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MYSTERY POLLSTER
Health Exchanges: Good Enough For The Goose?
Obama Should Use His Congressional Address To Take On GOP Criticism
Wednesday night, in an address to a joint session of Congress, President Obama will provide more detailed descriptions that, according to recent reports, will spell out "exactly where he stands" on the issue of health care reform.
While much of the drama centers on what the president may say about the much-debated "public option," I want to focus instead on two ways Obama might better sell health care reform.
The Exchange. The first involves the still-obscure mechanism known as an insurance exchange (or gateway, as described by the Senate HELP Committee), intended to provide insurance to those without access to employer-sponsored insurance or existing public programs.
While the terminology can quickly get wonky, the basic idea is simple: Pool enrollees into a large group and create an entity that offers a choice of health insurance plans, creates rules regarding what those plans offer and how much they cost, and provides information to guide consumers on their options.
The pollsters at the Kaiser Foundation were able to ask about the exchange concept with a one-sentence description in their June survey: "If you had to get health insurance on your own, how helpful would you find an independent organization or exchange that provides a range of health insurance plans approved by the government?" More than two-thirds (70 percent) said it would be at least somewhat helpful (including 27 percent who said it would be "very helpful"). Only 26 percent said it would be not too helpful or not at all helpful.
Democrats should not dismiss the intrinsic appeal of Tom Coburn's dare: If it's good enough for us, why isn't it good enough for you?
An alternate version of the question said the organization would also "[guarantee] that participating plans would not deny coverage to those with pre-existing conditions or charge higher premiums to those who are in poorer health." The same 70 percent said the plan would be at least somewhat helpful, including 31 percent who said it would be "very helpful."
As a campaign pollster, I saw the appeal of this concept in tests we did six years ago on proposals to allow uninsured Americans to "buy in" to the Federal Employees Health Benefits Program that provides health insurance to all federal workers, including members of Congress.
We were surprised to learn in focus groups how many voters were familiar with the plan through federal workers who were friends or relatives and how quickly they approved of being able to choose from several reasonably priced health insurance options. Our experience mirrored results from a 1994 CBS News/New York Times survey of Americans that found 66 percent in favor of "allowing people outside the government who cannot get health insurance to participate in the federal government workers' health plan."
What's Good For The Goose. And speaking of the federal employee health care plan, an array of politicians have used its inherent appeal in a different way: to point out the disparity between the options available to members of Congress and ordinary Americans without health insurance.
Sen. Edward Kennedy, D-Mass., famously and repeatedly invoked the fact that members of Congress could get immediate treatment from the Capitol physician. "If health insurance is good enough for the president, the vice president, the Congress of the United States," he told the 1980 Democratic convention, "then it's good enough for you and every family in America."
In 1991, Democrat Harris Wofford upped the ante during his successful campaign for the Senate with a television advertisement promising to "cut off special health benefits for Congress until they pass a health care plan for this country."
And this year, the conservative Heritage Foundation turned the table on liberal supporters of health care reform by urging town hall attendees to ask legislators if they would "promise that you and your family will enroll in the public plan" included in the Democratic reform bills. Heritage also embraced an amendment sponsored by Sen. Tom Coburn, R-Okla., that would require all members of Congress and their staffs to enroll in the newly created public option plan.
The reluctance of some Democrats to endorse Coburn's proposal is understandable, given that it would mandate for legislators what would remain optional even for the uninsured. However, Democrats should not dismiss the intrinsic appeal of Coburn's dare: If it's good enough for us, why isn't it good enough for you?
So my advice to President Obama is to offer this rejoinder to critics like Coburn: Challenge Congress to pass a reform bill that requires all members to obtain their health insurance the same way as those without employer-provided health insurance -- through the newly created health care exchanges, rather than the Federal Employee Health Benefit Plan. The two systems are conceptually similar -- similar enough that the pledge could help sell voters on the benefits of the exchange itself.
I should note that when pollsters and political consultants float this sort of creative proposal, it tends to drive policy experts crazy. So to be responsible about it, I ran my admittedly half-baked idea by a few high-powered, nonpartisan health policy analysts. They cautioned that while the proposed exchanges are conceptually similar to the FEHBP, there would be important differences in the rules, and variations in the insured pools that would affect the pricing of premiums and complicate the process of allowing a big employer like the federal government to buy in. As one analyst put it bluntly, "I don't see members of Congress agreeing to get coverage from the exchange."
Perhaps. But public skepticism of reform is growing. The exchange is one concept that has the potential to attract broad popular support, especially if members of Congress find a way to demonstrate that what's good enough for the uninsured is good enough for them.
How about it, President Obama?
Previously in Mystery Pollster
- Don't Shoot The Pollsters (08/31/2009)
- Town Halls And Public Opinion (08/17/2009)
- Is Polling As We Know It Doomed? (08/10/2009)
- Huffington's Unintended Gift To Polling (08/03/2009)
- The Value Of Polling (07/27/2009)
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