When it comes to understanding public opinion about the new health reform law, poll watchers might be forgiven for being confused as to whether or not the idea of repeal is actually popular.

Between September and October 2010, at least eight well-respected polls asked Americans whether they supported the idea of repealing health reform. The responses have been all over the map, ranging from a high of 51 percent in an NBC News/Wall Street Journal poll to a low of 26 percent in September’s Kaiser Health Tracking survey.

Why the range? After a closer look at the data, it seems the culprit may be the question’s wording. At the same time, recent polling suggests that, for at least some Americans, a vote for repeal means a vote to eliminate certain provisions of the health reform law while also keeping many of its benefits, rather than a desire to overturn the entire law.

Timing, administration, and sampling

One might expect that those surveys – which were conducted before several short-term patient protections kicked in on Sept. 23, might have found more support for repeal than those fielded after the big publicity push about these relatively popular provisions. In fact, to the extent that there is a pattern, it’s the reverse, with repeal numbers looking somewhat lower in the three surveys fielded in the first half of September. We can’t attribute the differences to the mode of administration or differences in the sampling population, either: All but two of the surveys were based on random sample surveys of all adults rather than on registered or likely voters – populations that are expected to tilt in a more conservative direction on the issues; the smallest survey has a respectable 721 respondents, and each was administered via telephone using live interviewers, rather than Interactive Voice Technology, the Internet, or other methodologies.

Poll fatigue

It’s hard to rule out the effects of poll fatigue out based on the data. While it’s true that the two lowest repeal numbers came from the questionnaires that placed the repeal questions at the beginning, before respondents had already gone through a number of other items, the biggest percentage in favor of repeal came from a survey that placed the item at question 14 – hardly as low as some other surveys carried it.

Wording and structure

Of the likeliest explanations for varying results, this leaves question wording and structure – both of which seem to be driving these rather dramatic differences.

First, wording: In describing the alternative to repeal, the two wordings that obtain the lowest percentages in favor of overturning the law both include language about “giving the law a chance” rather than offering a more black or white, “keep or repeal.”

The Pew/National Journal status quo option said “[Congress should] let the law stand and see how it works,” and Kaiser’s September health tracking survey item reads, “the law should be given a chance to work, with Congress making necessary changes along the way.” The items that garnered higher responses were more straightforward, particularly the NBC/WSJ survey, an item in a longer list of items in the same format, which asked simply, “Please tell me if this outcome would be acceptable or unacceptable to you: The health care reform plan that was passed earlier this year is repealed.” Clearly, when respondents are reminded that the newly passed law may need some time to work, or perhaps need to be modified, they are less interested in overturning it in the short term.

Second is the issue of question structure: Each of the four surveys with the lowest proportion in favor of repeal first gave respondents an opportunity to weigh in with their overall views on health reform and whether they like it or dislike it, and then only asked those with a negative view of the law whether they would support repeal. In the four surveys with somewhat higher repeal numbers, on the other hand, respondents were asked to consider repeal without first being asked if they support or oppose the law in general. It’s difficult to know what to conclude about this. It’s possible that the surveys that ask Americans about repeal right off the bat are, to some extent, picking up a generic opposition to the bill that has no other channel through which to flow. On the other hand, it’s possible that by not asking those with favorable views of the law whether they want it repealed, other surveys are missing some liberals who might be satisfied with the bill but prefer to repeal it in favor of something that goes even farther.

The one survey that somewhat complicates this wording and structural analysis is the CNN/Opinion Research poll, which obtains a fairly high repeal percentage (47 percent) in a different question format from the others.

The item, which is the first in the survey to mention health reform, is the only one to include three specific options rather than just two.

  • The first is a “leave as is” option, which does not include language suggesting that this might include making needed fixes.
  • Second is an option which allows respondents to say they want to take the legislation even further, including references to ‘increased government involvement’ (“Congress should make additional changes to increase the government’s involvement in the nation’s health care system”).
  • Finally, the repeal option specifically mentions the idea of passing an entirely new piece of legislation (“Congress should repeal most of the major provisions in that bill and replace them with a completely different set of proposals”), which might appeal to people without making clear that any new set of proposals would involve tradeoffs.

What does it all mean?

While it’s hard to reach any definite conclusions in this kind of analysis, there are some big picture observations worth making. We know from this and other polling that roughly half – or just under half–of the public holds unfavorable views of health reform. The current analysis suggests that many, if not most, of these Americans would not be upset if Congress were able to repeal the new health reform law – at least until they realized that some of the law’s more popular provisions would be part of such a repeal. It’s less clear which proportion of Americans are demanding repeal, as opposed to expressing a more passive opposition to the law. If offered an option of saying it would be best to first give the law a chance to work, some in the opposition camp would likely choose that option over immediate repeal. And the current crop of surveys do not provide any good means of estimating the intensity with which those who advocate repeal would push their cause, to differentiate those for whom saying ‘repeal’ is just another way of saying ‘I don’t like it’ from those who would rank overturning health care reform high on their policy agenda.

Source: Kaiser Family Foundation