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Press Release · February 23, 2005

Picture Of Health? Californians Prefer To Make Health Policy At The Ballot Box

Affordability of Health Care, Uninsured Key Concerns

SAN FRANCISCO, California, February 23, 2005 — Fueled by their lack of trust in government and concern about the cost of health care, Californians seek a greater role in health policymaking at the state level, according to a report released today by the Public Policy Institute of California (PPIC), with funding from The California Endowment. But although state voters made a number of significant health policy decisions at the ballot box last November, being in the driver’s seat has not improved their perception of the health care system.

The study, based on a large-scale public opinion survey of California voters taken directly after the November 2nd election, is the first comprehensive analysis of how voters make health policy decisions. A solid majority (58%) believe state voters – not the governor or legislature – should set health policy, while less than one-third (32%) think elected officials should lead the way. But participation doesn’t necessarily equal satisfaction: Over half (55%) of voters say they felt the same way towards the health care system after the November election as they did before voting, despite the fact that they decided the fate of five health-related ballot measures. Nearly half (49%) say the state’s health care system is in worse shape today than it was a decade ago, while only 15 percent believe it is in better shape.

If participating doesn’t improve voter perceptions, what’s driving their interest in ballot box policymaking? Half (51%) of California voters say they have little or no trust in state government to do what is right, but 55 percent say they have at least a fair amount of trust and confidence in the state’s voters. As a result, support for the initiative process is strong: Over three-fourths (78%) think the citizens’ initiative has been a good thing for California and 61 percent believe that public policy decisions made through the initiative process are better than those made by the governor or legislature.

“The initiative process is here to stay, even though voters see its flaws, because they view it as a better option than putting policy decisions in the hands of elected leaders,” says PPIC Statewide Survey Director Mark Baldassare. “We can expect more health-related policies to be decided directly by voters.”

When it comes to health issues, voters are clearly engaged: Over three-quarters (77%) say they followed November’s health measures at least fairly closely. Proposition 71 – the measure to fund stem cell research – drew the most attention (49%), followed by Proposition 72 (health care coverage requirements, 16%), and Proposition 61 (children’s hospital bonds, 12%). However, voter concern about a topic doesn’t necessarily translate into success at the ballot box: Although 84 percent of voters say the issue of California’s uninsured is at least somewhat of a problem, Proposition 72 did not pass. One reason for its defeat? Despite the perception that employer-provided insurance is important, 77 percent of voters say the financial burden of requiring small and medium employers to provide health benefits is a problem.

Majorities of voters believe the state does not spend enough on mental health programs (55%) and say the federal government spends too little on stem cell research (52%) – measures to fund both programs passed in November. One reason for their success? These measures don’t affect the pocketbooks of most voters directly (stem cell research will be supported by bonds and mental health funding will be generated from a tax on income over $1 million). “No matter how important the issue, voters generally have misgivings about dipping into their own wallets – especially when they have little confidence in how government spends their tax dollars,” says Baldassare. When asked why they voted no on Proposition 67 (emergency medical services funding), three in four voters said they were opposed to all new fees and surcharges (43%) or they wanted to avoid paying higher telephone bills (29%).

The report, Making Health Policy at the Ballot Box: Californians and the November 2004 Election, was authored by Mark Baldassare and PPIC research associates Renatta DeFever and Kristy Michaud.

More Key Findings

  • Partisan Health — Page 9
    A majority (55%) of Democrats, but only 23 percent of Republicans, said the presidential candidates’ positions on health care were very important in determining how they voted in November.
  • Good Guide! — Page 17
    Nearly half (47%) of voters named the state voters’ guide as the most useful source of information in deciding how to vote on November’s health measures. Trailing far behind was news coverage (15%), opinions of friends and family (11%), and paid advertisements (9%).
  • Universal Split On Universal Health Coverage — Page 22
    California voters are almost evenly divided over whether they prefer the nation’s current health care system (45%) or would prefer a universal health insurance program run by the government (47%).
  • Affordability Anxiety — Page 25
    Many (43%) voters say they are very concerned about being able to afford health care if a member of their family gets sick. These same voters were strong supporters of Propositions 61 on children’s hospital bonds (73%), Proposition 63 on mental health funding (65%), and Proposition 72 on health care coverage (61%).

About the Survey

The purpose of the PPIC Statewide Survey is to develop an in-depth profile of the social, economic, and political forces affecting California elections and public policy preferences. Findings of this survey are based on a telephone survey of 2,500 California voters who participated in the November 2004 election and were interviewed between November 4 and November 18, 2004. Interviews were conducted in English, Spanish, Chinese, Korean, and Vietnamese. The sampling error for the total sample is +/- 2%. The sampling error for subgroups is larger. For more information on methodology, see page 33.

Mark Baldassare is research director at PPIC, where he holds the Arjay and Frances Fearing Miller Chair in Public Policy. He is founder of the PPIC Statewide Survey, which he has directed since 1998. His recent book, A California State of Mind: The Conflicted Voter in a Changing World, is available at

PPIC is a private, nonprofit organization dedicated to improving public policy through objective, nonpartisan research on the economic, social, and political issues that affect Californians. The institute was established in 1994 with an endowment from William R. Hewlett. PPIC does not take or support positions on any ballot measure or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office.