enough. And in February, an Ipsos-Associated Press (AP) poll found that, by 71 percent to 26 percent, the public thought that the government should negotiate with drug companies for lower drug prices, rather than allow drug companies to set their prices without government interference. The poll also found that, by more than two to one (65 percent to 32 percent), the public thought that the government should make it easier to important drugs from Canada. Finally, after all the GOP’s efforts on the prescription drugs issue, the poll found that the public strongly favored the Democrats over the Republicans (52 percent to 33 percent) as the party most likely to make prescription drugs more affordable.

Also in February, a poll by the Kaiser Family Foundation found that seniors, by more than three to one (55 percent to 17 percent), had an unfavorable impression of the new law. Moreover, among those who knew the law had been passed and signed into law (just one-third of seniors), an overwhelming majority (73 percent) had an unfavorable impression of the new law.

These data suggest a couple of key areas of vulnerability for the GOP around this legislation: inadequate coverage and no curbs on prices.

Of the two, inadequate coverage presents the most glaring vulnerability. As the data above suggest, seniors already see the benefit, in a general way, as not going far enough. And, once seniors are informed of the specifics of the coverage, particularly the “doughnut hole” in coverage between $2,250 and $5,100 in out-of-pocket costs, it really sends them through the roof, according to both news stories and focus group research.

This is just not what seniors had in mind when they envisioned a prescription drug benefit. As nonpartisan analyst Charlie Cook presciently observed back in July 2003, when negative sentiment about the impending bill was starting to become obvious:

Even the most cursory look at polling data and reports from focus groups indicates that senior citizens have very specific ideas of what they expect in a prescription drug benefit. What they have in mind is something resembling what a Fortune 500 company provides (or used to provide) employees: A modest premium, minimal co-pay, no gaps, no restrictions on what drugs physicians can prescribe and unlimited coverage.

Cook concluded, given that the drug benefit likely to be passed didn’t look anything like this, that “If the prescription drug benefit is a factor in next year’s election, it will be as an albatross around the necks of Republicans and the Bush administration.”

Exactly. Seniors just aren’t getting anything close to what they had in mind and this discrepancy, so vividly encapsulated in the doughnut hole, is potentially a very, very serious problem for the GOP.

But the issue of no curbs on prices is also very important. The AP data indicate that the public overwhelmingly favors the use of government negotiating power to lower drug prices. And, as with the doughnut hole in coverage, reports from the field indicate that seniors are outraged to learn that the bill expressly prohibits the government from doing so.

The issue of failing to curb prices gains additional force from its relation to the generic problem of escalating health care costs. Poll after poll shows that the most serious overall health care worry for voters is costs and that, in fact, concern about health care costs is either at the top or near the top of voters’ economic worries. The general perception is that these costs are out-of-control and are more likely than any other factor suddenly to bankrupt or impoverish a family. Failure to control drug prices is just one more example of this critical problem that the GOP, in the public’s eyes, has done little to address.

These two broad areas of vulnerability suggest that the GOP in 2004 may have a hard time defending their greatest programmatic achievement in the domestic area.

Public Opinion on the No Child Left Behind Act

The February 22 New York Times had a fascinating article on the huge difficulties administration officials are having selling the No Child Left Behind (NCLB) Act in rock-ribbed Republican Utah. To say they’re getting a skeptical reception would be to understate the case considerably.

In light of this reception, which has been duplicated in numerous states around the country, Democrats may be tempted to run hard against NCLB and say, implicitly or explicitly, that it needs to be gotten rid of. A review of public opinion data on NCLB suggests they should resist that temptation.

Public opinion on public education consistently has shown that the public has a two-point program for education reform: more accountability and more resources. The linkage between the two is neatly captured by a result from a 2001 Education Testing Service (ETS) survey. Respondents were asked what was the best way to improve the quality of the public education: more funding, accountability, or both funding and accountability. The dominant response was both funding and accountability (48 percent), rather than simply more funding (25 percent) or accountability (23 percent).

In many ways, this was the premise of the bipartisan NCLB. Backers of the bill, who not only included the Bush administration and its congressional allies but also Democratic liberals such as Ted Kennedy and George Miller, maintained that the strict standards set by the law would be accompanied by increased funding that would help schools, particularly those with many at-risk students, meet those goals.

The public for its part, was also favorably disposed toward the bill in the period before its passage. The 2001 ETS poll, for example, reported support levels ranging from 58 percent (funds tied to performance) to 93 percent (funding for K–3 reading) for the very general provisions of the bill, with the emphasis on annualized testing scoring about in the middle of that range (76 percent to 78 percent). The poll also found, however, that a large chunk of the public—about two-fifths—did not have any real knowledge about the bill prior to being asked about it on the survey. A 2002 Gallup/Phi Delta Kappa (PDK) poll, conducted roughly five months after passage of the bill, found similar support levels for NCLB’s general provisions, combined with the same lack of prior knowledge of NCLB among two-fifths on the public=

Since that period leading up to and right after NCLB’s passage, however, the bipartisan consensus around education policy has broken down. Critics describe the NCLB as being inflexible and constituting, in many ways, an “unfunded mandate” on the states. Recently, we have had the spectacle of Republican-dominated state legislatures in Ohio, Virginia, and Utah severely criticizing the law and threatening to opt out of federal funding to avoid being subject to it.

Unfortunately, it is difficult to gauge how much public support for NCLB actually has shifted due to the lack of knowledge problem and the lack of consistent time series data (that is, there hasn’t been a study that asked questions about NCLB in the same way, from passage of the bill to the current time period). However, there are certainly indicators that the public has serious problems with many specific aspects of NCLB implementation.

In terms of testing, the public, in a 2003 Gallup/PDK poll, overwhelmingly (84 percent to 14 percent) said that the best way to judge a school’s performance is to see whether students show reasonable improvement from where they started, rather than whether they meet a fixed standard, as specified in NCLB. And, in the same poll, by more than two to one (66 percent to 32 percent), the public thought that a single test, as in NCLB, cannot provide a fair picture of whether or not a public school needs improvement. The public also strongly endorsed the idea (72 percent to 26 percent) that a single test cannot judge a student’s proficiency in English and math accurately. And, in a January, 2004 Greenberg Quinlan Rosner/Tarrance Group/National Education Association (GQR/TG) poll, 67 percent agreed that the law was unfair because it labels schools as “failing” if one group of students doesn’t do well on a test, even if the vast majority do; 71 percent agreed that some kids should be given more time to pass tests for their grade due to differing ability levels; and 89 percent supported a proposal to allow schools to evaluate students’ progress on a number of criteria in addition to standardized tests, including classroom performance and graduation rates.

In terms of sanctions and funding, in a January 2004 CBS News/New York Times poll, the public, by 58 points (77 percent to 19 percent), opposed using the results of tests to withhold federal funds from those schools where students perform poorly. And over four-fifths (81 percent) in the GQR/TG poll wanted schools to be given more time before penalties were assessed if funding promised under NCLB had not been given to these schools. In the same poll, by 60 percent to 38 percent, voters supported increased funding, rather than cuts, for schools that are not able to meet federal testing standards.

On the other hand, there is little evidence that the public rejects the law itself or wants to do away with it. General descriptions of the law, particularly its goals and emphasis on accountability, continue to elicit strong public support. But it seems fair to say that the public would be supportive of changes that would make NCLB more flexible and better-funded. That’s the sweet spot for Democrats in criticizing NCLB—not opposing the act, but seeking to reform it in line with the public’s twin commitments to effective accountability and more funding.

Ruy Teixeira is a senior fellow at the Center for American Progress.