Health Reform WK-EDGE Urban Institute analyzes Medicare for all and public option wishes
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Wednesday, December 18, 2019

Urban Institute analyzes Medicare for all and public option wishes

By Cathleen Calhoun, J.D.

What do a large number of adults think would be the next best thing in health insurance?

Just over half of adults under the age of 65 support either (1) a public option health insurance program, or (2) Medicare for All, with more preferring a public option, according to a brief by the Urban Institute. The brief noted that the Affordable Care Act (ACA) (P.L. 111-148) expanded health insurance coverage but coverage gaps and affordability issues remain. Options are now being discussed by both policymakers and presidential candidates and among the most talked about are Medicare for All and the public option. "Medicare for All" would enroll everyone in a single government-run plan with comprehensive benefits and no cost-sharing requirements. The "public option" would provide some or all people under the age of 65 the option to keep their private insurance or buy into a government-run plan, generally with larger premium and cost-sharing subsidies than under current law. The brief examined attitudes towards both, and assessed preferences between the proposals, while stating that findings in the brief are not intended to endorse or oppose any candidate for public office or the proposed platforms or policies of any candidate for public office.

Methodology. The Urban Institute used data from 9,619 participants in the September 2019 round of the Health Reform Monitoring Survey (HRMS), a nationally representative survey of adults ages 18 to 64. All participants were asked whether they support or oppose a public option and Medicare for All. In response to the questions, participants could say that they (1) strongly support; (2) somewhat support; (3) neither support nor oppose; (4) somewhat oppose, or (5) strongly oppose each proposal.

The Urban Institute also assessed variation by party affiliation. Those who identified as Democrat or as leaning Democrat were considered "Democrat" and those who identified as Republican or as leaning Republican were considered "Republican."

Findings. The findings were analyzed in three groups—all adults age 64 and under, Democrats, and Republicans:

  • Adults age 64 and under: 51.6 percent support either a public option or Medicare for All, with more preferring a public option. Nearly 25 percent are neutral toward both approaches.
  • Democrats: About 66 percent support either a public option or Medicare for All, with a slightly higher share preferring a public option to Medicare for All. About 25% were neutral toward both, and 9.1 percent did not support either approach and oppose one or both.
  • Republicans: Over 33 percent support either a public option or Medicare for All, including 24.5 percent who prefer a public option and 9.4 percent who prefer Medicare for All. About 20 percent were neutral toward both, and 44.6 percent do not support either approach and oppose one or both.

Limitations. The Urban Institute noted that the brief had several limitations, including the fact that the sample did not include adults 65 and older, and almost all of those adults are covered by Medicare. The survey also did not assess how much the respondents understood the public option and Medicare for All.

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