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 recent study that appeared in 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. 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.
Overall, only 48 percent of respondents expressed support for an individual mandate. The stand-alone mandate garnered majority support from self-described Democrats (56 percent), those making under $30,000 (59 percent) or over $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. 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).