Most Americans don't support an "individual mandate" for health insurance, although they do support a "shared-responsibility" plan that combines an individual mandate with expanded roles for employers, government and insurers.
This according to a new study on the Web site of the journal Health Affairs.
"The administration and key Congressional Democrats have put forward shared-responsibility approaches to expanding coverage," said study co-author Bob Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "The individual mandate provides the vehicle for universal coverage, but public support for mandate-based reform increases markedly, particularly among African Americans and upper-income people, if requirements for government, employers and insurers are also included."
The paper's lead author, Tara Sussman, a doctoral candidate in the Ph.D. program in health policy at Harvard, said public support is even higher for a coverage mandate limited to children, but that would not achieve universal coverage except as a transitional measure.
In a telephone survey of 1,704 adults age 18 and older, conducted Feb. 14-24, 2008, half of the respondents were asked about a stand-alone mandate and the other half were asked about a shared-responsibility plan containing an individual mandate. In both cases, respondents were told that everyone would be required to have insurance, with a fine for those without coverage and government help for low-income people.
Sussman and her co-authors note that attitudes might have shifted since the survey was conducted.
Overall, only 48 percent of respondents expressed support for an individual mandate on its own. The stand-alone mandate garnered majority support from self-described Democrats (56 percent), those making less than $30,000 (59 percent) or more than $100,000 (53 percent) annually, and those with less than a high school education (66 percent).
By contrast, only 36 percent of Republicans and 38 percent of those with some college education or an associate's degree expressed support, and the stand-alone mandate also failed to obtain majority support among those making between $30,000 and $100,000.
However, a shared-responsibility approach with an individual mandate was considerably more popular than a stand-alone mandate. Overall, 59 percent of the public supported this approach. Spreading responsibility among government, employers, insurers and individuals was more popular than a stand-alone mandate among all subgroups of respondents, and this shared-responsibility approach obtained 50 percent support or better in each subgroup except Republicans (44 percent).
The biggest increases in support for a shared-responsibility approach, as compared to a stand-alone individual mandate, were found among those making $80,000 to $100,000 and among African Americans. Seventy percent of respondents in the $80,000-$100,000 range supported a shared responsibility approach, versus 27 percent who supported a stand-alone mandate.
The idea of shared responsibility is particularly popular among African Americans. Eighty percent supported the shared-responsibility approach, versus 56 percent who supported a stand-alone mandate.
Sixty-five percent of respondents and majorities of both parties backed a coverage mandate limited to children.
"Policymakers in favor of mandate-based reform would do well to emphasize the arguments for it that resonate with people of both parties – that it is the right thing to do, that it will provide better care for the uninsured, and that it will save money for the insured," wrote the report's authors.