Iowans really, really don't like the Senate Republican health care bill

Only 27 percent of Iowans support the Senate Republican proposal to repeal and replace the Affordable Care Act, according to a recent Public Policy Polling survey. By a 20-point margin, respondents said Senator Joni Ernst "should fix and improve our current health care law" rather than "continue trying to pass the Republican plan to repeal and replace it" when Congress goes back to work after the July 4 recess.

Those numbers reflect answers given before respondents had heard any negative messages about specific provisions in the Better Care Reconciliation Act, which Senate leaders hope to bring up for a vote soon.

Public Policy Polling's automated telephone poll reached 784 Iowa voters between June 30 and July 1. The questionnaire, toplines, and cross-tabs are available here. The Save My Care coalition, which opposes repeal of the 2010 health care reform law, commissioned the Iowa poll and similar surveys in Colorado and North Carolina to draw attention to the possible impact of health care policy on key U.S. Senate races in 2020.

Republicans often discount PPP surveys, saying the company is a Democratic pollster. But the sample of this poll looks representative of Iowa's electorate. Results for questions 12 through 16 show that 48 percent of respondents said they voted for Donald Trump last year, 39 percent for Hillary Clinton. (Trump won the state by a little more than 9 points.) About 31 percent of PPP's respondents identified themselves as Democrats, 33 percent Republicans, and 36 percent independents, which is not far off the actual partisan makeup of Iowa's registered voters. Some 29 percent of respondents said they were between the ages of 18 and 45, 39 percent between ages 46 and 65, and 32 percent older than 65. This statewide statistical report shows the age breakdown of Iowa voters in the 2014 midterm election. Turnout rates are significantly higher for older voters.

A frequent problem with partisan polling is "priming" respondents by putting leading questions about issues before questions about preferences. PPP's survey wasn't structured that way. Respondents heard neutral questions first: about the president's job performance (46 percent approve of Trump, 49 percent disapprove), Ernst's job performance (47 percent approve of Iowa's first-term U.S. senator, 41 percent disapprove), and a ballot test of Ernst against an unnamed Democratic opponent (48 percent inclined to support Ernst, 41 percent the Democrat).

When asked "How important is the issue of healthcare when deciding who to vote for in this next midterm election," only 8 percent of Iowa respondents answered "not that important" or "not important at all," compared to 32 percent who said it was the "most important" issue to them, 43 percent who said "very important," and 17 percent who said "somewhat important." That's not surprising, given how access to health care and health insurance can be a major factor in the quality of a person's life. The controversy over repealing the Affordable Care Act and problems in Iowa's health insurance market have also been big news stories in recent months, raising the salience of the issue.

Question 5 asked respondents, "As you may have already heard, the U. S. Senate is considering a new health care law. Do you approve or disapprove of the Senate Republican’s health care repeal and place plan that is currently being debated?" The question wasn't loaded with negative information, as sometimes happens in partisan polling. Only 27 percent of respondents said they support the GOP bill, 54 percent oppose it, and 19 percent were unsure.

Asked if they would be more or less likely to vote to re-elect Ernst if she voted for this health care repeal bill, 47 percent of respondents said they would be less likely to vote for her, 24 percent more likely, 23 percent no difference, and 5 percent unsure.

Asked what Ernst should do when the Senate reconvenes, 54 percent of respondents said she "should fix and improve our current health care law known as the Affordable Care Act passed in 2010," while only 34 percent said "she should continue trying to pass the Republican plan to repeal and replace it." About 12 percent of respondents were unsure.

Worth noting: at this point in the PPP survey, respondents had not heard about any specific provisions in the Senate GOP's bill.

The PPP poll then asked four questions about elements of the Republican proposal. The first related to the lack of public input on a bill being drafted in unprecedented secrecy: "The Senate bill will be passed without any public hearings from health care experts or constituents who would be impacted by repeal. Democrats were excluded from it and it would pass with only Republicans in support. Does hearing this give you very serious concerns, somewhat serious concerns, no real concerns, or are you not sure?" About 57 percent of respondents said "very serious concerns," 14 percent "somewhat serious." Only 20 percent said "no real concerns," and 8 percent were not sure.

The next question related to the prospect of dropping "essential health benefits" that the Affordable Care Act requires in health insurance policies. (Ernst and Senator Chuck Grassley have both expressed support for more flexible insurance plans that aren't required to cover so many services or conditions.) "The Senate bill would no longer guarantee coverage for basic services like hospital visits, maternity care, opioid addiction treatment and cancer screenings – meaning you would have to pay more to get coverage for these services or pay out of pocket." About 61 percent answered "very serious concerns," 19 percent "somewhat serious," and only 16 percent "no real concerns," with 4 percent unsure.

The next question related to the Republican proposal to allow insurance companies to charge policy-holders over age 50 much more: "The bill could raise your health care costs by 74% for the same insurance coverage and allow insurance companies to charge people over 50 up to 5 times more for their coverage." This time 75 percent said "very serious concerns," 9 percent "somewhat serious," 13 percent "no real concerns," and 3 percent unsure.

The next question drew from the Congressional Budget Office assessment of the last draft of the Better Care Reconciliation Act: "Under this bill, 22 million Americans would lose health insurance, including 4 million with coverage from their employer, and 35% would be cut from Medicaid – putting seniors and people with disabilities at risk." About 67 said this information raised "very serious concerns," 13 percent "somewhat serious," 17 percent "no real concerns," 3 percent unsure.

Remember: This recorded survey asked whether respondents backed the Senate health care bill (only 27 percent said they supported it) and whether Ernst should work to fix the current health care law (54 percent) or try to repeal and replace it (34 percent) before the respondents had heard any of those statements about particularly harmful elements of the Republican proposal.

Ernst has scheduled a town hall meeting for Monday, July 10, starting at 8 am in Harlan Community High School (Shelby County). I'm not aware of any other public events where Iowans could question her about health care policy. Around dinnertime on July 5, with no advance notice, she held a "telephone town hall" that was over in less than 30 minutes after the senator took a few friendly questions.

Grassley isn't holding any public town halls during this recess, to my knowledge. He has been touring southeast Iowa, meeting with business groups or others at invitation-only events. James Q. Lynch reported for the Cedar Rapids Gazette from Mount Pleasant,

U.S. Sen. Chuck Grassley is not as optimistic as he was a couple of weeks ago that Congress will approve health care reforms.

“Compared to how optimistic I was the week before now ... I’m very pessimistic,” Grassley said in Mount Pleasant Thursday. [...]

Despite the difficulties majority Republicans have had marshaling the votes to replace Obamacare, Grassley said he doesn’t “have a right to be pessimistic because we all know something’s got to be done.”

Rather than “repeal and replace,” he told reporters after speaking to the Mount Pleasant Rotary Club, Grassley said Congress may opt for “repeal, then replace.”

That would “put pressure on Congress to do something instead of dancing around like we’re doing now,” the Iowa Republican said. “You’d still have Obamacare as it is for another year or two” while Congress figures out what should replace it.

Iowans who want to urge our senators to oppose the Better Care Reconciliation Act should call or visit any of their Iowa offices. Contact information is at the end of this post, which also includes many facts and figures about the Senate GOP proposal.

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