11/10/2009 04:09 pm ET | Updated May 25, 2011

What's Up With the Health Care Reform Polls?

If you look at our chart mashing up the various pollster questions that track support or opposition to health care reform, it is hard to miss that the red "opposition" line has been rising during October. Why?

Keep in mind that differences in methodology (question wording, populations sampled) produce huge variation in the results. Use the chart's "plot" tool to hide the trend lines, and you see quite a bit of overlap between the dots representing individual poll results for favor (black) and oppose (red). As such, the "nose" of this particular chart gets fooled more often than election charts when the most recent polls come from pollsters that are typically skewed in one direction or another.

In this case, however, the change looks to be real. First, try using the "smoothing" tool to change to the "less sensitive" setting, which effectively reduces the influence of the most recent surveys on the trend line. Doing so in this case shows the same upward drift in the oppose line.

Second, forget the chart and focus on apples-to-apples comparisons for three pollsters that released new surveys over the last week:

  • Last week, CNN/ORC showed 45% of adults favoring "Barack Obama's plan to reform health care" and 53% opposed. That represents a reversal since mid-September, when 51% were in favor and 56% opposed.
  • Gallup shows initial support for the "health care legislation now being considered by Congress" falling sharply from 38% in mid-September and 40% in early October to 28% this week, with opposition remaining flat and "or do you not have an opinion" jumping sharply (from 22% to 33% since mid-September). When Gallup pushes their adult samples to say which way they lean, their results look similar to the CNN poll: 43% support or lean to support while 48% are opposed or lean that way -- a reversal since September and mid-October.
  • Last week's IPSOS/McClatchy poll shows a similar change: Earlier in the month, their adult sample divided on "the health care proposals now being discussed" (40% favor, 42% oppose). Their survey last week shows 39% in favor and 49% opposed.

Mickey Kaus noticed the trend in the IPSOS/McClatchy poll last week and asked what this apparent change might be about. Here is my take.

The most important thing to remember is that Americans most likely to be shifting their opinions are those least engaged in news about the ongoing Congressional health care debate. And even though most of the Pew Research News Index surveys in recent months show large majorities who say they are "closely" following the debate, they also find that nearly half of adults (44%) do not know that the "public option" deals with health care, while four-out-of-five cannot pick Max Baucus' name from a list of four senators as the chair of the Senate Finance committee working on health care.

Bob Blendon, the widely respected Harvard academic who has studied public opinion on health for much of his career, makes a similar point in a just published article in the New England Journal of Medicine (co-authored by John Benson, summarized on Kaiser Health News and blogged about yesterday by Karen Tumulty):

Most Americans are not health policy specialists, and they are unlikely to read a long and complex piece of legislation. Instead, they will rely on trusted intermediaries to clarify its likely impact on them. The President and congressional leaders play a critical role, but public confidence in leaders in Washington is not universally high.

As he has argued all along, Blendon believes that as the health care debate comes to a close, the "most important factor in determining the level of public approval" will be "Americans' impressions of the legislation's likely impact on their own situation. Support for or opposition to specific elements of the legislation and concerns about the need for reform in general will be secondary influences."

In that context, here are two theories about what might be behind the October trend:

1) More negative ads from reform opponents - CNN reports:

Opponents of President Obama's approach to health care reform have outspent supporters by more than $7 million in the past 30 days... "We are starting to see a separation in the messaging," said Evan Tracey, president of CMAG and CNN's consultant on political television advertising. "Groups that are opposed to President Obama's health care plan are starting to turn up the volume in key states to put pressure on lawmakers to vote against these bills."

2) Process coverage and Democratic disunity - As always, news coverage tends to focus on the legislative process - who is up, who is down and what tactics are working or not working. In September, President Obama's speech largely rallied Democrats who were generally upbeat and supportive in public comments. Over the last few weeks, however, the story reverted to previous form: Most coverage focused on threats of filibuster or non-support from Senators Landrieu, Bayh, Lieberman, etc. in contrast to the relatively unified opposition of the Republicans. My guess is that the contrast of Republican opposition and Democratic squabbling gives greater credibility to the Republican arguments against reform.

I called Blendon for his reaction, and he largely agrees. He points to the Gallup result showing 26% of adults who say the health care bill will "make your own health care situation better," 36% who say it will make it worse and 31% who think it will not make much difference. "In the absence of not having a fixed view of what this [reform bill] is and how it will work out for me," he said, Americans are "more susceptible to advertising."

In the same context, Americans are also watching the news coverage focused on the legislative process and "getting more scared." He said he watched the cable news coverage following passage of the bill on Saturday night and saw "not a word telling you why you should care if the thing passes."

Blendon still believes, as he and Benson argue in NEJM, that "public opinion is still fluid on the key question about the impact of the legislation." Again, the percentage that say they will be worse off still falls far below a majority, and Gallup has tracked in increase in the initial "not sure" response (from 22% to 33%) over the last month. Proponents of health care, Blendon argues, must invest time telling seniors and others who stand to benefit "how they will be better off...that's the thing they have to do to turn this around."

Subscribe to the Politics email.
How will Trump’s administration impact you?