Donate
Independent, objective, nonpartisan research

OP 205MBOP

Authors

OP 205MBOP

Tagged with:

Publication PDFs

Database

This is the content currently stored in the post and postmeta tables.

View live version

object(Timber\Post)#3742 (44) { ["ImageClass"]=> string(12) "Timber\Image" ["PostClass"]=> string(11) "Timber\Post" ["TermClass"]=> string(11) "Timber\Term" ["object_type"]=> string(4) "post" ["custom"]=> array(5) { ["_wp_attached_file"]=> string(14) "OP_205MBOP.pdf" ["wpmf_size"]=> string(7) "1345017" ["wpmf_filetype"]=> string(3) "pdf" ["wpmf_order"]=> string(1) "0" ["searchwp_content"]=> string(95364) "Occasional Papers Making Health Policy at the Ballot Box: Californians and the November 2004 Election Mark Baldassare Renatta DeFever Kristy Michaud With Funding From The California Endowment Woodland Hills, California February 23, 2005 Public Policy Institute of California The Public Policy Institute of California (PPIC) is a private operating foundation established in 1994 with an endowment from William R. Hewlett. The Institute is dedicated to improving public policy in California through independent, objective, nonpartisan research. PPIC's research agenda focuses on three program areas: population, economy, and governance and public finance. Studies within these programs are examining the underlying forces shaping California’s future, cutting across a wide range of public policy concerns, including education, health care, immigration, income distribution, welfare, urban growth, and state and local finance. PPIC was created because three concerned citizens – William R. Hewlett, Roger W. Heyns, and Arjay Miller – recognized the need for linking objective research to the realities of California public policy. Their goal was to help the state’s leaders better understand the intricacies and implications of contemporary issues and make informed public policy decisions when confronted with challenges in the future. David W. Lyon is founding President and Chief Executive Officer of PPIC. Cheryl White Mason is Chair of the Board of Directors. Copyright © 2005 by Public Policy Institute of California All rights reserved San Francisco, CA Short sections of text, not to exceed three paragraphs, may be quoted without written permission provided that full attribution is given to the source and the above copyright notice is included. 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. Research publications reflect the views of the authors and do not necessarily reflect the views of the staff, officers, or Board of Directors of the Public Policy Institute of California. Contents Introduction STATE POLITICAL CONTEXT Overall Mood Government Trust Citizens’ Initiatives Health Policy Initiatives Presidential Election NOVEMBER BALLOT CHOICES Voters’ Interests Proposition 61 Proposition 63 Proposition 67 Proposition 71 Proposition 72 Voters’ Information Sources Satisfaction with Information Sources HEALTH POLICY ATTITUDES Perceived Policy Problems Employee Health Coverage Universal Health Coverage State Mental Health Funding Federal Stem Cell Research Funding Health Care Affordability The Health Care System Appendix A. Health Policy Ballot Measures Propositions 61, 63, 67: Percentage Vote Yes, No, No Vote, by County Propositions 71, 72: Percentage Vote Yes, No, No Vote, by County Appendix B. Survey Methodology Appendix C. Survey Questions and Responses 1 5 5 6 7 8 9 10 10 11 12 13 14 15 16 18 19 19 20 21 22 23 25 26 29 29 31 33 35 -i- Summary California voters were asked to make decisions on five health policy measures on the November ballot. They voted yes on state bond measures to increase funding for children’s hospital projects (Proposition 61) and stem cell research (Proposition 71) and to levy a tax on million-dollar incomes for expanded mental health services (Proposition 63). They defeated a measure to fund emergency medical services with a telephone surcharge (Proposition 67) and a measure requiring medium and large employers to provide employee health care coverage (Proposition 72). Given the growing reliance on citizens’ initiatives to make public policy in California, voters may be asked to make more health policy decisions in the future. The PPIC Statewide Survey of California voters in the November 2nd 2004 election, funded by The California Endowment, provides the first comprehensive analysis of voters making health policy decisions at the ballot box. The goal of this effort is to consider how this experience may influence voters’ reactions to future ballot measures and health policymaking in the state. This survey report presents the responses of 2,500 California voters who were randomly selected and interviewed by telephone in English, Spanish, or one of three Asian languages from November 4th through 18th on election, policy, and political issues. The large sample size and multilingual interviewing allowed us to address the following questions: How do Californians feel about their expanding role in making state policy? Fewer than half of California voters said they have even a fair amount of trust in state government when it comes to making laws. The survey respondents expressed more trust and confidence in voters when it comes to making policy choices. Three in four said that it is a good thing that voters can vote directly on public policies. By a three-to-one margin, they thought that the public policy decisions made by the voters are probably better than those made by the governor and the legislature. What are the reasons for their ballot choices? • Proposition 61—the Children’s Hospital Bond—won by 58 to 42 percent. It was strongly supported by Democrats and independents, narrowly supported by Republicans, and solidly backed across racial/ethnic groups. The main reasons given for voting yes were general support for children and children’s hospitals. • Proposition 63—Mental Health Services Funding—won by 54 to 46 percent. Although opposed by Republicans and higher-income voters, it had strong support among Democrats and independents. People who voted “yes” cited concern about the homeless mentally ill, while “no” voters cited general opposition to taxes. • Proposition 67—Emergency Medical Services Funding—lost by 72 to 28 percent. It was opposed by majorities across political groups and most racial/ethnic and demographic groups. The reasons given for voting no were general opposition to new fees and surcharges and not wanting to pay higher telephone bills. • Proposition 71—Stem Cell Research Bonds—won by 59 to 41 percent. It was opposed by Republicans but strongly supported by Democrats and independents and -iii- had solid support across racial/ethnic groups. The main reason for a yes vote was the potential for medical advances. “No” voters cited their beliefs and the condition of the state budget as deciding factors. • Proposition 72—Health Care Coverage Requirements—lost by 51 to 49 percent. Democrats solidly supported it, Republicans were strongly opposed, and independents were evenly divided. Support was higher among nonwhites than whites, and opposition increased with age, education, income, nonunion status, and a health insurance plan. The top reasons for voting yes were the high number of uninsured Californians and the belief that employers should provide health insurance. “No” voters cited the fiscal burden on business and opposition to yet another government-run program. What types of information and information sources enter into their decisions? Half of the voters said the voter’s guide provided the most helpful information about the five measures. One in 10 cited each of these sources: paid advertisements, news stories, newspaper endorsements, and family and friends. One in five said they went on-line for information. Eight in 10 voters were satisfied with the amount of information they had to make good choices on the measures. Half said they did not have enough time to go through the already existing information, which limits interest in having more sources. Do voters believe that making health policy at the ballot box has positive effects? When asked how the new state policies emerging from the election affected their feelings about the state’s health care system, just over half said they felt about the same as they had before the election. However, over four in 10 said the results made them more optimistic about the system. Fewer than two in 10 were more pessimistic. What post-election attitudes of the voters may affect future legislation and initiatives? Concerns about health care coverage are still high. Six in 10 voters believe that “people without health insurance” is a big problem where they live. They also feel it is “very important” for them that medium and large employers provide health care benefits. However, about four in 10 voters think the financial costs of providing health care coverage are a big problem for those employers, and another four in 10 think it is “somewhat of a problem.” Voters are split along partisan lines when asked if they would support a universal health insurance program and if they would be willing to pay more in order to increase the number of Americans who have health insurance coverage. In their personal attitudes toward the health care system, half of the voters report that they are less than somewhat satisfied with the affordability of health care in their part of California. Four in 10 voters are very concerned, and seven in 10 are at least somewhat concerned, about affording health care when a family member gets sick. They are more satisfied about the quality and availability of health care. However, about half of the voters think that the health care system is worse today than it was 10 years ago, one in four say it is the same, and one in six thinks it is better today than it was a decade ago. Those who think the health care system is in worse shape today are among the strong supporters of the three health policy measures that passed. Those who see the health care system as being worse today supported Proposition 72 by only a narrow margin, indicating that many voters who find fault with the current health care system were not strongly drawn to this health policy reform. -iv- Introduction On November 2, 2004, 12.5 million voters in California cast their ballots for president, senate, and federal and state legislators, as well as local elected offices in many jurisdictions. In absolute numbers, this was the largest voter turnout in California history. It was also the highest turnout in percent of registered voters (76%) and eligible adults (57%) since the presidential election in 1980. This stood in surprising contrast to the last general election, which had the lowest turnout in the state’s history. However, the November ballot contained a number of controversial initiatives; and a movement toward increasing voter participation, as well as increasing interest in “direct democracy ” was evident during the recall election on October 7, 2003, and again during the previous general election. On the November ballot, voters were asked to make policy decisions on 16 state propositions involving many issues, including Indian gaming, local government funding, three strikes reform, open primaries, and health policy. A total of five measures would either make new laws or reverse existing laws on health policy: Proposition 61 (Children’s Hospital Projects), Proposition 63 (Mental Health Expansion Funding), Proposition 67 (Emergency Medical Services Funding), Proposition 71 (Stem Cell Research), and Proposition 72 (Referendum on Health Care Coverage). The voters chose to fund children’s hospitals, stem cell research, and mental health expansion but opposed funding for emergency medical services and refused to mandate health care coverage by medium and large employers. There is good reason to believe the voters will be asked to make many decisions at the ballot box in the post-recall era. The 2004 election offered an unprecedented opportunity to learn how Californians make health policy decisions at the ballot box and how they react to using the initiative process for this purpose. With funding from the California Endowment, we undertook a PPIC Statewide Survey designed to gain a better understanding of these issues. How do Californians feel about their expanding role in deciding on major state policies? What are the reasons for their ballot choices? What types of information and information sources enter into their decisions? Do voters believe that making health policy choices at the ballot box has positive effects? We were also interested in the health policy attitudes of the state’s voters after the election, because these preferences might foreshadow their support for future policy efforts in either the legislative or initiative arenas. In the two-week period immediately after the November 2nd election, we conducted a 20minute telephone survey of 2,500 voters. We contacted a random sample of California adults, offered to interview them in one of five languages, and surveyed only those who had voted in the recent election. These topics were covered in this post-election survey of voters: (1) general attitudes toward citizens’ initiatives and making health policy at the ballot box; (2) specific awareness of and interest in the five health policy ballot measures; (3) voter choices on each of the five state ballot measures and major reasons for those choices; (4) awareness of and reactions to information sources, including advertising, the media, and the voter’s guide; (5) attitudes toward health policy issues that are related to the five ballot items; (6) health policy issues related to the presidential election and candidate preferences; (7) personal concerns about health coverage; (8) ratings of the health care system and its attributes; (9) trust and confidence in state government; and (10) general state conditions. In addition, we asked respondents our standard battery of -1- questions on their political characteristics, racial/ethnic self-identification, and demographic characteristics. The remainder of this report addresses these issues under three headings: State Political Context, November Ballot Measures, and Health Policy Attitudes. Three data sources contributed to the analysis for this report: (1) county vote tallies for the five ballot measures, as recorded by the Secretary of State; (2) campaign contributions and expenditures for the five health policy measures, as reported by the Secretary of State, and; (3) focus groups with voters in Fresno, Los Angeles, Sacramento, San Diego, and San Francisco, before and after the election, to inform the question design and the data analysis of our survey. Throughout the report, we look for underlying political, social, and economic attitudes that might be shaping Californians’ interest in making policy decisions at the ballot box, as well as attitudes that affect the specific health policy decisions voters made in this election. We also look for evidence of sharp differences across political groups that may be consistent with the “partisan divide” found in recent state and national surveys. Given the changing demographics of the state’s population, we are interested in differences in health policy preferences and vote choices across racial/ethnic groups and regions of the state. In addition, we seek to understand the role of age, socioeconomic factors, and health insurance status in determining general and specific attitudes toward health policies. Finally, we look for evidence of changes in health policy attitude during and after this election. In this report we look at differences across partisan lines, race/ethnicity, and the five major regions of California, as defined in the map on the following page. -2- State Political Context Overall Mood California voters were relatively upbeat after the November 2004 election. About half said the state was headed in the right direction, while one in three said it was headed in the wrong direction. Half expect good economic times and one in three anticipates bad times over the next 12 months. These post-election findings show an improvement in the voters’ mood since our preelection survey series, when likely voters were evenly divided on the current state of the state and the near-term direction of the California economy. These results also point to a dramatic turnaround from a year ago when the state was in the midst of a historic recall of the governor . In fact, the overall mood among voters has not been brighter since the 2000 general election. In a trend that surfaced after the recall of Democrat Gray Davis and his replacement by Republican Arnold Schwarzenegger in October 2003, Democrats are much more pessimistic than Republicans about current conditions in the state. The re-election of President Bush may be adding to the gloomier overall outlook among Democrats and higher optimism among Republicans in this post-election survey. There are also differences across the state’s regions and racial/ethnic groups. Residents of the San Francisco Bay area are more pessimistic than residents of other areas, and blacks and Latinos are more pessimistic than Asians and whites. Less educated and lower-income voters are also more pessimistic than others about the state of the state. Table 1 “Do you think things in California are generally going in the right direction or the wrong direction?” All Voters Right direction 53% Wrong direction 35 Don't know 12 Party Registration Dem Rep Ind 44% 64% 55% 42 27 31 14 9 14 CV 56% 33 11 Region SF LA OC/SD 48% 53% 59% 38 36 29 14 11 12 IE Asians 54% 56% Race/Ethnicity Blacks Latinos 34% 44% Whites 57% 38 27 52 43 32 8 17 14 13 11 Table 2 “Turning to economic conditions in California, do you think that during the next 12 months we will have good times financially or bad times?” All Voters Good times 52% Bad times 34 Don't know 14 Party Registration Dem 37% 47 16 Rep 72% 16 12 Ind 47% 40 13 CV 55% 30 15 Region SF 43% 41 16 LA 48% 39 13 OC/SD 60% 29 11 Race/Ethnicity IE 63% 25 12 Asians 50% 34 16 Blacks 34% 53 13 Latinos 42% 46 12 Whites 57% 30 13 -5- Government Trust The PPIC Statewide Survey has consistently found that California voters trust their fellow citizens more than their elected representatives when it comes to making laws and public policies. In the context of the 2002 governor’s race and the 2003 governor’s recall, California voters’ trust in state government reached historic lows and did not rebound in 2004, despite high approval ratings during Governor Schwarzenegger’s first year in office. This post-election survey indicates that most voters across the state’s major regions and racial/ethnic groups are still reluctant to express confidence in state government when it comes to making public policies. Only 6 percent have a “great deal of confidence” in state government, and just over half say they have little or no trust. Given that a Republican is in the governor’s office and Democrats control the legislature and every other state executive office, it is noteworthy that voters from both parties express a lack of trust and confidence in their state government. When asked how much they trust voters to make election choices, voters are more likely to say they trust the people a great deal or fair amount compared to the state government (55% to 48%). The public’s confidence in voters today is exactly what we recorded in the week before the October 2003 governor’s recall. Republicans are more likely to say they trust state government than the public overall (52% to 46%), while Democrats and independent voters express more trust in the voters than in their state government. Still, many voters across party lines express considerable skepticism when it comes to voters making choices on Election Day. Table 3 “How much trust and confidence do you have in the state government when it comes to making public policy – a great deal, a fair amount, not too much, or none at all?” All Voters Party Registration Dem Rep Ind Great deal 6% 5% Fair amount 42 41 Not much 39 41 None at all 12 12 Don't know 1 1 7% 45 35 12 1 6% 40 40 12 2 CV 6% 44 36 14 0 Region SF LA OC/SD 4% 6% 7% 41 44 44 43 37 35 11 12 13 11 1 Race/Ethnicity IE Asians Blacks Latinos Whites 5% 9% 8% 10% 4% 40 47 35 36 44 41 33 42 38 39 12 10 15 13 11 2 10 32 Table 4 “How much trust and confidence do you have in California's voters when it comes to making choices on election day -- a great deal, a fair amount, not too much, or none at all?” All Voters Great deal Fair amount Not much None at all Don't know 14% 41 33 10 2 Party Registration Dem Rep Ind 16% 46 29 7 2 12% 34 38 14 2 11% 47 30 10 2 CV 17% 33 37 11 2 Region SF LA OC/SD 10% 48 32 8 2 16% 42 29 12 1 15% 41 33 9 2 Race/Ethnicity IE Asians Blacks Latinos Whites 16% 37 32 13 2 12% 49 27 9 3 20% 44 28 7 1 26% 32 29 11 2 12% 42 34 10 2 -6- Citizens’ Initiatives In the wake of a November election that included 16 state ballot propositions, California voters give highly favorable marks to the initiative process. About three in four say it is a good thing that the state’s voters can vote directly on state policies. This approval of the initiative process is the same as in the August pre-election survey and similar to responses in earlier surveys. Also as in the past, the initiative process gets high marks across political, regional, and racial/ethnic groups. Even though some may have reservations about voters’ abilities to make good choices on Election Day, most voters say they prefer initiative decisions to the legislative process. Six in 10 say that the public policy decisions made through the initiative process are “probably better” than can be expected from the governor and state legislature. However, about one in four say ballot box decisions are “probably worse” than the decisions that are made in Sacramento. Across political groups, regions, and race/ethnic groups, there are solid majorities who expect the initiative process in California to produce better public policy decisions than the governor and state legislature elected to represent the people’s views in lawmaking. These opinions were similar to results of our pre-election survey and earlier statewide surveys. Table 5 “Do you think that the citizens' initiative process that allows state voters to vote directly on citizen-sponsored policies is a good thing or a bad thing for California?” Good thing Bad thing Don't know All Voters 78% 15 7 Party Registration Dem Rep Ind 73% 19 8 81% 12 7 84% 12 4 CV 77% 13 10 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 73% 78% 81% 82% 85% 77% 79% 77% 21 15 15 9 9 14 14 16 6749 6 9 7 7 Table 6 “Do you think public policy decisions made through the initiative process by California voters are probably better or probably worse than public policy decisions made by the governor and state legislature?” Party Registration All Voters Dem Rep Ind CV Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites Probably better Probably worse Same (volunteered) Don't know 61% 22 6 11 57% 64% 64% 63% 55% 62% 26 19 17 24 27 20 667667 11 11 12 7 12 11 62% 69% 21 12 76 10 13 71% 11 7 11 69% 16 3 12 65% 21 2 12 59% 24 7 10 -7- Health Policy Initiatives Does the voters’ general preference for the initiative over the legislative process apply to making health policy? Voters faced a wide range of health policy decisions in the five measures on the November ballot. The election results were mixed—two bond measures passed; mental health services were funded and emergency services were not; and a referendum passed overturning a state law requiring certain employers to provide health coverage. After the election, six in 10 voters said that they most prefer to have the voters make the health policy decisions at the ballot box while three in 10 said that the governor and legislature should be making these choices. The belief that California voters rather than elected officials should be making state health policy was the majority view across party lines, racial/ethnic groups, and regions of the state. Concerning the five health policy decisions made by the voters, a majority said that it had no sizeable effect on their outlook for the state’s health care system. Perhaps most important for their perceptions of health care, only one in six said the results of the election made them feel more pessimistic. Most voters across party lines said the results on the five health policy measures made them feel more optimistic or the same as before the election. Table 7 Thinking specifically about health policy, which do you most prefer: that the governor and state legislature make state health policy or that California voters make state health policy at the ballot box?” All Voters Voters should make health policy Governor and state legislature should make health policy Other answer 58% 32 4 Don't know 6 Party Registration Dem Rep Ind 60% 53% 61% 32 35 27 65 29 4 6 CV 59% 33 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 52% 58% 59% 66% 59% 74% 71% 54% 37 34 31 23 35 21 24 35 3 53 75 1 31 5 65 36 5 2 4 5 6 Table 8 “California voters passed the children's hospital bonds, the expansion of mental health services initiative, and the stem cell research bonds, and they rejected the emergency medical services and health care coverage measures. Do these new state policies make you more optimistic about the state’s health care system, more pessimistic, or do you feel about the same as you did before the election?” More optimistic More pessimistic About the same Don't know All Voters 27% 16 55 2 Party Registration Dem Rep Ind 34% 19% 25% 12 22 15 53 57 60 1 20 CV 22% 16 60 2 Region SF LA OC/SD 32% 28% 25% 11 17 16 55 52 57 232 Race/Ethnicity IE Asians Blacks Latinos Whites 23% 33% 19% 25% 28% 23 13 14 17 15 53 51 64 55 55 13332 -8- Presidential Election The five health policy measures appeared on the California ballot during a presidential election that the state’s voters followed closely and viewed as highly important to the nation’s future. In California, Democratic challenger John Kerry led Republican President George W. Bush in every public opinion poll taken before the election. California was virtually ignored by the national campaigns that focused their attention on the “battleground states.” In the end, Kerry won in California by 1.2 million votes and a 10-point margin, while Bush won the national election and a second term. According to voters in our post-election survey, health policy was not one of the most important issues in the presidential campaign. When asked which one issue was most important in deciding how to vote for president, voters gave the top four positions to the situation in Iraq (23%), moral and family values (14%), jobs and the economy (12%), and terrorism and security (8%). A second tier of concerns included education, health care, federal budget and tax, and foreign policy. Although health care had rated among the top issues in our pre-election survey in September and October, and moral and family values were infrequently mentioned as the most important campaign issue, the closing days of the campaign and its aftermath evidently shifted the major priorities of voters. Nevertheless, health care issues remained salient to the voters in the election: Four in 10 said the candidates’ positions on health were “very important” in deciding their vote for president, and three in four said this issue was at least somewhat important. The importance of health care for voters is evident across the state’s regions, especially in Los Angeles and the San Francisco Bay Area. What is most striking about voters’ responses, however, is that Democrats were more than twice as likely as Republicans to say health care was highly relevant in their voting decisions. Similarly, Kerry voters were much more likely than Bush voters to say that the candidate’s positions on health care were very important in their decisions. In other words, health care issues appear to be part of the “partisan divide” between Republicans and Democrats. Because this divide is relevant for responses to the five health policy initiatives on the state’s ballot, we explore the partisan differences on each of the measures in the analysis that follows. Table 9 “How important were the candidates' positions on health care in deciding your vote -- very important, somewhat important, not too important, or not at all important?” All Voters Very important Somewhat important Not too important Not at all important Don't know 40% 36 14 9 1 Party Registration Dem 55% 35 6 3 1 Rep 23% 39 23 15 0 Ind 38% 37 17 8 0 CV 37% 35 16 12 0 Region SF 43% 39 13 4 1 LA OC/SD 48% 36% 34 40 9 15 98 01 IE 40% 30 20 9 1 Presidential Vote 2004 Bush Kerry 24% 54% 38 35 22 8 15 3 10 -9- November Ballot Choices Voters’ Interests Three in four voters said they were very closely or fairly closely following the news about the five health policy measures. In comparison, our pre-election poll in mid-October indicated that over nine in 10 likely voters were very closely (61%) or fairly closely (34%) following the news about the presidential election, while fewer than half reported the same level of attention to the U.S. Senate race (12% very closely; 30% fairly closely). In other words, the five health policy measures ranked in level of news interest somewhere between the two top-of-the ticket races. Although more were “fairly closely” than “very closely” following the news about the health measures, substantial percentages of voters across party lines, regions, racial/ethnic groups, and demographic categories were paying fairly close attention to that news. Which of the five ballot measures drew the most attention? Nearly half named the measure to fund stem cell research (Proposition 71). One in six named the referendum on health care coverage (Proposition 72), and one in eight named the children’s hospital bonds. Fewer than one in 10 voters were most interested in the measures on mental health and emergency medical services. Proposition 71 was the top choice across political parties, Kerry voters, Bush voters, and across regions, age, education, and income groups. Even among uninsured voters, Proposition 71 was mentioned more often than Proposition 72 (39% to 23%) as the top interest. Table 10 “Regardless of how you voted, before deciding how to vote on these five health-related propositions, how closely were you following news about these measures?” Very closely Fairly closely Not too closely Not at all closely Don't know All Voters 28% 49 17 6 0 Party Registration Region Race/Ethnicity Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 28% 28% 26% 29% 22% 32% 28% 34% 11% 37% 31% 28% 48 49 50 47 52 49 46 46 62 47 43 49 18 15 15 17 21 13 22 13 17 13 20 17 57 8 75 5 3 7 9 2 6 6 1 11001 1 0 1 1 0 0 -10- Table 11 Health ballot measure most interested in… Proposition 71, Stem cell research bonds Proposition 72, Health care coverage referendum Proposition 61, Children's hospital bonds Proposition 63, Mental health services Proposition 67, Emergency medical services Other answer Don't know All Voters 49% 16 12 8 8 5 2 Proposition 61 This ballot measure was an initiative to authorize $750 million in 30-year general obligation bonds for construction, expansion, and remodeling of children’s hospitals. The “yes” campaign received a total of $5.2 million in contributions; the opposition campaign received no contributions. The measure passed by 58 percent to 42 percent statewide. San Francisco (71%) and Alameda (69%) Counties had the highest percentage of yes votes. The largest margins of opposition were in rural inland counties. However, Proposition 61 passed in populous Republican-leaning regions such as Fresno, Orange, Riverside, San Bernardino, and San Diego Counties. Our survey indicates that Democrats and independents supported the children’s hospital bond by wide margins, while Republicans were evenly divided. Kerry voters (78%) were much more likely than Bush voters (51%) to favor it. Voter support was higher among younger voters and nonwhites than other groups; however, majorities in all age and racial/ethnic groups favored this measure. Similarly, we found solid support among men and women, across education and income levels, and among those with and without children under 18. When asked why they voted yes on Proposition 61, voters most often mentioned general support for children (52%) and need to strengthen children’s hospitals (31%); major reasons for voting no were the state’s budget (44%) and opposition to state bonds (32%). Table 12 “Proposition 61 proposed 750 million dollars in state bonds to fund children's hospitals. Did you vote yes or no on this measure?” All Voters Yes 58% No 42 Party Registration Dem 80% 20 Rep 51% 49 Ind 69% 31 18-34 71% 29 Age 35-54 64% 36 Race/Ethnicity 55 or older Asians Blacks Latinos Whites 65% 75% 80% 81% 62% 35 25 20 19 38 -11- Table 13 Top three reasons for vote All Voters Did you vote YES because... Did you vote NO because... General support for children Children's hospitals need to be strengthened Direct experience with Children's hospitals State's budget situation General opposition to state bonds Some other reason 52% 31 10 44 32 8 Proposition 63 Proposition 63 established a 1 percent tax on incomes above $1 million to fund expanded health services for mentally ill children, adults, and seniors. The “yes” campaign received a total of $4.7 million in contributions; the “no” campaign had contributions of about $16,000. The measure passed by 54 percent to 46 percent statewide. San Francisco (74%) and Alameda and Santa Cruz (66% each) Counties passed it by the largest majorities. Rural and inland counties had the highest “no” votes. Orange County, Inland Empire, and Fresno voters also opposed this measure, but by narrower margins. Seven in 10 Democrats and independents supported the high-income tax for mental health expansion, while seven in 10 Republicans opposed it. There were no differences across age groups, but blacks were more supportive than other racial/ethnic groups. Kerry voters (76%) were much more likely than Bush voters (33%) to vote yes on Proposition 63, as were liberals and moderates compared to conservatives, and women (63%) compared to men (50%). Although there were no differences across education groups, a substantial majority of voters with incomes below $80,000 (63%) supported the measure, while those in the higher income group were slightly opposed to it. When asked why they voted yes on Proposition 63, voters most often named the number of homeless mentally ill people (54%). A general opposition to new taxes was cited most often as the rationale for voting no on the mental health expansion measure (43%); a secondary reason was that the tax on high income would drive entrepreneurs out of the state. -12- Table 14 “Proposition 63 proposed an additional 1 percent tax on taxable incomes over 1 million dollars to pay for mental health services. Did you vote yes or no on this measure?” Party Registration All Voters Yes 54% No 46 Dem 76% 24 Rep 31% 69 Ind 71% 29 Income Under $40k $40k to 79k 63% 63% 37 37 $80k plus 49% 51 Asians 59% 41 Race/Ethnicity Blacks 75% 25 Latinos 58% 42 Whites 55% 45 Table 15 Top three reasons for vote Did you vote YES because... There are too many homeless mentally ill people Direct experience with the public mental health system Not in that tax bracket Generally oppose new taxes Did you vote NO because... New tax would drive entrepreneurs out of CA These programs haven't been proven to be effective All Voters 54% 17 13 43 21 13 Proposition 67 Proposition 67 would have authorized an increase in the telephone surcharge in order to allocate other funds for emergency room physicians, emergency hospitals and community clinics, emergency personnel equipment and training, and the 911 telephone system. The “no” campaign received a total of $9.2 million in contributions, compared to $7.2 million for the “yes” campaign. The measure lost by 72 percent to 28 percent statewide. Proposition 67 did not pass in any county and lost by large margins in Democratic-leaning regions such as the San Francisco Bay Area and Los Angeles. The top two counties in terms of support were Santa Cruz and Monterey (38% each); rural inland counties opposed the telephone surcharge by more than four-to-one margins. Proposition 67 was opposed across all voter groups, including both Kerry and Bush supporters. Voter support for the proposition was lower among Republicans and conservatives than among Democrats and liberals and lower among whites and blacks than Asians and Latinos, among older than younger voters, and among upper-income than lower-income groups. There were no differences in support between women and men or across education groups. When asked why they voted no on Proposition 67, three in four said they were opposed to all new fees and surcharges (43%) or they wanted to avoid paying higher telephone bills (29%). Two in three who voted yes on the telephone surcharge cited overcrowded emergency rooms (33%) or a shortage of emergency rooms (30%). -13- Table 16 “Proposition 67 proposed to raise the telephone surtax to pay for emergency medical services and the 911 response system. Did you vote yes or no on this measure?” All Voters Yes 28% No 72 Party Registration Dem 47% 53 Rep 25% 75 Ind 34% 66 18-34 44% 56 Age 35-54 33% 67 55 or older 35% 65 Asians 55% 45 Race/Ethnicity Blacks Latinos Whites 37% 41% 34% 63 59 66 Table 17 Top three reasons for vote All Voters Did you vote YES because... Emergency rooms are too crowded There are too few emergency rooms 33% 30 Direct experience with emergency medical care 15 Did you vote NO because... General opposition to new fees and surcharges Did not want higher telephone bills 43 29 Some other reason 14 Proposition 71 Proposition 71 sought to establish a “California Institute for Regenerative Medicine” to regulate and fund stem cell research with $3 billion in state bonds, at a cost of $6 billion over 30 years to pay off the bonds. The “yes” campaign received a total of about $27 million in contributions while the “no” campaign had total contributions of just under $750,000. The measure passed by 59 percent to 41 percent statewide. The counties with the largest majorities of support were again in the San Francisco Bay Area (71% in San Francisco, 70% each in Santa Cruz and San Mateo, and 68% in Alameda). The counties that voted no were largely rural, inland counties, while Orange County voters (52%) narrowly supported the measure. Independents favored Proposition 71 by a large majority (61%). However, there was a deep partisan divide: 79 percent of Democrats favored the measure; 67% of Republicans opposed it. Similarly, Kerry voters (81%) were highly supportive while Bush voters (68%) were strongly opposed. There were no differences between men and women or across age and income groups. Support for Proposition 71 was higher among nonwhites than whites and increased with college education. However, there was majority support for it across all demographic groups. Among supporters of the stem cell research measure, three in four voted for it because this type of research will lead to medical advancements in the future. Far fewer cited lack of federal dollars -14- for stem cell research. For those opposed, the two main issues were a conflict with their beliefs and the state budget situation. Table 18 “Proposition 71 proposed $3 billion in state bonds to fund stem cell research in the state. Did you vote yes or no on this measure?” All Voters Yes 59% No 41 Party Registration Dem Rep Ind 79% 33% 61% 21 67 39 College Education None Some Grad 51% 57% 61% 49 43 39 Asians 66% 34 Race/Ethnicity Blacks Latinos Whites 77% 59% 56% 23 41 44 Table 19 Top three reasons for vote All Voters Did you vote YES because…. this research will lead to medical advancements the lack of federal dollars for stem cell research Your thinking this will lead to good business opportunities and jobs 75% 11 6 Did you vote NO because... Stem cell research is against your beliefs State's budget situation Some other reason 42 24 13 Proposition 72 Proposition 72 was a referendum that would have overturned an existing state law. A “yes” vote would approve and a “no” vote reject a state requirement that large and medium employers provide health insurance coverage for their employees. The “no” campaign received a total of $18.4 million in contributions compared to $14.9 million for the yes campaign. Proposition 72 lost statewide by 51 percent to 49 percent, or a narrow margin of about 180,000 votes. Proposition 72 passed by large majorities in the San Francisco Bay Area (69% in San Francisco and 64% in Alameda) and had majority support in Los Angeles (57%). The top counties in terms of opposition were rural, inland area. However, Proposition 72 had majority opposition in large counties across the state, such as Fresno and Sacramento in the Central Valley and Orange, San Diego, Riverside, and San Bernardino in Southern California. Among Republicans, 74 percent opposed the health care coverage requirements, while 71 percent of Democratic voters were in favor of it, and independents were divided on the measure. Kerry voters (70%) were strongly supportive while Bush voters (73%) were strongly opposed. Support for the health care coverage requirement declined with age and income, and the “yes” -15- vote on Proposition 72 was higher among women than men. Although union members and the uninsured approved of it by large margins, the majority of insured voters and nonunion voters were opposed to this measure. A majority of whites were opposed, but solid majorities of Asians, blacks, and Latinos were in favor of it. Nearly all who voted in favor of Proposition 72 said it was because they believe that all employers should provide health insurance (54%) and that there were too many Californians who were without health insurance (37%). Among those who voted against it, most said the health care coverage requirements would be a burden on businesses and would create another government-run program. Table 20 “Proposition 72 proposed that medium and large employers in California be required to provide health insurance for their employees. Did you vote yes or no on this measure?” All Voters Yes 49% No 51 18-34 62% 38 Age 35-54 49% 51 55+ 45% 55 Under $40K 66% 34 Income $40K$79K 54% 46 $80K Plus 40% 60 Asians 64% 36 Race/Ethnicity Blacks Latinos Whites 86% 71% 43% 14 29 57 Table 21 Top three reasons for vote Did you vote YES because... All employers should provide health insurance to workers Too many Californians without health insurance Some other reason Did you vote NO because... A burden to businesses It would create another government-run program Governor’s opposition All Voters 54% 37 2 66 16 6 Voters’ Information Sources The voters’ guide and sample ballot were seen by about half of the voters as the most helpful sources of information in deciding how to vote on the five health policy measures. About one in six voters named news coverage, while one in 10 voters found paid ads, newspaper endorsements, and advice from friends and families to be the most useful sources of information. The strong reliance on the voters’ guide was evident across political, regional, racial/ethnic, and demographic categories. Latinos were less likely than whites to say that the -16- voters’ guide and sample ballot were most helpful in decisionmaking. Voters’ reliance on paid advertisements and family and friends tended to decline with age, education, and income. Fewer than one in five voters said they went on line to get information about the five health policy measures on the ballot. The search for on-line information declined sharply with age and increased with education and income. Seeking on-line information was highest among those age 35 and younger (29 percent), compared to 10 percent of those age 55 and older. As another point of comparison, 34 percent of voters said they went on-line to get information about the presidential race, including one in three Democrats, Republicans, and independent voters. Five percent recall visiting the Healthvote2004.org website, and most of them said they found the information helpful. Table 22 “Please tell me the top one or two that you found most helpful in deciding how to vote on these five health-related propositions in the last election ...” Voters’ guide and sample ballot News coverage The opinions of friends and family Paid ads on radio, television or mail News endorsements Endorsements by interests, celebrities or politicians Other (specify) Don't know Party Registration All Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 47% 45% 48% 50% 49% 49% 43% 15 15 14 19 16 18 15 49% 47% 12 14 37% 18 47% 12 35% 21 50% 15 11 11 11 8 11 8 10 18 6 10 9 13 10 9 9 10 8 11 7 13 8 12 14 21 11 9 9 7 8 7 8 10 7 11 8 3 9 8 9 5 653346 4 5 7 4 7 4 3 343243 2 4 4 2 3 3 1 211120 0 1 2 2 1 1 Table 23 “Did you go on-line to get information about any of the five health-related ballot propositions?” All Party Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites Yes 18% 17% 19% 22% 15% 19% 21% 21% 15% 19% 15% 15% 19% No 82 83 81 78 85 81 79 79 85 81 85 85 81 -17- Satisfaction with Information Sources Eight in 10 voters believed that they had sufficient information to make good choices overall on the five health policy measures. There were no differences in this perception across political party groups or regions of the state. Satisfaction with ballot information was high across all demographic groups. However, the belief that there was enough information to make good ballot choices tended to increase with age, education, and income. There were no differences between men and women or across racial/ethnic groups. About half of the voters said they lacked sufficient time to go through existing information on the health policy measures, while the other half said they would have liked to have other information sources to make good choices on these measures. However, few voters cited any specific information sources—such as debates and impartial sources—while most asked generally for “something else.” Latinos (71%), those under age 55, and those without college degrees were more likely than others to believe that insufficient time to go through existing information sources stood in the way of making good decisions on the health policy measures. Table 24 “Did you feel that you had enough information to make good choices on these five health-related ballot measures?” All Voters Party Registration Dem Rep Ind Yes 81% 79% 85% 81% No 19 21 15 19 CV 74% 26 Region SF LA OC/SD 80% 84% 83% 20 16 17 IE 86% 14 Asians 77% 23 Race/Ethnicity Blacks Latinos Whites 83% 80% 81% 17 20 19 Table 25 “What additional sources or types of information would you have liked to make good choices on these measures, or did you just not have enough time to go through the already existing information?” Just didn't have enough time Specifically wanted something else More impartial information Generally more information Clearer information and wording More debates Don't know All Voters 49% 26 6 6 4 2 7 -18- Health Policy Attitudes Perceived Policy Problems Just after the health policy decisions were made at the ballot box in November, we asked voters to assess how big a problem was represented by four of the issues they had voted on: the number of people without heath insurance, the availability of mental health services, emergency medical services, and children’s hospitals. We did not ask about stem cell research because this issue is not directly related to the health care available today. Despite the close defeat of Proposition 72 (employer-provided health insurance), 84 percent of voters said that the number of people without health insurance in their part of the state is at least somewhat of a problem, and 58 percent saw it as a big problem. Only 10 percent said this issue is not much of a problem or not a problem at all. Democrats were nearly twice as likely as Republicans to say this was a serious problem. It was also seen as more of a problem by nonwhites than whites and by lower-income than higher-income voters. Concern about the availability of mental health services and emergency medical care was not as great as concern about lack of insurance coverage. About half of the voters rank both of these issues as at least somewhat of a problem. However, perceptions of the problem for these issues differed along two dimensions: Voters were more likely to have no opinion about mental health services than emergency services (21% to 5%), and they were more likely to say that there was not much of a problem or no problem with emergency services than with mental health services (43% to 24%). Only 14 percent of voters think that the availability and quality of children’s hospitals is a big problem, while close to one in four say it is somewhat of a problem. Yet, Proposition 61 passed by a wide margin. This ballot measure was clearly supported by large percentages of voters who saw this issue as less than a big problem. How do problem perceptions correlate with voting on the other measures? Among those who say the number of people without health insurance is a “big problem,” 62 percent voted yes on Proposition 72, while the measure was opposed among those who rated it somewhat of a problem. In comparison, of those who rated mental health services as a big problem, 70 percent voted yes on Proposition 63, and the measure was also supported by those who saw this issue as somewhat of a problem. -19- Table 26 “Is ________________ a big problem, somewhat of a problem, not much of a problem, or not a problem at all?” Percent big problem People without health insurance Availability of mental health services Availability of emergency medical services Availability of children's hospitals Party All Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 58% 75% 39% 59% 52% 60% 66% 59% 47% 60% 69% 69% 55% 30 44 14 28 27 33 37 24 21 20 47 29 30 25 34 14 28 21 19 44 18 20 28 47 40 20 14 20 7 14 13 14 17 9 15 16 31 22 11 Employee Health Coverage Even after Proposition 72 was defeated 51 percent to 49 percent at the ballot box, 58 percent of voters thought it was very important for medium and large employers to provide health care benefits for their employees. The percentage of voters who said this is very important declined during the campaign (66% in August, 64% in October, 58% in November). Yet, 85 percent still said it is at least somewhat important for employers to provide health care benefits. Employee health coverage is seen as more important by Democrats than Republicans, by nonwhites than whites, and by lower-income than higher-income voters; and it varies across the state’s regions. Of those who think that health coverage is very important, 70 percent voted yes on Proposition 72, but most who say it is only somewhat important voted no. Despite the perception that employer-provided insurance is important, 77 percent of voters thought that the financial cost of requiring large and medium employers to provide benefits was at least somewhat of a problem, and 37 percent thought it was a big problem. Democrats and Republicans differed sharply in their perceptions about employer costs. However, the perception that financial cost was a big problem grew over the course of the election campaign (24% in August, 37% in November). Sixty-eight percent of those who saw the financial burden on employers as a big problem voted against Proposition 72, but voters who saw it as somewhat of a problem were divided. -20- Table 27 “How important is it to you that large and medium employers provide health care benefits for their employees -- very important, somewhat important, not too important, or not at all important?” Very important Somewhat important Not too important Not at all important Don't know All Voters 58% 27 7 7 1 Party Registration Dem Rep Ind 71% 43% 54% 21 34 31 4 10 8 3 11 5 122 CV 56% 28 6 8 2 Region SF LA OC/SD 63% 63% 51% 25 24 31 768 358 222 IE 54% Asians 65% Race/Ethnicity Blacks Latinos 77% 72% Whites 53% 26 23 17 19 31 7 7 32 8 11 5 2 6 7 2011 1 Table 28 “Do you think that the financial cost of requiring large and medium employers to provide health care benefits for their employees is a big problem, somewhat of a problem, not too much of a problem , or not a problem?” All Voters Big problem 37% Somewhat of a problem 40 Not too much of a problem 13 Not a problem 8 Don't know 2 Party Registration Dem 29% Rep 48% Ind 33% 42 37 43 16 8 14 11 4 7 233 CV 42% 37 11 7 3 Region SF 34% LA OC/SD 34% 38% 39 42 42 17 14 11 887 222 Race/Ethnicity IE Asians Blacks Latinos Whites 38% 33% 25% 28% 40% 42 42 43 40 39 9 16 14 17 11 9 8 13 12 6 2 1 534 Universal Health Coverage California voters were evenly divided when asked if they favor a universal health insurance program rather than the current health system in the United States. Prior to the election, voters supported universal health care by 54 percent to 40 percent; and a national survey by ABC News/Washington Post had also found support for universal health insurance. In our survey, Bush voters (21%) and voters Kerry (68%) varied sharply in support for this policy change. Would California voters be willing to pay more—either in higher taxes or health insurance premiums—to increase the number of Americans who have health insurance? Fifty-two percent said yes, and 43 percent said no in results that are similar to our pre-election survey in September (55% yes) and a national survey by the Kaiser Family Foundation in February 2003 (52% yes). Republicans and Democrats have sharply different perspectives on universal health care and paying more to increase the number of Americans with coverage. Whites are more supportive -21- of the current system than nonwhites. Voters’ support for the current system increases with income, but willingness to pay more to increase coverage declines with age. Proposition 72 was strongly supported among voters who favored universal health care (70%) and who were willing to pay more to increase the number of Americans with health insurance (64%). However, those who favor the current system and are unwilling to pay more for more Americans to have health coverage voted against Proposition 72 by a two-to-one margin. Table 29 “Which would you prefer: the current health insurance system in the United States in which most people get their health insurance from private employers but some people have no insurance, or a universal health insurance program, in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers?” Current system Universal health insurance Don't know All Voters 45% 47 8 Party Registration Dem Rep Ind 25% 69% 44% 67 22 47 899 CV 48% 43 9 Region SF LA OC/SD 34% 40% 51% 54 53 42 12 7 7 Race/Ethnicity IE Asians Blacks Latinos Whites 56% 29% 35% 36% 48% 34 65 60 60 42 10 6 5 4 10 Table 30 “Would you be willing to pay more -- either in higher health insurance premiums or higher taxes -- in order to increase the number of Americans who have health insurance, or not?” Yes, willing to pay more No, not willing to pay more Don't know All Voters 52% 43 5 Party Registration Dem Rep Ind 69% 32% 56% 27 63 39 455 CV 47% 47 6 Region SF LA 61% 59% OC/SD 46% Race/Ethnicity IE Asians Blacks Latinos Whites 42% 51% 63% 50% 52% 33 37 51 49 44 33 46 43 6 4 395445 State Mental Health Funding A majority of voters believe that the state does not currently provide enough funding for mental health programs, and this attitude contributed to the passage of Proposition 63. During the course of the November 2004 election, the perception of inadequate funding actually declined (63% in August, 66% in October, 55% in November). Among those who believed that state funding was not enough, 74 percent voted yes on mental health expansion. However, even among those who thought that current mental health funding was enough, 33 percent voted yes on Proposition 63. This may partly reflect the fact that the mental health funding mechanism—a tax on incomes of more than one million dollars—did not have consequences for most of the voters in this election. -22- Democrats and Republicans had very different perceptions about the adequacy of state funding for mental health programs, while a majority of independents felt that the current funding was inadequate. Across the state’s regions, voters in the San Francisco Bay Area were most likely to see the current level of state funding as inadequate. Women were more likely than men to see funding as inadequate (61% to 49%), while Asians were the least likely and blacks the most likely to say that the state is not spending enough on mental health. Among those who voted yes on Proposition 63, voters overwhelmingly believed that there was not enough state funding for mental health programs. In contrast, fewer than half of those who voted no thought that the current level of state funding was either adequate or too high. Table 31 “Do you think that the current level of state funding for mental health programs is more than enough, just enough, or not enough?” More than enough Just enough Not enough Don't know All Voters 8% 20 55 17 Party Registration Dem Rep Ind 3% 13% 7% 13 28 22 71 38 52 13 21 19 Region CV SF LA OC/SD IE Asians 8% 4% 5% 8% 15% 7% 24 14 22 21 23 25 49 63 56 53 49 42 19 19 17 18 13 26 Race/Ethnicity Blacks Latinos Whites 5% 10% 7% 12 18 21 74 59 54 9 13 18 Table 32 Vote YES on Proposition 63 Vote NO on Proposition 63 Not enough Just enough More than enough Don’t know Not enough Just enough More than enough Don’t know All Voters 74% 12 3 11 32 31 15 22 Federal Stem Cell Research Funding A majority of voters thought that the federal government was spending too little on stem cell research—a perception that persisted from before the election (53% in October, 52% in November). Among those who believed that federal funding was too little, 86 percent voted yes on stem cell research. Even among those who thought that current stem cell funding was adequate, 39 percent voted yes. However, 59 percent voted no. Once again, the trend may partly -23- reflect the state funding mechanism for stem cell research—state bonds that do not require higher taxes by the voters. A majority of Democrats (74%) and independents (55%) believed that there is too little federal funding of stem cell research, while a majority of Republicans (51%) thought federal funding was the right amount (19%) or too much (32%). Most Kerry supporters (76%) but few Bush supporters (23%) thought that funding was inadequate. San Francisco Bay Area voters led the state in their perception that federal funding was too little. The perception was also higher among those with college education. Among those voting yes on Proposition 71, 78 percent believed that there was too little federal funding. In contrast, fewer than half of those who voted no held this perception. Obviously, as noted earlier, there were other factors contributing to voters’ opposition to Proposition 71—personal beliefs about the research use of stem cells and the state budget deficit. Table 33 “Do you think the federal government spends too much, the right amount, or too little on medical research using embryonic stem cells?” Too much Right amount Too little Other Don't know All Voters 19% 13 52 4 12 Party Registration Dem 8% Rep 32% Ind 17% 7 19 14 74 27 55 17 2 10 15 12 CV 28% 14 43 3 12 Region SF 10% LA OC/SD 18% 17% 10 12 14 64 55 49 245 14 11 15 IE 27% 18 41 5 9 Asians 10% 17 49 11 13 Race/Ethnicity Blacks Latinos Whites 15% 25% 19% 6 11 13 61 52 52 313 15 11 13 -24- Vote YES on Proposition 71 Vote NO on Proposition 71 Table 34 Too little Right amount Too much Other Don’t know Too little Right amount Too much Other Don’t know All Voters 78% 9 2 0 11 17 18 43 9 13 Health Care Affordability According to national surveys, one of the major concerns that Americans have about their health care is affordability. When asked to rate satisfaction with three health care issues— affordability, availability, and quality—voters gave affordability of the health care in their region their lowest ratings. Only 13 percent said they were very satisfied, while about half were not too satisfied or not at all satisfied. Among the least-satisfied voters were Democrats, San Francisco Bay Area residents, low-income residents, and the uninsured. Bush voters (60%) were much more likely then Kerry voters (36%) to say they are very satisfied or somewhat satisfied with the affordability of health care. Fewer than half of voters said that they are very concerned about being able to afford necessary health care if they or a family member gets sick—a slight decrease since before the election (49% in September, 43% in November). Democrats were more likely than Republicans, and nonwhites were more likely than whites, to express high level of concern about health care costs. High levels of personal concern about health care costs decline with higher education and income and differ between the insured and uninsured (39% to 71%). Is there a connection between personal concern about health care costs and decisions at the ballot box? Those who were very concerned about being able to afford health care were strong supporters of Proposition 61 (73%), Proposition 63 (65%), and Proposition 72 (61%). -25- Table 35 “How satisfied are you with the affordability of health care in your part of California?” Party All Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites Very satisfied 13% 10% 18% 9% 12% 9% 14% 15% 21% 10% 9% 10% 15% Somewhat satisfied 33 26 41 36 32 30 35 33 35 30 31 34 33 Not too satisfied 27 28 23 31 23 33 24 30 23 37 26 28 26 Not at all satisfied 24 33 15 22 29 26 27 19 18 20 31 25 24 Don’t know 3 3 32420 33 3 3 3 2 Table 36 “How concerned are you about being able to afford necessary health care when a family member gets sick– very concerned, somewhat concerned, not very concerned, or not at all concerned?” Very concerned Somewhat concerned Not very concerned Not at all concerned All Voters 43% 27 17 13 Party Registration Dem Rep Ind 51% 32% 43% 27 26 29 12 23 18 10 19 10 Region Race/Ethnicity CV SF LA OC/SD IE Asians Blacks Latinos Whites 44% 39% 50% 23 33 22 39% 44% 29 21 51% 30 74% 13 62% 23 35% 28 22 16 15 17 13 10 8 11 20 11 12 13 15 22 9 5 4 17 The Health Care System While they were busy making health policy at the ballot box in November, about half of California voters thought that the health care system today is worse than it was 10 years ago. Only 15 percent thought that it is in better shape today. Democrats were much more likely than Republicans to say that the health care system is worse off now. While there are no major differences in general perceptions of negative trends in the health care system across regions or racial/ethnic groups, we find that pessimism does increase with age, higher income, and college education. Kerry voters (59%) were more likely than Bush voters (36%) to believe that the health care system today is in worse shape than it was 10 years ago. How did this negative perception relate to voter choices on health policy at the ballot box? Those who thought the health care system is in worse shape today than it was a decade ago were -26- among the stronger supporters of Proposition 61 (Children’s Hospital Bonds), 68%, Proposition 63 (Mental Health Expansion), 64%, and Proposition 71 (Stem Cell Research Bonds), 65%. However, those who perceived the health care system as deteriorating supported Proposition 72—Health Care Coverage Requirement—by only a narrow margin (53% yes, 46% no). In fact, those who voted yes on Proposition 72 were only slightly more likely than those who voted no to say that the health care system is worse today than it was in the past. For whatever reasons, many voters who found fault with the current system were not strongly drawn to this legislative effort toward health policy reform. Table 37 “Compared to 10 years ago, do you think the health care system today is better, worse, or is it about the same as it was 10 years ago?” Better than 10 years ago Worse than 10 years ago The same as 10 years ago Don’t know All Voters 15% 49 Party Registration Dem Rep Ind CV 11% 18% 16% 19% 60 37 49 43 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 12% 14% 54 53 18% 45 18% 47 17% 40 21% 49 18% 54 14% 49 27 20 36 25 32 23 24 29 30 29 24 22 29 9 9 9 10 6 11 9 8 5 14 6 6 8 Vote YES on Proposition 72 Vote NO on Proposition 72 Table 38 Health care system is worse Health care system is better Health care system is same Don’t know Health care system is worse Health care system is better Health care system is same Don’t know All Voters 53% 14 24 9 48% 16 30 6 -27- Appendix A. Health Policy Ballot Measures Propositions 61, 63, 67: Percentage Vote Yes, No, No Vote, by County Actual Vote Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin Prop. 61 -Children's Hospital Y 69% 56% 45% 48% 44% 44% 65% 48% 45% 56% 42% 52% 66% 49% 52% 60% 49% 46% 63% 54% 60% 50% 55% 57% 40% 51% 63% 58% 45% 52% 42% 46% 59% 51% 60% 57% 56% 71% 57% N 31% 44% 55% 52% 56% 56% 35% 52% 55% 44% 58% 48% 34% 51% 48% 40% 51% 55% 38% 46% 40% 50% 45% 43% 60% 49% 37% 42% 55% 49% 58% 55% 41% 49% 41% 43% 44% 29% 44% NV 10% 8% 8% 7% 7% 9% 8% 6% 10% 9% 7% 8% 7% 6% 6% 8% 5% 6% 11% 6% 11% 18% 8% 8% 6% 10% 9% 8% 9% 9% 8% 7% 7% 8% 10% 7% 11% 14% 7% Prop. 63 - Mental Health Services Y N NV 66% 34% 9% 57% 43% 8% 45% 55% 6% 49% 51% 6% 46% 54% 6% 37% 64% 7% 56% 44% 8% 53% 47% 7% 43% 57% 7% 49% 51% 8% 39% 61% 8% 61% 39% 7% 55% 46% 10% 48% 52% 7% 42% 58% 6% 47% 53% 7% 57% 43% 5% 44% 56% 5% 58% 42% 10% 47% 53% 6% 63% 37% 8% 48% 52% 16% 65% 35% 7% 48% 52% 8% 36% 64% 5% 51% 49% 8% 59% 41% 7% 56% 44% 7% 49% 51% 5% 43% 57% 9% 41% 59% 6% 47% 53% 5% 48% 52% 6% 50% 50% 7% 53% 47% 6% 47% 53% 7% 50% 50% 10% 74% 26% 11% 50% 50% 7% Prop. 67 -Emergency Medical Service Y N NV 34% 66% 10% 29% 71% 7% 18% 82% 7% 19% 81% 8% 20% 80% 6% 16% 85% 6% 31% 69% 10% 25% 75% 6% 20% 80% 8% 24% 76% 9% 15% 85% 5% 28% 72% 9% 33% 67% 7% 25% 75% 5% 21% 79% 6% 21% 79% 6% 27% 73% 5% 18% 82% 5% 32% 68% 11% 20% 80% 7% 35% 65% 10% 22% 78% 18% 33% 68% 8% 21% 79% 7% 15% 85% 5% 28% 72% 9% 38% 62% 7% 32% 68% 8% 22% 78% 7% 29% 71% 8% 18% 82% 7% 22% 78% 5% 25% 75% 5% 21% 79% 7% 27% 73% 6% 24% 76% 6% 25% 75% 10% 34% 66% 16% 23% 77% 7% -29- Actual Vote San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba State Totals Prop 61 – Children’s Hospital Y 49% 64% 57% 63% 64% 43% 46% 42% 61% 56% 52% 43% 43% 46% 53% 50% 54% 55% 46% 58% N 51% 36% 43% 37% 36% 57% 54% 58% 39% 44% 49% 57% 57% 54% 47% 50% 46% 45% 54% 42% NV 10% 13% 10% 11% 9% 7% 7% 10% 7% 9% 7% 8% 6% 7% 7% 8% 8% 8% 8% 10% Prop 63 – Mental Health Services Y N NV 50% 50% 8% 61% 39% 11% 54% 47% 8% 56% 44% 8% 66% 34% 7% 46% 54% 5% 47% 54% 6% 50% 50% 9% 55% 45% 6% 63% 37% 8% 50% 50% 6% 38% 62% 7% 45% 55% 5% 52% 48% 5% 44% 56% 6% 49% 52% 6% 47% 53% 7% 56% 44% 8% 44% 56% 6% 54% 46% 8% Prop 67 Emergency Medical Service Y N NV 28% 72% 10% 33% 67% 12% 34% 66% 10% 31% 69% 9% 38% 62% 10% 15% 85% 5% 24% 76% 5% 22% 78% 9% 24% 76% 7% 36% 64% 8% 21% 79% 7% 17% 83% 9% 14% 87% 5% 21% 79% 5% 23% 77% 6% 21% 79% 7% 25% 75% 10% 31% 69% 7% 19% 81% 8% 28% 72% 9% -30- Propositions 71, 72: Percentage Vote Yes, No, No Vote, by County Actual Vote (SOV) Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Actual Vote (SOV) Prop. 71 Stem Cell Y N VN 68% 32% 6% 59% 41% 8% 48% 52% 4% 53% 47% 4% 50% 50% 3% 42% 58% 4% 66% 34% 5% 50% 50% 5% 49% 51% 4% 48% 52% 6% 42% 58% 5% 58% 42% 6% 50% 50% 8% 53% 47% 4% 45% 55% 4% 45% 55% 5% 58% 43% 4% 41% 59% 4% 65% 35% 7% 43% 57% 4% 66% 34% 7% 48% 52% 15% 60% 40% 5% 45% 55% 5% 37% 63% 4% 59% 41% 6% 66% 34% 4% 64% 36% 4% 51% 49% 4% 52% 48% 5% 47% 54% 4% 49% 51% 3% 54% 46% 4% 53% 47% 5% 62% 38% 4% 52% 48% 4% 59% 42% 6% 71% 29% 9% 51% 49% 5% 56% 44% 5% 70% 30% 7% Prop. 71 - Stem Cell Prop. 72 – Health Care Y N VN 64% 36% 9% 49% 51% 8% 34% 66% 5% 41% 59% 6% 36% 64% 5% 33% 67% 5% 52% 48% 8% 44% 57% 7% 33% 67% 6% 42% 58% 8% 33% 67% 6% 50% 50% 8% 56% 44% 9% 39% 61% 6% 39% 61% 5% 42% 58% 6% 46% 54% 5% 38% 62% 5% 57% 43% 10% 37% 63% 5% 52% 48% 10% 37% 64% 18% 53% 47% 7% 45% 55% 6% 29% 71% 4% 42% 58% 8% 54% 46% 5% 48% 52% 7% 36% 64% 5% 38% 62% 7% 32% 68% 6% 34% 66% 5% 43% 57% 5% 45% 55% 6% 47% 53% 7% 45% 55% 6% 44% 56% 9% 69% 31% 12% 48% 52% 6% 41% 59% 8% 55% 45% 11% Prop. 72 - Health Care -31- Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba State Totals Y 58% 66% 70% 44% 46% 42% 61% 63% 46% 44% 44% 50% 42% 51% 57% 57% 45% 59% N 42% 34% 30% 56% 54% 58% 39% 37% 54% 56% 56% 51% 58% 49% 43% 43% 55% 41% NV 6% 5% 4% 4% 4% 7% 4% 5% 4% 6% 3% 3% 4% 4% 4% 5% 4% 6% Y 46% 53% 57% 35% 35% 40% 54% 52% 42% 35% 36% 37% 36% 37% 42% 52% 38% 49% N 54% 47% 43% 65% 65% 60% 46% 48% 58% 65% 65% 63% 64% 63% 58% 48% 62% 51% 9% 8% 7% 5% 6% 9% 5% 8% 6% 7% 5% 4% 5% 5% 6% 7% 4% 8% -32- Appendix B. Survey Methodology The PPIC Statewide Survey is directed by Mark Baldassare, research director and survey director at the Public Policy Institute of California, with assistance in research and writing for this report from Renatta DeFever, Kristy Michaud, and Kim Curry, survey research associates, and Jennifer Paluch, PPIC research associate. Darshan Goux moderated the focus groups that informed the survey design and analysis. Jon Cohen assisted with the survey design and analysis, and Max Neiman and Paul Lewis reviewed an earlier draft of this report. The survey was conducted with funding from The California Endowment and benefited from discussions with its staff and grantees and its colleagues at other institutions and from focus groups with voters; however, the survey methods, questions, and content of the report were determined solely by Mark Baldassare. The findings of this survey are based on a telephone survey of 2,500 California voters in the general election between November 4 and November 18, 2004. Interviewing took place on weekday nights and weekend days, using a computer-generated random sample of telephone numbers that ensured that both listed and unlisted telephone numbers were called. All telephone exchanges in California were eligible for calling. Telephone numbers in the survey sample were called up to six times to increase the likelihood of reaching eligible households. Once a household was reached, an adult respondent (age 18 or older) was randomly chosen for interviewing by using the “last birthday method” in order to reduce selection biases in age and gender. Eligible respondents were those who reported that they had voted in the November 2nd general election either at their local polling place or by absentee ballot. Each interview took an average of 20 minutes to complete. Interviewing was conducted in English, Spanish, Chinese, Korean, or Vietnamese. We chose these languages because Spanish is the dominant non-English language in the state and these three Asian languages account for most of the non-English speaking Asian adults in California. Publication Services translated the survey into Spanish. Schulman, Ronca & Bucuvalas, Inc. translated the survey into Chinese, Korean, and Vietnamese and conducted the telephone interviewing. We used the PPIC Statewide Survey data base to compare the demographic characteristics of California’s likely voters to the characteristics of the survey sample. We also used voting statistics from the California Secretary of State and the Los Angeles Times exit polls to compare with the current survey results. The survey sample of voters’ characteristics was closely comparable to the state figures. The survey data in this report were statistically weighted to account for demographic, political, and vote differences. The sampling error for the total sample of 2,500 voters is +/- 2 percent at the 95 percent confidence level. This means that 95 times out of 100 the results will be within 2 percentage points of what they would be if all voters in California were interviewed. The sampling error for subgroups is larger, such as the political groups, age and income brackets, health insurance status, and the regional and ethnic/racial categories that are reported in text and tables. Sampling error is only one type of error to which surveys are subject. Results may also be affected by factors such as question wording, question order, and survey timing. 33 Throughout the report, we refer to five geographic regions. “Central Valley” includes Butte, Colusa, El Dorado, Fresno, Glenn, Kern, Kings, Madera, Merced, Placer, Sacramento, San Joaquin, Shasta, Stanislaus, Sutter, Tehama, Tulare, Yolo, and Yuba Counties. “SF Bay Area” includes Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, and Sonoma Counties. “Los Angeles” refers to Los Angeles County, “Inland Empire” includes Riverside and San Bernardino Counties, and “Orange/San Diego” refers to Orange and San Diego Counties. These five regions represent the major population centers of the state, accounting for approximately 90 percent of the state population. We present specific results for respondents in the four self-identified racial/ethnic groups of Asian, black, Latino, and non-Hispanic white. We also compare the opinions of registered Democrats, Republicans, and independents. The “independents” category includes only those who are registered to vote as “decline to state.” We use earlier PPIC Statewide Surveys to analyze trends over time in California and use the Kaiser Family Foundations and ABC News/Washington Post surveys for national comparisons. 34 Appendix C. Survey Questions and Responses PPIC STATEWIDE SURVEY: SPECIAL SURVEY ON CALIFORNIANS AND HEALTH POLICY NOVEMBER 4—NOVEMBER 18, 2004 2,500 CALIFORNIA VOTERS IN THE NOVEMBER 2ND ELECTION ENGLISH, SPANISH, CHINESE, KOREAN, AND VIETNAMESE INTERVIEWS MARGIN OF ERROR +/- 2% AT 95% CONFIDENCE LEVEL FOR TOTAL SAMPLE 1. For president, did you happen to vote for [rotate] (1) George W. Bush, the Republican [or] (2) John Kerry, the Democrat? 44% George W. Bush and Dick Cheney 54 John Kerry and John Edwards 2 other answer 2. Which one issue was most important to you in deciding how to vote for president? 23% Iraq situation, war in Iraq 14 moral and family values 12 economy, jobs, unemployment 8 terrorism, security issues 4 abortion 4 against Bush 4 foreign policy in general 2 environment, pollution 2 health care, health costs, HMO reform 1 crime, gangs 1 education, schools 1 gay rights, gay marriages 1 government regulations 1 immigration, illegal immigration 1 party allegiance 1 social security 1 taxes, federal budget, deficit spending 1 women's rights 11 other 7 don’t know 35 3. Is there another issue that was almost as important? 20% Iraq situation, war in Iraq 17 economy, jobs, unemployment 9 moral and family values 9 terrorism, security issues 6 health care, health costs, HMO reform 6 taxes, federal budget, deficit spending 4 education, schools 4 foreign policy in general 3 abortion 3 gay rights, gay marriages 3 government regulations 2 environment, pollution 2 immigration, illegal immigration 2 social security 2 stem cell research 1 against Bush 1 women's rights 6 other 4. And how important were the candidates' positions on health care in deciding your vote— very important, somewhat important, not too important, or not at all important? 40% very important 36 somewhat important 14 not too important 9 not at all important 1 don't know 5. For U.S. Senate, did you happen to vote for [rotate] (1) Barbara Boxer, the Democrat [or] (2) Bill Jones, the Republican? 58% Barbara Boxer, the Democrat 38 Bill Jones, the Republican 4 other answer [question 6 deleted] Thinking more generally just about the state of California, 7. Do you think things in California are generally going in the right direction or the wrong direction? 53% right direction 35 wrong direction 12 don't know 36 8. Turning to economic conditions in California, do you think that during the next 12 months we will have good times financially or bad times? 52% good times 34 bad times 14 don't know I would like you to rate your satisfaction with conditions in your part of California today in some different areas. For each one, please tell me if you are very satisfied, somewhat satisfied, not too satisfied, or not at all satisfied. How about … [rotate questions 9a to 9c] 9a. The availability of health care in your part of California? 35% very satisfied 40 somewhat satisfied 14 not too satisfied 10 not at all satisfied 1 don't know 9b. The affordability of health care in your part of California? 13% very satisfied 33 somewhat satisfied 27 not too satisfied 24 not at all satisfied 3 don't know 9c. The quality of health care in your part of California? 35% very satisfied 42 somewhat satisfied 13 not too satisfied 8 not at all satisfied 2 don't know 10. Turning to your own life, how concerned are you about being able to afford necessary health care when a family member gets sick—very concerned, somewhat concerned, not very concerned, or not at all concerned? 43% very concerned 27 somewhat concerned 17 not very concerned 13 not at all concerned 37 As I read the following list of issues, please tell me if each is a big problem, somewhat of a problem, not much of a problem, or not a problem at all. [rotate questions 11a to 11d] 11a. How about the number of people without health insurance? 58% big problem 26 somewhat of a problem 6 not much of a problem 4 not a problem at all 6 don't know 11b. How about the availability of public mental health services? 30% big problem 25 somewhat of a problem 14 not much of a problem 10 not a problem at all 21 don't know 11c. How about the availability of emergency medical care? 25% big problem 27 somewhat of a problem 20 not much of a problem 23 not a problem at all 5 don't know 11d. How about the availability and quality of specialized children's hospitals? 14% big problem 23 somewhat of a problem 23 not much of a problem 22 not a problem at all 18 don't know 12. Compared to 10 years ago, do you think the health care system today is better, worse, or is it about the same as it was 10 years ago? 15% system is better than 10 years ago 49 system is worse than 10 years ago 27 system is about the same as 10 years ago 9 don't know [rotate questions 13 and 14] 13. In general, how much trust and confidence do you have in the state government when it comes to making public policy—a great deal, a fair amount, not too much, or none at all? 6% a great deal 42 a fair amount 39 not too much 12 none at all 1 don't know 38 14. Thinking about the role of the public in politics, how much trust and confidence do you have in California's voters when it comes to making choices on election day—a great deal, a fair amount, not too much, or none at all? 14% a great deal 41 a fair amount 33 not too much 10 none at all 2 don't know Turning back to the recent election, the California ballot included 16 state ballot measures. 15. Do you think that the citizens' initiative process that allows state voters to vote directly on citizen-sponsored policies is a good thing or a bad thing for California? 78% good thing 15 bad thing 7 don't know 16. Do you think public policy decisions made through the initiative process by California voters are probably better or probably worse than public policy decisions made by the governor and state legislature? 61% probably better 22 probably worse 6 same 11 don't know 17. Thinking specifically about health policy, which do you most prefer: [rotate] (1) that the governor and state legislature make state health policy [or] (2) that California voters make state health policy at the ballot box? 32% governor and state legislature should make health policy 58 California voters should make health policy 2 other 1 both 1 neither 6 don't know [question 18 deleted] 19. Proposition 61 proposed 750 million dollars in state bonds to fund children's hospitals. Did you vote yes or no on this measure? 58% voted yes [ask q. 20a] 42 voted no [ask q. 20b] 20a. Did you vote yes because of ... 52% your general support for children 31 your thinking children's hospitals need to be strengthened and expanded 10 your direct experience with children's hospitals 3 for some other reason (specify) 3 all of the above (volunteered) 1 don't know 39 [go to q. 21] 20b. Did you vote no because of ... 44% the state's budget situation 32 your general opposition to state bonds 2 your direct experience with children's hospitals 8 some other reason (specify) 1 all of the above (volunteered) 3 money is not used as it should be(volunteered) 4 there is no need for children’s hospitals (volunteered) 4 didn’t want any new taxes (volunteered) 2 don't know 21. Proposition 63 proposed an additional 1 percent tax on taxable incomes over 1 million dollars to pay for mental health services. Did you vote yes or no on this measure? 54% voted yes [ask q. 22a] 46 voted no [ask q. 22b] 22a. Did you vote yes because of ... 54% your thinking there are too many homeless mentally ill people 17 your direct experience with the public mental health system 13 your not being in that tax bracket 4 some other reason (specify) 3 all of the above (volunteered) 3 help is needed (volunteered) 2 rich people can afford it (volunteered) 4 don’t know [go to q. 23] 22b. Did you vote no because ... 43% you generally oppose new taxes 21 you think this new tax would drive entrepreneurs out of California 13 you think these programs haven't been proven to be effective 9 some other reason (specify) 3 all of the above (volunteered) 8 it is not fair (volunteered) 1 money will not be spent as it should be (volunteered) 2 don’t know 23. Proposition 67 proposed to raise the telephone surtax to pay for emergency medical services and the 911 response system. Did you vote yes or no on this measure? 28% voted yes [ask q. 24a] 72 voted no [ask q. 24b] 40 24a. Did you vote yes because of ... 33% your thinking emergency rooms are too crowded 30 your thinking there are too few emergency rooms 15 your direct experience with emergency medical care 5 some other reason (specify) 5 all of the above (volunteered) 7 there is a need for emergency services (volunteered) 5 don’t know [go to q. 25] 24b. Did you vote no because of ... 43% your general opposition to new fees and surcharges 29 your not wanting higher phone bills 4 your direct experience with emergency medical care 14 some other reason (specify) 2 all of the above (volunteered) 3 not clear where the money would go (volunteered) 3 did not want new taxes (volunteered) 2 don’t know 25. Proposition 71 proposed 3 billion dollars in state bonds to fund stem cell research in the state. Did you vote yes or no on this measure? 59% voted yes [ask q. 26a-1] 41 voted no [ask q. 26b] 26a-1. Do you have any friends or family members you think might benefit from stem cell research? 44% yes 54 no 2 don't know 26a. Did you vote yes because of ... 75% your thinking this research will lead to medical advancements 11 the lack of federal dollars for stem cell research 6 your thinking this will lead to good business opportunities and jobs 2 for some other reason (specify) 6 all of the above (volunteered) [go to q. 27] 41 26b. Did you vote no because ... 42% stem cell research is against your beliefs 24 of the state's budget situation 10 you generally oppose all state bonds 13 for some other reason (specify) 2 all of the above (volunteered) 6 it is not the government’s role (volunteered) 2 no accountability (volunteered) 1 don’t know 27. Proposition 72 proposed that medium and large employers in California be required to provide health insurance for their employees. Did you vote yes or no on this measure? 49% voted yes [ask q. 28a] 51 voted no [ask q. 28b] 28a. Did you vote yes because ... 54% you think all employers should provide health insurance to their employees 37 you think the number of Californians without health insurance is too high 2 some other reason (specify) 6 all of the above (volunteered) 1 don’t know [go to q. 29] 28b. Did you vote no because ... 66% you think it would be a burden to businesses 16 you think it would create another government-run program 6 Governor Schwarzenegger's opposition to the measure 8 some other reason (specify) 3 all of the above (volunteered) 1 don't know 29. Regardless of how you voted, before deciding how to vote on these five health-related propositions, how closely were you following news about these measures—very closely, fairly closely, not too closely, or not at all closely? 28% very closely 49 fairly closely 17 not too closely 6 not at all closely 42 30. Which one or two of these five health measures were you most interested in? 49% Proposition 71, stem cell research bonds 16 Proposition 72, health care coverage referendum 12 Proposition 61, children's hospital bonds 8 Proposition 63, mental health services 8 Proposition 67, emergency medical services 2 did not pay attention to any of these measures 3 all equally (volunteered) 2 don’t know 31. I am going to read different ways people learn about ballot propositions. Please tell me the top one or two that you found most helpful in deciding how to vote on these five healthrelated propositions in the last election. [rotate] 47% the official voter information guide and sample ballot 15 news and media coverage 11 the opinions of friends and family members 9 advertisements on radio or television or in the mail 9 newspaper endorsements such as columns or editorials 5 endorsements by interest groups, politicians, or celebrities 3 something/someone else (specify) 1 don’t know 32. On another topic, prior to the election, did you happen to go on-line to get information about the presidential election? 34% yes 65 no 1 no on-line/internet access [go to q. 34] 33. Did you go on-line to get information about any of the 5 health-related ballot propositions? 18% yes [ask q. 33a] 82 no [go to q. 34] 33a. Did you ever go to an independent website called healthvote2004.org? 5% yes [ask q. 33b] 88 no [go to q. 34] 7 don't know [go to q. 34] 33b. Was this web site very helpful, somewhat helpful, not too helpful, or not at all helpful to you in deciding how to vote on these propositions? 16% very helpful 53 somewhat helpful 23 not too helpful 8 not at all helpful 43 34. Overall, did you feel that you had enough information to make good choices on these five health-related ballot measures? 81% yes [go to q .35] 18 no [ask q. 34a] 1 don't know [go to q. 35] 34a. What additional sources or types of information would you have liked to make good choices on these measures, or did you just not have enough time to go through the already existing information? 49% just didn't have enough time 26 wanted something else (specify) 6 impartial information 6 more information 4 clear information/wording 2 more debate 7 don't know 35. In the recent election, California voters passed the children's hospital bonds, the expansion of mental health services initiative, and the stem cell research bonds, and they rejected the emergency medical services and health care coverage measures. Do these new state policies make you more optimistic about the state’s health care system, more pessimistic, or do you feel about the same as you did before the election? 27% feel more optimistic 16 feel more pessimistic 55 feel about the same 2 don't know And regardless of how you voted … [rotate questions 36 and 37] 36. Do you think that the current level of state funding for mental health programs is more than enough, just enough, or not enough? 8% more than enough 20 just enough 55 not enough 17 don't know 37. Do you think the federal government spends too much, the right amount, or too little on medical research using embryonic stem cells? 19% too much 13 the right amount 52 too little 4 federal government should not fund stem cell research (specify) 12 don't know 44 [rotate questions 38 and 39] 38. Do you think that the financial cost of requiring large and medium employers to provide health care benefits for their employees is a big problem for those employers, somewhat of a problem, not too much of a problem, or not a problem at all? 37% big problem 40 somewhat of a problem 13 not much of a problem 8 not a problem at all 2 don't know 39. How important is it to you that large and medium employers provide health care benefits for their employees—very important, somewhat important, not too important, or not at all important? 58% very important 27 somewhat important 7 not too important 7 not at all important 1 don't know [questions 40 and 41 deleted] [rotate questions 42 and 43] 42. Which would you prefer: [rotate] (1) the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance [or] (2) a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers? 45% current system 47 universal health insurance program 8 don't know 43. Would you be willing to pay more—either in higher health insurance premiums or higher taxes—in order to increase the number of Americans who have health insurance, or not? 52% yes, willing to pay more 43 no, not willing to pay more 5 don't know 44. Are you registered to vote as a Democrat, a Republican, another party, or as an independent? 45% Democrat 40 Republican 13 independent 2 other 45 45. Regardless of your current voter registration status, generally speaking, do you usually think of yourself as a Democrat, a Republican, independent, or what? 42% Democrat [go to q. 46b] 36 Republican [go to q. 46c] 17 independent [ask q. 46a] 5 other [ask to q. 46a] 46a.Do you think of yourself as closer to the Republican Party or Democratic Party? 31% Republican party 45 Democratic party 21 neither 3 don't know [go to q. 47] 46b.Would you call yourself a strong Democrat or not a very strong Democrat? 64% strong 35 not very strong 1 don't know [go to q. 47] 46c.Would you call yourself a strong Republican or not a very strong Republican? 67% strong 30 not very strong 3 don't know 47. On another topic, would you consider yourself to be politically: [rotate] 12% very liberal 22 somewhat liberal 26 middle-of-the-road 26 somewhat conservative 13 very conservative 1 don't know 48. Generally speaking, how much interest would you say you have in politics—a great deal, a fair amount, only a little, or none? 34% a great deal 47 a fair amount 17 only a little 2 none 49. Was this November the first time you voted? 8% yes [skip to q. 50] 92 no [ask q. 49a] 46 49a. How often would you say you vote? 70% always 18 nearly always 2 part of the time 1 seldom 8 first-time voter 1 don't know 50. Did you vote at your local polling place or by absentee ballot? 69% local polling place 30 absentee ballot 1 early voting 51. On another topic, are you, yourself, now covered by any form of health insurance or health plan? 90% yes [ask q. 51a] 10 no [skip to q. 55] 51a. Which type of health insurance do you now have? Is it a plan through your or your spouse's employer, a plan you purchased yourself, or are you covered by Medicare or Medi-Cal, some other government program, or do you get your health insurance from somewhere else? 72% private plan through your or your spouse's employer 14 plan purchased yourself 8 Medicare 2 Medi-Cal 3 some other government program 1 somewhere else 52. Overall how do you feel about your current health insurance policy—are you very satisfied, somewhat satisfied, not too satisfied, or not at all satisfied with your coverage? 45% very satisfied 42 somewhat satisfied 9 not too satisfied 3 not at all satisfied 1 don't know [question 53 deleted] 54. At any time in the past 12 months, have you or a family member been without health insurance? 17% yes 83 no 55. Are you or is anyone in your immediate family a member of a labor union? 15% yes, respondent 11 yes, another person in family 3 yes, both 70 no 1 don't know [56-70 : demographic questions] 47 PUBLIC POLICY INSTITUTE OF CALIFORNIA Board of Directors Cheryl White Mason, Chair Chief, Civil Liability Management Los Angeles City Attorney’s Office Edward K. Hamilton Chairman Hamilton, Rabinovitz & Alschuler, Inc. Gary K. Hart Founder Institute for Education Reform California State University, Sacramento Arjay Miller Dean Emeritus Graduate School of Business Stanford University Ki Suh Park Design and Managing Partner Gruen Associates Constance L. Rice Co-Director The Advancement Project Walter B. Hewlett Director Center for Computer Assisted Research in the Humanities David W. Lyon President and CEO Public Policy Institute of California Thomas C. Sutton Chairman & CEO Pacific Life Insurance Company Raymond L. Watson Vice Chairman of the Board Emeritus The Irvine Company Carol Whiteside President Great Valley Center Advisory Council Mary C. Daly Vice President Federal Reserve Bank of San Francisco Clifford W. Graves General Manager Department of Community Development City of Los Angeles Daniel A. Mazmanian C. Erwin and Ione Piper Dean and Professor School of Policy, Planning, and Development University of Southern California Dean Misczynski Director California Research Bureau Elizabeth G. Hill Legislative Analyst State of California Rudolf Nothenberg Chief Administrative Officer (Retired) City and County of San Francisco Hilary W. Hoynes Associate Professor Department of Economics University of California, Davis Andrés E. Jiménez Director California Policy Research Center University of California Office of the President Norman R. King Executive Director San Bernardino Associated Governments Manuel Pastor Professor, Latin American & Latino Studies University of California, Santa Cruz Peter Schrag Contributing Editor The Sacramento Bee James P. Smith Senior Economist RAND Corporation PUBLIC POLICY INSTITUTE OF CALIFORNIA 500 Washington Street, Suite 800 O San Francisco, California 94111 Phone: (415) 291-4400 O Fax: (415) 291-4401 www.ppic.org O info@ppic.org" } ["___content":protected]=> string(106) "

OP 205MBOP

" ["_permalink":protected]=> string(127) "https://www.ppic.org/publication/making-health-policy-at-the-ballot-box-californians-and-the-november-2004-election/op_205mbop/" ["_next":protected]=> array(0) { } ["_prev":protected]=> array(0) { } ["_css_class":protected]=> NULL ["id"]=> int(8460) ["ID"]=> int(8460) ["post_author"]=> string(1) "1" ["post_content"]=> string(0) "" ["post_date"]=> string(19) "2017-05-20 02:37:48" ["post_excerpt"]=> string(0) "" ["post_parent"]=> int(3666) ["post_status"]=> string(7) "inherit" ["post_title"]=> string(10) "OP 205MBOP" ["post_type"]=> string(10) "attachment" ["slug"]=> string(10) "op_205mbop" ["__type":protected]=> NULL ["_wp_attached_file"]=> string(14) "OP_205MBOP.pdf" ["wpmf_size"]=> string(7) "1345017" ["wpmf_filetype"]=> string(3) "pdf" ["wpmf_order"]=> string(1) "0" ["searchwp_content"]=> string(95364) "Occasional Papers Making Health Policy at the Ballot Box: Californians and the November 2004 Election Mark Baldassare Renatta DeFever Kristy Michaud With Funding From The California Endowment Woodland Hills, California February 23, 2005 Public Policy Institute of California The Public Policy Institute of California (PPIC) is a private operating foundation established in 1994 with an endowment from William R. Hewlett. The Institute is dedicated to improving public policy in California through independent, objective, nonpartisan research. PPIC's research agenda focuses on three program areas: population, economy, and governance and public finance. Studies within these programs are examining the underlying forces shaping California’s future, cutting across a wide range of public policy concerns, including education, health care, immigration, income distribution, welfare, urban growth, and state and local finance. PPIC was created because three concerned citizens – William R. Hewlett, Roger W. Heyns, and Arjay Miller – recognized the need for linking objective research to the realities of California public policy. Their goal was to help the state’s leaders better understand the intricacies and implications of contemporary issues and make informed public policy decisions when confronted with challenges in the future. David W. Lyon is founding President and Chief Executive Officer of PPIC. Cheryl White Mason is Chair of the Board of Directors. Copyright © 2005 by Public Policy Institute of California All rights reserved San Francisco, CA Short sections of text, not to exceed three paragraphs, may be quoted without written permission provided that full attribution is given to the source and the above copyright notice is included. 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. Research publications reflect the views of the authors and do not necessarily reflect the views of the staff, officers, or Board of Directors of the Public Policy Institute of California. Contents Introduction STATE POLITICAL CONTEXT Overall Mood Government Trust Citizens’ Initiatives Health Policy Initiatives Presidential Election NOVEMBER BALLOT CHOICES Voters’ Interests Proposition 61 Proposition 63 Proposition 67 Proposition 71 Proposition 72 Voters’ Information Sources Satisfaction with Information Sources HEALTH POLICY ATTITUDES Perceived Policy Problems Employee Health Coverage Universal Health Coverage State Mental Health Funding Federal Stem Cell Research Funding Health Care Affordability The Health Care System Appendix A. Health Policy Ballot Measures Propositions 61, 63, 67: Percentage Vote Yes, No, No Vote, by County Propositions 71, 72: Percentage Vote Yes, No, No Vote, by County Appendix B. Survey Methodology Appendix C. Survey Questions and Responses 1 5 5 6 7 8 9 10 10 11 12 13 14 15 16 18 19 19 20 21 22 23 25 26 29 29 31 33 35 -i- Summary California voters were asked to make decisions on five health policy measures on the November ballot. They voted yes on state bond measures to increase funding for children’s hospital projects (Proposition 61) and stem cell research (Proposition 71) and to levy a tax on million-dollar incomes for expanded mental health services (Proposition 63). They defeated a measure to fund emergency medical services with a telephone surcharge (Proposition 67) and a measure requiring medium and large employers to provide employee health care coverage (Proposition 72). Given the growing reliance on citizens’ initiatives to make public policy in California, voters may be asked to make more health policy decisions in the future. The PPIC Statewide Survey of California voters in the November 2nd 2004 election, funded by The California Endowment, provides the first comprehensive analysis of voters making health policy decisions at the ballot box. The goal of this effort is to consider how this experience may influence voters’ reactions to future ballot measures and health policymaking in the state. This survey report presents the responses of 2,500 California voters who were randomly selected and interviewed by telephone in English, Spanish, or one of three Asian languages from November 4th through 18th on election, policy, and political issues. The large sample size and multilingual interviewing allowed us to address the following questions: How do Californians feel about their expanding role in making state policy? Fewer than half of California voters said they have even a fair amount of trust in state government when it comes to making laws. The survey respondents expressed more trust and confidence in voters when it comes to making policy choices. Three in four said that it is a good thing that voters can vote directly on public policies. By a three-to-one margin, they thought that the public policy decisions made by the voters are probably better than those made by the governor and the legislature. What are the reasons for their ballot choices? • Proposition 61—the Children’s Hospital Bond—won by 58 to 42 percent. It was strongly supported by Democrats and independents, narrowly supported by Republicans, and solidly backed across racial/ethnic groups. The main reasons given for voting yes were general support for children and children’s hospitals. • Proposition 63—Mental Health Services Funding—won by 54 to 46 percent. Although opposed by Republicans and higher-income voters, it had strong support among Democrats and independents. People who voted “yes” cited concern about the homeless mentally ill, while “no” voters cited general opposition to taxes. • Proposition 67—Emergency Medical Services Funding—lost by 72 to 28 percent. It was opposed by majorities across political groups and most racial/ethnic and demographic groups. The reasons given for voting no were general opposition to new fees and surcharges and not wanting to pay higher telephone bills. • Proposition 71—Stem Cell Research Bonds—won by 59 to 41 percent. It was opposed by Republicans but strongly supported by Democrats and independents and -iii- had solid support across racial/ethnic groups. The main reason for a yes vote was the potential for medical advances. “No” voters cited their beliefs and the condition of the state budget as deciding factors. • Proposition 72—Health Care Coverage Requirements—lost by 51 to 49 percent. Democrats solidly supported it, Republicans were strongly opposed, and independents were evenly divided. Support was higher among nonwhites than whites, and opposition increased with age, education, income, nonunion status, and a health insurance plan. The top reasons for voting yes were the high number of uninsured Californians and the belief that employers should provide health insurance. “No” voters cited the fiscal burden on business and opposition to yet another government-run program. What types of information and information sources enter into their decisions? Half of the voters said the voter’s guide provided the most helpful information about the five measures. One in 10 cited each of these sources: paid advertisements, news stories, newspaper endorsements, and family and friends. One in five said they went on-line for information. Eight in 10 voters were satisfied with the amount of information they had to make good choices on the measures. Half said they did not have enough time to go through the already existing information, which limits interest in having more sources. Do voters believe that making health policy at the ballot box has positive effects? When asked how the new state policies emerging from the election affected their feelings about the state’s health care system, just over half said they felt about the same as they had before the election. However, over four in 10 said the results made them more optimistic about the system. Fewer than two in 10 were more pessimistic. What post-election attitudes of the voters may affect future legislation and initiatives? Concerns about health care coverage are still high. Six in 10 voters believe that “people without health insurance” is a big problem where they live. They also feel it is “very important” for them that medium and large employers provide health care benefits. However, about four in 10 voters think the financial costs of providing health care coverage are a big problem for those employers, and another four in 10 think it is “somewhat of a problem.” Voters are split along partisan lines when asked if they would support a universal health insurance program and if they would be willing to pay more in order to increase the number of Americans who have health insurance coverage. In their personal attitudes toward the health care system, half of the voters report that they are less than somewhat satisfied with the affordability of health care in their part of California. Four in 10 voters are very concerned, and seven in 10 are at least somewhat concerned, about affording health care when a family member gets sick. They are more satisfied about the quality and availability of health care. However, about half of the voters think that the health care system is worse today than it was 10 years ago, one in four say it is the same, and one in six thinks it is better today than it was a decade ago. Those who think the health care system is in worse shape today are among the strong supporters of the three health policy measures that passed. Those who see the health care system as being worse today supported Proposition 72 by only a narrow margin, indicating that many voters who find fault with the current health care system were not strongly drawn to this health policy reform. -iv- Introduction On November 2, 2004, 12.5 million voters in California cast their ballots for president, senate, and federal and state legislators, as well as local elected offices in many jurisdictions. In absolute numbers, this was the largest voter turnout in California history. It was also the highest turnout in percent of registered voters (76%) and eligible adults (57%) since the presidential election in 1980. This stood in surprising contrast to the last general election, which had the lowest turnout in the state’s history. However, the November ballot contained a number of controversial initiatives; and a movement toward increasing voter participation, as well as increasing interest in “direct democracy ” was evident during the recall election on October 7, 2003, and again during the previous general election. On the November ballot, voters were asked to make policy decisions on 16 state propositions involving many issues, including Indian gaming, local government funding, three strikes reform, open primaries, and health policy. A total of five measures would either make new laws or reverse existing laws on health policy: Proposition 61 (Children’s Hospital Projects), Proposition 63 (Mental Health Expansion Funding), Proposition 67 (Emergency Medical Services Funding), Proposition 71 (Stem Cell Research), and Proposition 72 (Referendum on Health Care Coverage). The voters chose to fund children’s hospitals, stem cell research, and mental health expansion but opposed funding for emergency medical services and refused to mandate health care coverage by medium and large employers. There is good reason to believe the voters will be asked to make many decisions at the ballot box in the post-recall era. The 2004 election offered an unprecedented opportunity to learn how Californians make health policy decisions at the ballot box and how they react to using the initiative process for this purpose. With funding from the California Endowment, we undertook a PPIC Statewide Survey designed to gain a better understanding of these issues. How do Californians feel about their expanding role in deciding on major state policies? What are the reasons for their ballot choices? What types of information and information sources enter into their decisions? Do voters believe that making health policy choices at the ballot box has positive effects? We were also interested in the health policy attitudes of the state’s voters after the election, because these preferences might foreshadow their support for future policy efforts in either the legislative or initiative arenas. In the two-week period immediately after the November 2nd election, we conducted a 20minute telephone survey of 2,500 voters. We contacted a random sample of California adults, offered to interview them in one of five languages, and surveyed only those who had voted in the recent election. These topics were covered in this post-election survey of voters: (1) general attitudes toward citizens’ initiatives and making health policy at the ballot box; (2) specific awareness of and interest in the five health policy ballot measures; (3) voter choices on each of the five state ballot measures and major reasons for those choices; (4) awareness of and reactions to information sources, including advertising, the media, and the voter’s guide; (5) attitudes toward health policy issues that are related to the five ballot items; (6) health policy issues related to the presidential election and candidate preferences; (7) personal concerns about health coverage; (8) ratings of the health care system and its attributes; (9) trust and confidence in state government; and (10) general state conditions. In addition, we asked respondents our standard battery of -1- questions on their political characteristics, racial/ethnic self-identification, and demographic characteristics. The remainder of this report addresses these issues under three headings: State Political Context, November Ballot Measures, and Health Policy Attitudes. Three data sources contributed to the analysis for this report: (1) county vote tallies for the five ballot measures, as recorded by the Secretary of State; (2) campaign contributions and expenditures for the five health policy measures, as reported by the Secretary of State, and; (3) focus groups with voters in Fresno, Los Angeles, Sacramento, San Diego, and San Francisco, before and after the election, to inform the question design and the data analysis of our survey. Throughout the report, we look for underlying political, social, and economic attitudes that might be shaping Californians’ interest in making policy decisions at the ballot box, as well as attitudes that affect the specific health policy decisions voters made in this election. We also look for evidence of sharp differences across political groups that may be consistent with the “partisan divide” found in recent state and national surveys. Given the changing demographics of the state’s population, we are interested in differences in health policy preferences and vote choices across racial/ethnic groups and regions of the state. In addition, we seek to understand the role of age, socioeconomic factors, and health insurance status in determining general and specific attitudes toward health policies. Finally, we look for evidence of changes in health policy attitude during and after this election. In this report we look at differences across partisan lines, race/ethnicity, and the five major regions of California, as defined in the map on the following page. -2- State Political Context Overall Mood California voters were relatively upbeat after the November 2004 election. About half said the state was headed in the right direction, while one in three said it was headed in the wrong direction. Half expect good economic times and one in three anticipates bad times over the next 12 months. These post-election findings show an improvement in the voters’ mood since our preelection survey series, when likely voters were evenly divided on the current state of the state and the near-term direction of the California economy. These results also point to a dramatic turnaround from a year ago when the state was in the midst of a historic recall of the governor . In fact, the overall mood among voters has not been brighter since the 2000 general election. In a trend that surfaced after the recall of Democrat Gray Davis and his replacement by Republican Arnold Schwarzenegger in October 2003, Democrats are much more pessimistic than Republicans about current conditions in the state. The re-election of President Bush may be adding to the gloomier overall outlook among Democrats and higher optimism among Republicans in this post-election survey. There are also differences across the state’s regions and racial/ethnic groups. Residents of the San Francisco Bay area are more pessimistic than residents of other areas, and blacks and Latinos are more pessimistic than Asians and whites. Less educated and lower-income voters are also more pessimistic than others about the state of the state. Table 1 “Do you think things in California are generally going in the right direction or the wrong direction?” All Voters Right direction 53% Wrong direction 35 Don't know 12 Party Registration Dem Rep Ind 44% 64% 55% 42 27 31 14 9 14 CV 56% 33 11 Region SF LA OC/SD 48% 53% 59% 38 36 29 14 11 12 IE Asians 54% 56% Race/Ethnicity Blacks Latinos 34% 44% Whites 57% 38 27 52 43 32 8 17 14 13 11 Table 2 “Turning to economic conditions in California, do you think that during the next 12 months we will have good times financially or bad times?” All Voters Good times 52% Bad times 34 Don't know 14 Party Registration Dem 37% 47 16 Rep 72% 16 12 Ind 47% 40 13 CV 55% 30 15 Region SF 43% 41 16 LA 48% 39 13 OC/SD 60% 29 11 Race/Ethnicity IE 63% 25 12 Asians 50% 34 16 Blacks 34% 53 13 Latinos 42% 46 12 Whites 57% 30 13 -5- Government Trust The PPIC Statewide Survey has consistently found that California voters trust their fellow citizens more than their elected representatives when it comes to making laws and public policies. In the context of the 2002 governor’s race and the 2003 governor’s recall, California voters’ trust in state government reached historic lows and did not rebound in 2004, despite high approval ratings during Governor Schwarzenegger’s first year in office. This post-election survey indicates that most voters across the state’s major regions and racial/ethnic groups are still reluctant to express confidence in state government when it comes to making public policies. Only 6 percent have a “great deal of confidence” in state government, and just over half say they have little or no trust. Given that a Republican is in the governor’s office and Democrats control the legislature and every other state executive office, it is noteworthy that voters from both parties express a lack of trust and confidence in their state government. When asked how much they trust voters to make election choices, voters are more likely to say they trust the people a great deal or fair amount compared to the state government (55% to 48%). The public’s confidence in voters today is exactly what we recorded in the week before the October 2003 governor’s recall. Republicans are more likely to say they trust state government than the public overall (52% to 46%), while Democrats and independent voters express more trust in the voters than in their state government. Still, many voters across party lines express considerable skepticism when it comes to voters making choices on Election Day. Table 3 “How much trust and confidence do you have in the state government when it comes to making public policy – a great deal, a fair amount, not too much, or none at all?” All Voters Party Registration Dem Rep Ind Great deal 6% 5% Fair amount 42 41 Not much 39 41 None at all 12 12 Don't know 1 1 7% 45 35 12 1 6% 40 40 12 2 CV 6% 44 36 14 0 Region SF LA OC/SD 4% 6% 7% 41 44 44 43 37 35 11 12 13 11 1 Race/Ethnicity IE Asians Blacks Latinos Whites 5% 9% 8% 10% 4% 40 47 35 36 44 41 33 42 38 39 12 10 15 13 11 2 10 32 Table 4 “How much trust and confidence do you have in California's voters when it comes to making choices on election day -- a great deal, a fair amount, not too much, or none at all?” All Voters Great deal Fair amount Not much None at all Don't know 14% 41 33 10 2 Party Registration Dem Rep Ind 16% 46 29 7 2 12% 34 38 14 2 11% 47 30 10 2 CV 17% 33 37 11 2 Region SF LA OC/SD 10% 48 32 8 2 16% 42 29 12 1 15% 41 33 9 2 Race/Ethnicity IE Asians Blacks Latinos Whites 16% 37 32 13 2 12% 49 27 9 3 20% 44 28 7 1 26% 32 29 11 2 12% 42 34 10 2 -6- Citizens’ Initiatives In the wake of a November election that included 16 state ballot propositions, California voters give highly favorable marks to the initiative process. About three in four say it is a good thing that the state’s voters can vote directly on state policies. This approval of the initiative process is the same as in the August pre-election survey and similar to responses in earlier surveys. Also as in the past, the initiative process gets high marks across political, regional, and racial/ethnic groups. Even though some may have reservations about voters’ abilities to make good choices on Election Day, most voters say they prefer initiative decisions to the legislative process. Six in 10 say that the public policy decisions made through the initiative process are “probably better” than can be expected from the governor and state legislature. However, about one in four say ballot box decisions are “probably worse” than the decisions that are made in Sacramento. Across political groups, regions, and race/ethnic groups, there are solid majorities who expect the initiative process in California to produce better public policy decisions than the governor and state legislature elected to represent the people’s views in lawmaking. These opinions were similar to results of our pre-election survey and earlier statewide surveys. Table 5 “Do you think that the citizens' initiative process that allows state voters to vote directly on citizen-sponsored policies is a good thing or a bad thing for California?” Good thing Bad thing Don't know All Voters 78% 15 7 Party Registration Dem Rep Ind 73% 19 8 81% 12 7 84% 12 4 CV 77% 13 10 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 73% 78% 81% 82% 85% 77% 79% 77% 21 15 15 9 9 14 14 16 6749 6 9 7 7 Table 6 “Do you think public policy decisions made through the initiative process by California voters are probably better or probably worse than public policy decisions made by the governor and state legislature?” Party Registration All Voters Dem Rep Ind CV Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites Probably better Probably worse Same (volunteered) Don't know 61% 22 6 11 57% 64% 64% 63% 55% 62% 26 19 17 24 27 20 667667 11 11 12 7 12 11 62% 69% 21 12 76 10 13 71% 11 7 11 69% 16 3 12 65% 21 2 12 59% 24 7 10 -7- Health Policy Initiatives Does the voters’ general preference for the initiative over the legislative process apply to making health policy? Voters faced a wide range of health policy decisions in the five measures on the November ballot. The election results were mixed—two bond measures passed; mental health services were funded and emergency services were not; and a referendum passed overturning a state law requiring certain employers to provide health coverage. After the election, six in 10 voters said that they most prefer to have the voters make the health policy decisions at the ballot box while three in 10 said that the governor and legislature should be making these choices. The belief that California voters rather than elected officials should be making state health policy was the majority view across party lines, racial/ethnic groups, and regions of the state. Concerning the five health policy decisions made by the voters, a majority said that it had no sizeable effect on their outlook for the state’s health care system. Perhaps most important for their perceptions of health care, only one in six said the results of the election made them feel more pessimistic. Most voters across party lines said the results on the five health policy measures made them feel more optimistic or the same as before the election. Table 7 Thinking specifically about health policy, which do you most prefer: that the governor and state legislature make state health policy or that California voters make state health policy at the ballot box?” All Voters Voters should make health policy Governor and state legislature should make health policy Other answer 58% 32 4 Don't know 6 Party Registration Dem Rep Ind 60% 53% 61% 32 35 27 65 29 4 6 CV 59% 33 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 52% 58% 59% 66% 59% 74% 71% 54% 37 34 31 23 35 21 24 35 3 53 75 1 31 5 65 36 5 2 4 5 6 Table 8 “California voters passed the children's hospital bonds, the expansion of mental health services initiative, and the stem cell research bonds, and they rejected the emergency medical services and health care coverage measures. Do these new state policies make you more optimistic about the state’s health care system, more pessimistic, or do you feel about the same as you did before the election?” More optimistic More pessimistic About the same Don't know All Voters 27% 16 55 2 Party Registration Dem Rep Ind 34% 19% 25% 12 22 15 53 57 60 1 20 CV 22% 16 60 2 Region SF LA OC/SD 32% 28% 25% 11 17 16 55 52 57 232 Race/Ethnicity IE Asians Blacks Latinos Whites 23% 33% 19% 25% 28% 23 13 14 17 15 53 51 64 55 55 13332 -8- Presidential Election The five health policy measures appeared on the California ballot during a presidential election that the state’s voters followed closely and viewed as highly important to the nation’s future. In California, Democratic challenger John Kerry led Republican President George W. Bush in every public opinion poll taken before the election. California was virtually ignored by the national campaigns that focused their attention on the “battleground states.” In the end, Kerry won in California by 1.2 million votes and a 10-point margin, while Bush won the national election and a second term. According to voters in our post-election survey, health policy was not one of the most important issues in the presidential campaign. When asked which one issue was most important in deciding how to vote for president, voters gave the top four positions to the situation in Iraq (23%), moral and family values (14%), jobs and the economy (12%), and terrorism and security (8%). A second tier of concerns included education, health care, federal budget and tax, and foreign policy. Although health care had rated among the top issues in our pre-election survey in September and October, and moral and family values were infrequently mentioned as the most important campaign issue, the closing days of the campaign and its aftermath evidently shifted the major priorities of voters. Nevertheless, health care issues remained salient to the voters in the election: Four in 10 said the candidates’ positions on health were “very important” in deciding their vote for president, and three in four said this issue was at least somewhat important. The importance of health care for voters is evident across the state’s regions, especially in Los Angeles and the San Francisco Bay Area. What is most striking about voters’ responses, however, is that Democrats were more than twice as likely as Republicans to say health care was highly relevant in their voting decisions. Similarly, Kerry voters were much more likely than Bush voters to say that the candidate’s positions on health care were very important in their decisions. In other words, health care issues appear to be part of the “partisan divide” between Republicans and Democrats. Because this divide is relevant for responses to the five health policy initiatives on the state’s ballot, we explore the partisan differences on each of the measures in the analysis that follows. Table 9 “How important were the candidates' positions on health care in deciding your vote -- very important, somewhat important, not too important, or not at all important?” All Voters Very important Somewhat important Not too important Not at all important Don't know 40% 36 14 9 1 Party Registration Dem 55% 35 6 3 1 Rep 23% 39 23 15 0 Ind 38% 37 17 8 0 CV 37% 35 16 12 0 Region SF 43% 39 13 4 1 LA OC/SD 48% 36% 34 40 9 15 98 01 IE 40% 30 20 9 1 Presidential Vote 2004 Bush Kerry 24% 54% 38 35 22 8 15 3 10 -9- November Ballot Choices Voters’ Interests Three in four voters said they were very closely or fairly closely following the news about the five health policy measures. In comparison, our pre-election poll in mid-October indicated that over nine in 10 likely voters were very closely (61%) or fairly closely (34%) following the news about the presidential election, while fewer than half reported the same level of attention to the U.S. Senate race (12% very closely; 30% fairly closely). In other words, the five health policy measures ranked in level of news interest somewhere between the two top-of-the ticket races. Although more were “fairly closely” than “very closely” following the news about the health measures, substantial percentages of voters across party lines, regions, racial/ethnic groups, and demographic categories were paying fairly close attention to that news. Which of the five ballot measures drew the most attention? Nearly half named the measure to fund stem cell research (Proposition 71). One in six named the referendum on health care coverage (Proposition 72), and one in eight named the children’s hospital bonds. Fewer than one in 10 voters were most interested in the measures on mental health and emergency medical services. Proposition 71 was the top choice across political parties, Kerry voters, Bush voters, and across regions, age, education, and income groups. Even among uninsured voters, Proposition 71 was mentioned more often than Proposition 72 (39% to 23%) as the top interest. Table 10 “Regardless of how you voted, before deciding how to vote on these five health-related propositions, how closely were you following news about these measures?” Very closely Fairly closely Not too closely Not at all closely Don't know All Voters 28% 49 17 6 0 Party Registration Region Race/Ethnicity Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 28% 28% 26% 29% 22% 32% 28% 34% 11% 37% 31% 28% 48 49 50 47 52 49 46 46 62 47 43 49 18 15 15 17 21 13 22 13 17 13 20 17 57 8 75 5 3 7 9 2 6 6 1 11001 1 0 1 1 0 0 -10- Table 11 Health ballot measure most interested in… Proposition 71, Stem cell research bonds Proposition 72, Health care coverage referendum Proposition 61, Children's hospital bonds Proposition 63, Mental health services Proposition 67, Emergency medical services Other answer Don't know All Voters 49% 16 12 8 8 5 2 Proposition 61 This ballot measure was an initiative to authorize $750 million in 30-year general obligation bonds for construction, expansion, and remodeling of children’s hospitals. The “yes” campaign received a total of $5.2 million in contributions; the opposition campaign received no contributions. The measure passed by 58 percent to 42 percent statewide. San Francisco (71%) and Alameda (69%) Counties had the highest percentage of yes votes. The largest margins of opposition were in rural inland counties. However, Proposition 61 passed in populous Republican-leaning regions such as Fresno, Orange, Riverside, San Bernardino, and San Diego Counties. Our survey indicates that Democrats and independents supported the children’s hospital bond by wide margins, while Republicans were evenly divided. Kerry voters (78%) were much more likely than Bush voters (51%) to favor it. Voter support was higher among younger voters and nonwhites than other groups; however, majorities in all age and racial/ethnic groups favored this measure. Similarly, we found solid support among men and women, across education and income levels, and among those with and without children under 18. When asked why they voted yes on Proposition 61, voters most often mentioned general support for children (52%) and need to strengthen children’s hospitals (31%); major reasons for voting no were the state’s budget (44%) and opposition to state bonds (32%). Table 12 “Proposition 61 proposed 750 million dollars in state bonds to fund children's hospitals. Did you vote yes or no on this measure?” All Voters Yes 58% No 42 Party Registration Dem 80% 20 Rep 51% 49 Ind 69% 31 18-34 71% 29 Age 35-54 64% 36 Race/Ethnicity 55 or older Asians Blacks Latinos Whites 65% 75% 80% 81% 62% 35 25 20 19 38 -11- Table 13 Top three reasons for vote All Voters Did you vote YES because... Did you vote NO because... General support for children Children's hospitals need to be strengthened Direct experience with Children's hospitals State's budget situation General opposition to state bonds Some other reason 52% 31 10 44 32 8 Proposition 63 Proposition 63 established a 1 percent tax on incomes above $1 million to fund expanded health services for mentally ill children, adults, and seniors. The “yes” campaign received a total of $4.7 million in contributions; the “no” campaign had contributions of about $16,000. The measure passed by 54 percent to 46 percent statewide. San Francisco (74%) and Alameda and Santa Cruz (66% each) Counties passed it by the largest majorities. Rural and inland counties had the highest “no” votes. Orange County, Inland Empire, and Fresno voters also opposed this measure, but by narrower margins. Seven in 10 Democrats and independents supported the high-income tax for mental health expansion, while seven in 10 Republicans opposed it. There were no differences across age groups, but blacks were more supportive than other racial/ethnic groups. Kerry voters (76%) were much more likely than Bush voters (33%) to vote yes on Proposition 63, as were liberals and moderates compared to conservatives, and women (63%) compared to men (50%). Although there were no differences across education groups, a substantial majority of voters with incomes below $80,000 (63%) supported the measure, while those in the higher income group were slightly opposed to it. When asked why they voted yes on Proposition 63, voters most often named the number of homeless mentally ill people (54%). A general opposition to new taxes was cited most often as the rationale for voting no on the mental health expansion measure (43%); a secondary reason was that the tax on high income would drive entrepreneurs out of the state. -12- Table 14 “Proposition 63 proposed an additional 1 percent tax on taxable incomes over 1 million dollars to pay for mental health services. Did you vote yes or no on this measure?” Party Registration All Voters Yes 54% No 46 Dem 76% 24 Rep 31% 69 Ind 71% 29 Income Under $40k $40k to 79k 63% 63% 37 37 $80k plus 49% 51 Asians 59% 41 Race/Ethnicity Blacks 75% 25 Latinos 58% 42 Whites 55% 45 Table 15 Top three reasons for vote Did you vote YES because... There are too many homeless mentally ill people Direct experience with the public mental health system Not in that tax bracket Generally oppose new taxes Did you vote NO because... New tax would drive entrepreneurs out of CA These programs haven't been proven to be effective All Voters 54% 17 13 43 21 13 Proposition 67 Proposition 67 would have authorized an increase in the telephone surcharge in order to allocate other funds for emergency room physicians, emergency hospitals and community clinics, emergency personnel equipment and training, and the 911 telephone system. The “no” campaign received a total of $9.2 million in contributions, compared to $7.2 million for the “yes” campaign. The measure lost by 72 percent to 28 percent statewide. Proposition 67 did not pass in any county and lost by large margins in Democratic-leaning regions such as the San Francisco Bay Area and Los Angeles. The top two counties in terms of support were Santa Cruz and Monterey (38% each); rural inland counties opposed the telephone surcharge by more than four-to-one margins. Proposition 67 was opposed across all voter groups, including both Kerry and Bush supporters. Voter support for the proposition was lower among Republicans and conservatives than among Democrats and liberals and lower among whites and blacks than Asians and Latinos, among older than younger voters, and among upper-income than lower-income groups. There were no differences in support between women and men or across education groups. When asked why they voted no on Proposition 67, three in four said they were opposed to all new fees and surcharges (43%) or they wanted to avoid paying higher telephone bills (29%). Two in three who voted yes on the telephone surcharge cited overcrowded emergency rooms (33%) or a shortage of emergency rooms (30%). -13- Table 16 “Proposition 67 proposed to raise the telephone surtax to pay for emergency medical services and the 911 response system. Did you vote yes or no on this measure?” All Voters Yes 28% No 72 Party Registration Dem 47% 53 Rep 25% 75 Ind 34% 66 18-34 44% 56 Age 35-54 33% 67 55 or older 35% 65 Asians 55% 45 Race/Ethnicity Blacks Latinos Whites 37% 41% 34% 63 59 66 Table 17 Top three reasons for vote All Voters Did you vote YES because... Emergency rooms are too crowded There are too few emergency rooms 33% 30 Direct experience with emergency medical care 15 Did you vote NO because... General opposition to new fees and surcharges Did not want higher telephone bills 43 29 Some other reason 14 Proposition 71 Proposition 71 sought to establish a “California Institute for Regenerative Medicine” to regulate and fund stem cell research with $3 billion in state bonds, at a cost of $6 billion over 30 years to pay off the bonds. The “yes” campaign received a total of about $27 million in contributions while the “no” campaign had total contributions of just under $750,000. The measure passed by 59 percent to 41 percent statewide. The counties with the largest majorities of support were again in the San Francisco Bay Area (71% in San Francisco, 70% each in Santa Cruz and San Mateo, and 68% in Alameda). The counties that voted no were largely rural, inland counties, while Orange County voters (52%) narrowly supported the measure. Independents favored Proposition 71 by a large majority (61%). However, there was a deep partisan divide: 79 percent of Democrats favored the measure; 67% of Republicans opposed it. Similarly, Kerry voters (81%) were highly supportive while Bush voters (68%) were strongly opposed. There were no differences between men and women or across age and income groups. Support for Proposition 71 was higher among nonwhites than whites and increased with college education. However, there was majority support for it across all demographic groups. Among supporters of the stem cell research measure, three in four voted for it because this type of research will lead to medical advancements in the future. Far fewer cited lack of federal dollars -14- for stem cell research. For those opposed, the two main issues were a conflict with their beliefs and the state budget situation. Table 18 “Proposition 71 proposed $3 billion in state bonds to fund stem cell research in the state. Did you vote yes or no on this measure?” All Voters Yes 59% No 41 Party Registration Dem Rep Ind 79% 33% 61% 21 67 39 College Education None Some Grad 51% 57% 61% 49 43 39 Asians 66% 34 Race/Ethnicity Blacks Latinos Whites 77% 59% 56% 23 41 44 Table 19 Top three reasons for vote All Voters Did you vote YES because…. this research will lead to medical advancements the lack of federal dollars for stem cell research Your thinking this will lead to good business opportunities and jobs 75% 11 6 Did you vote NO because... Stem cell research is against your beliefs State's budget situation Some other reason 42 24 13 Proposition 72 Proposition 72 was a referendum that would have overturned an existing state law. A “yes” vote would approve and a “no” vote reject a state requirement that large and medium employers provide health insurance coverage for their employees. The “no” campaign received a total of $18.4 million in contributions compared to $14.9 million for the yes campaign. Proposition 72 lost statewide by 51 percent to 49 percent, or a narrow margin of about 180,000 votes. Proposition 72 passed by large majorities in the San Francisco Bay Area (69% in San Francisco and 64% in Alameda) and had majority support in Los Angeles (57%). The top counties in terms of opposition were rural, inland area. However, Proposition 72 had majority opposition in large counties across the state, such as Fresno and Sacramento in the Central Valley and Orange, San Diego, Riverside, and San Bernardino in Southern California. Among Republicans, 74 percent opposed the health care coverage requirements, while 71 percent of Democratic voters were in favor of it, and independents were divided on the measure. Kerry voters (70%) were strongly supportive while Bush voters (73%) were strongly opposed. Support for the health care coverage requirement declined with age and income, and the “yes” -15- vote on Proposition 72 was higher among women than men. Although union members and the uninsured approved of it by large margins, the majority of insured voters and nonunion voters were opposed to this measure. A majority of whites were opposed, but solid majorities of Asians, blacks, and Latinos were in favor of it. Nearly all who voted in favor of Proposition 72 said it was because they believe that all employers should provide health insurance (54%) and that there were too many Californians who were without health insurance (37%). Among those who voted against it, most said the health care coverage requirements would be a burden on businesses and would create another government-run program. Table 20 “Proposition 72 proposed that medium and large employers in California be required to provide health insurance for their employees. Did you vote yes or no on this measure?” All Voters Yes 49% No 51 18-34 62% 38 Age 35-54 49% 51 55+ 45% 55 Under $40K 66% 34 Income $40K$79K 54% 46 $80K Plus 40% 60 Asians 64% 36 Race/Ethnicity Blacks Latinos Whites 86% 71% 43% 14 29 57 Table 21 Top three reasons for vote Did you vote YES because... All employers should provide health insurance to workers Too many Californians without health insurance Some other reason Did you vote NO because... A burden to businesses It would create another government-run program Governor’s opposition All Voters 54% 37 2 66 16 6 Voters’ Information Sources The voters’ guide and sample ballot were seen by about half of the voters as the most helpful sources of information in deciding how to vote on the five health policy measures. About one in six voters named news coverage, while one in 10 voters found paid ads, newspaper endorsements, and advice from friends and families to be the most useful sources of information. The strong reliance on the voters’ guide was evident across political, regional, racial/ethnic, and demographic categories. Latinos were less likely than whites to say that the -16- voters’ guide and sample ballot were most helpful in decisionmaking. Voters’ reliance on paid advertisements and family and friends tended to decline with age, education, and income. Fewer than one in five voters said they went on line to get information about the five health policy measures on the ballot. The search for on-line information declined sharply with age and increased with education and income. Seeking on-line information was highest among those age 35 and younger (29 percent), compared to 10 percent of those age 55 and older. As another point of comparison, 34 percent of voters said they went on-line to get information about the presidential race, including one in three Democrats, Republicans, and independent voters. Five percent recall visiting the Healthvote2004.org website, and most of them said they found the information helpful. Table 22 “Please tell me the top one or two that you found most helpful in deciding how to vote on these five health-related propositions in the last election ...” Voters’ guide and sample ballot News coverage The opinions of friends and family Paid ads on radio, television or mail News endorsements Endorsements by interests, celebrities or politicians Other (specify) Don't know Party Registration All Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 47% 45% 48% 50% 49% 49% 43% 15 15 14 19 16 18 15 49% 47% 12 14 37% 18 47% 12 35% 21 50% 15 11 11 11 8 11 8 10 18 6 10 9 13 10 9 9 10 8 11 7 13 8 12 14 21 11 9 9 7 8 7 8 10 7 11 8 3 9 8 9 5 653346 4 5 7 4 7 4 3 343243 2 4 4 2 3 3 1 211120 0 1 2 2 1 1 Table 23 “Did you go on-line to get information about any of the five health-related ballot propositions?” All Party Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites Yes 18% 17% 19% 22% 15% 19% 21% 21% 15% 19% 15% 15% 19% No 82 83 81 78 85 81 79 79 85 81 85 85 81 -17- Satisfaction with Information Sources Eight in 10 voters believed that they had sufficient information to make good choices overall on the five health policy measures. There were no differences in this perception across political party groups or regions of the state. Satisfaction with ballot information was high across all demographic groups. However, the belief that there was enough information to make good ballot choices tended to increase with age, education, and income. There were no differences between men and women or across racial/ethnic groups. About half of the voters said they lacked sufficient time to go through existing information on the health policy measures, while the other half said they would have liked to have other information sources to make good choices on these measures. However, few voters cited any specific information sources—such as debates and impartial sources—while most asked generally for “something else.” Latinos (71%), those under age 55, and those without college degrees were more likely than others to believe that insufficient time to go through existing information sources stood in the way of making good decisions on the health policy measures. Table 24 “Did you feel that you had enough information to make good choices on these five health-related ballot measures?” All Voters Party Registration Dem Rep Ind Yes 81% 79% 85% 81% No 19 21 15 19 CV 74% 26 Region SF LA OC/SD 80% 84% 83% 20 16 17 IE 86% 14 Asians 77% 23 Race/Ethnicity Blacks Latinos Whites 83% 80% 81% 17 20 19 Table 25 “What additional sources or types of information would you have liked to make good choices on these measures, or did you just not have enough time to go through the already existing information?” Just didn't have enough time Specifically wanted something else More impartial information Generally more information Clearer information and wording More debates Don't know All Voters 49% 26 6 6 4 2 7 -18- Health Policy Attitudes Perceived Policy Problems Just after the health policy decisions were made at the ballot box in November, we asked voters to assess how big a problem was represented by four of the issues they had voted on: the number of people without heath insurance, the availability of mental health services, emergency medical services, and children’s hospitals. We did not ask about stem cell research because this issue is not directly related to the health care available today. Despite the close defeat of Proposition 72 (employer-provided health insurance), 84 percent of voters said that the number of people without health insurance in their part of the state is at least somewhat of a problem, and 58 percent saw it as a big problem. Only 10 percent said this issue is not much of a problem or not a problem at all. Democrats were nearly twice as likely as Republicans to say this was a serious problem. It was also seen as more of a problem by nonwhites than whites and by lower-income than higher-income voters. Concern about the availability of mental health services and emergency medical care was not as great as concern about lack of insurance coverage. About half of the voters rank both of these issues as at least somewhat of a problem. However, perceptions of the problem for these issues differed along two dimensions: Voters were more likely to have no opinion about mental health services than emergency services (21% to 5%), and they were more likely to say that there was not much of a problem or no problem with emergency services than with mental health services (43% to 24%). Only 14 percent of voters think that the availability and quality of children’s hospitals is a big problem, while close to one in four say it is somewhat of a problem. Yet, Proposition 61 passed by a wide margin. This ballot measure was clearly supported by large percentages of voters who saw this issue as less than a big problem. How do problem perceptions correlate with voting on the other measures? Among those who say the number of people without health insurance is a “big problem,” 62 percent voted yes on Proposition 72, while the measure was opposed among those who rated it somewhat of a problem. In comparison, of those who rated mental health services as a big problem, 70 percent voted yes on Proposition 63, and the measure was also supported by those who saw this issue as somewhat of a problem. -19- Table 26 “Is ________________ a big problem, somewhat of a problem, not much of a problem, or not a problem at all?” Percent big problem People without health insurance Availability of mental health services Availability of emergency medical services Availability of children's hospitals Party All Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites 58% 75% 39% 59% 52% 60% 66% 59% 47% 60% 69% 69% 55% 30 44 14 28 27 33 37 24 21 20 47 29 30 25 34 14 28 21 19 44 18 20 28 47 40 20 14 20 7 14 13 14 17 9 15 16 31 22 11 Employee Health Coverage Even after Proposition 72 was defeated 51 percent to 49 percent at the ballot box, 58 percent of voters thought it was very important for medium and large employers to provide health care benefits for their employees. The percentage of voters who said this is very important declined during the campaign (66% in August, 64% in October, 58% in November). Yet, 85 percent still said it is at least somewhat important for employers to provide health care benefits. Employee health coverage is seen as more important by Democrats than Republicans, by nonwhites than whites, and by lower-income than higher-income voters; and it varies across the state’s regions. Of those who think that health coverage is very important, 70 percent voted yes on Proposition 72, but most who say it is only somewhat important voted no. Despite the perception that employer-provided insurance is important, 77 percent of voters thought that the financial cost of requiring large and medium employers to provide benefits was at least somewhat of a problem, and 37 percent thought it was a big problem. Democrats and Republicans differed sharply in their perceptions about employer costs. However, the perception that financial cost was a big problem grew over the course of the election campaign (24% in August, 37% in November). Sixty-eight percent of those who saw the financial burden on employers as a big problem voted against Proposition 72, but voters who saw it as somewhat of a problem were divided. -20- Table 27 “How important is it to you that large and medium employers provide health care benefits for their employees -- very important, somewhat important, not too important, or not at all important?” Very important Somewhat important Not too important Not at all important Don't know All Voters 58% 27 7 7 1 Party Registration Dem Rep Ind 71% 43% 54% 21 34 31 4 10 8 3 11 5 122 CV 56% 28 6 8 2 Region SF LA OC/SD 63% 63% 51% 25 24 31 768 358 222 IE 54% Asians 65% Race/Ethnicity Blacks Latinos 77% 72% Whites 53% 26 23 17 19 31 7 7 32 8 11 5 2 6 7 2011 1 Table 28 “Do you think that the financial cost of requiring large and medium employers to provide health care benefits for their employees is a big problem, somewhat of a problem, not too much of a problem , or not a problem?” All Voters Big problem 37% Somewhat of a problem 40 Not too much of a problem 13 Not a problem 8 Don't know 2 Party Registration Dem 29% Rep 48% Ind 33% 42 37 43 16 8 14 11 4 7 233 CV 42% 37 11 7 3 Region SF 34% LA OC/SD 34% 38% 39 42 42 17 14 11 887 222 Race/Ethnicity IE Asians Blacks Latinos Whites 38% 33% 25% 28% 40% 42 42 43 40 39 9 16 14 17 11 9 8 13 12 6 2 1 534 Universal Health Coverage California voters were evenly divided when asked if they favor a universal health insurance program rather than the current health system in the United States. Prior to the election, voters supported universal health care by 54 percent to 40 percent; and a national survey by ABC News/Washington Post had also found support for universal health insurance. In our survey, Bush voters (21%) and voters Kerry (68%) varied sharply in support for this policy change. Would California voters be willing to pay more—either in higher taxes or health insurance premiums—to increase the number of Americans who have health insurance? Fifty-two percent said yes, and 43 percent said no in results that are similar to our pre-election survey in September (55% yes) and a national survey by the Kaiser Family Foundation in February 2003 (52% yes). Republicans and Democrats have sharply different perspectives on universal health care and paying more to increase the number of Americans with coverage. Whites are more supportive -21- of the current system than nonwhites. Voters’ support for the current system increases with income, but willingness to pay more to increase coverage declines with age. Proposition 72 was strongly supported among voters who favored universal health care (70%) and who were willing to pay more to increase the number of Americans with health insurance (64%). However, those who favor the current system and are unwilling to pay more for more Americans to have health coverage voted against Proposition 72 by a two-to-one margin. Table 29 “Which would you prefer: the current health insurance system in the United States in which most people get their health insurance from private employers but some people have no insurance, or a universal health insurance program, in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers?” Current system Universal health insurance Don't know All Voters 45% 47 8 Party Registration Dem Rep Ind 25% 69% 44% 67 22 47 899 CV 48% 43 9 Region SF LA OC/SD 34% 40% 51% 54 53 42 12 7 7 Race/Ethnicity IE Asians Blacks Latinos Whites 56% 29% 35% 36% 48% 34 65 60 60 42 10 6 5 4 10 Table 30 “Would you be willing to pay more -- either in higher health insurance premiums or higher taxes -- in order to increase the number of Americans who have health insurance, or not?” Yes, willing to pay more No, not willing to pay more Don't know All Voters 52% 43 5 Party Registration Dem Rep Ind 69% 32% 56% 27 63 39 455 CV 47% 47 6 Region SF LA 61% 59% OC/SD 46% Race/Ethnicity IE Asians Blacks Latinos Whites 42% 51% 63% 50% 52% 33 37 51 49 44 33 46 43 6 4 395445 State Mental Health Funding A majority of voters believe that the state does not currently provide enough funding for mental health programs, and this attitude contributed to the passage of Proposition 63. During the course of the November 2004 election, the perception of inadequate funding actually declined (63% in August, 66% in October, 55% in November). Among those who believed that state funding was not enough, 74 percent voted yes on mental health expansion. However, even among those who thought that current mental health funding was enough, 33 percent voted yes on Proposition 63. This may partly reflect the fact that the mental health funding mechanism—a tax on incomes of more than one million dollars—did not have consequences for most of the voters in this election. -22- Democrats and Republicans had very different perceptions about the adequacy of state funding for mental health programs, while a majority of independents felt that the current funding was inadequate. Across the state’s regions, voters in the San Francisco Bay Area were most likely to see the current level of state funding as inadequate. Women were more likely than men to see funding as inadequate (61% to 49%), while Asians were the least likely and blacks the most likely to say that the state is not spending enough on mental health. Among those who voted yes on Proposition 63, voters overwhelmingly believed that there was not enough state funding for mental health programs. In contrast, fewer than half of those who voted no thought that the current level of state funding was either adequate or too high. Table 31 “Do you think that the current level of state funding for mental health programs is more than enough, just enough, or not enough?” More than enough Just enough Not enough Don't know All Voters 8% 20 55 17 Party Registration Dem Rep Ind 3% 13% 7% 13 28 22 71 38 52 13 21 19 Region CV SF LA OC/SD IE Asians 8% 4% 5% 8% 15% 7% 24 14 22 21 23 25 49 63 56 53 49 42 19 19 17 18 13 26 Race/Ethnicity Blacks Latinos Whites 5% 10% 7% 12 18 21 74 59 54 9 13 18 Table 32 Vote YES on Proposition 63 Vote NO on Proposition 63 Not enough Just enough More than enough Don’t know Not enough Just enough More than enough Don’t know All Voters 74% 12 3 11 32 31 15 22 Federal Stem Cell Research Funding A majority of voters thought that the federal government was spending too little on stem cell research—a perception that persisted from before the election (53% in October, 52% in November). Among those who believed that federal funding was too little, 86 percent voted yes on stem cell research. Even among those who thought that current stem cell funding was adequate, 39 percent voted yes. However, 59 percent voted no. Once again, the trend may partly -23- reflect the state funding mechanism for stem cell research—state bonds that do not require higher taxes by the voters. A majority of Democrats (74%) and independents (55%) believed that there is too little federal funding of stem cell research, while a majority of Republicans (51%) thought federal funding was the right amount (19%) or too much (32%). Most Kerry supporters (76%) but few Bush supporters (23%) thought that funding was inadequate. San Francisco Bay Area voters led the state in their perception that federal funding was too little. The perception was also higher among those with college education. Among those voting yes on Proposition 71, 78 percent believed that there was too little federal funding. In contrast, fewer than half of those who voted no held this perception. Obviously, as noted earlier, there were other factors contributing to voters’ opposition to Proposition 71—personal beliefs about the research use of stem cells and the state budget deficit. Table 33 “Do you think the federal government spends too much, the right amount, or too little on medical research using embryonic stem cells?” Too much Right amount Too little Other Don't know All Voters 19% 13 52 4 12 Party Registration Dem 8% Rep 32% Ind 17% 7 19 14 74 27 55 17 2 10 15 12 CV 28% 14 43 3 12 Region SF 10% LA OC/SD 18% 17% 10 12 14 64 55 49 245 14 11 15 IE 27% 18 41 5 9 Asians 10% 17 49 11 13 Race/Ethnicity Blacks Latinos Whites 15% 25% 19% 6 11 13 61 52 52 313 15 11 13 -24- Vote YES on Proposition 71 Vote NO on Proposition 71 Table 34 Too little Right amount Too much Other Don’t know Too little Right amount Too much Other Don’t know All Voters 78% 9 2 0 11 17 18 43 9 13 Health Care Affordability According to national surveys, one of the major concerns that Americans have about their health care is affordability. When asked to rate satisfaction with three health care issues— affordability, availability, and quality—voters gave affordability of the health care in their region their lowest ratings. Only 13 percent said they were very satisfied, while about half were not too satisfied or not at all satisfied. Among the least-satisfied voters were Democrats, San Francisco Bay Area residents, low-income residents, and the uninsured. Bush voters (60%) were much more likely then Kerry voters (36%) to say they are very satisfied or somewhat satisfied with the affordability of health care. Fewer than half of voters said that they are very concerned about being able to afford necessary health care if they or a family member gets sick—a slight decrease since before the election (49% in September, 43% in November). Democrats were more likely than Republicans, and nonwhites were more likely than whites, to express high level of concern about health care costs. High levels of personal concern about health care costs decline with higher education and income and differ between the insured and uninsured (39% to 71%). Is there a connection between personal concern about health care costs and decisions at the ballot box? Those who were very concerned about being able to afford health care were strong supporters of Proposition 61 (73%), Proposition 63 (65%), and Proposition 72 (61%). -25- Table 35 “How satisfied are you with the affordability of health care in your part of California?” Party All Registration Region Race/Ethnicity Voters Dem Rep Ind CV SF LA OC/SD IE Asians Blacks Latinos Whites Very satisfied 13% 10% 18% 9% 12% 9% 14% 15% 21% 10% 9% 10% 15% Somewhat satisfied 33 26 41 36 32 30 35 33 35 30 31 34 33 Not too satisfied 27 28 23 31 23 33 24 30 23 37 26 28 26 Not at all satisfied 24 33 15 22 29 26 27 19 18 20 31 25 24 Don’t know 3 3 32420 33 3 3 3 2 Table 36 “How concerned are you about being able to afford necessary health care when a family member gets sick– very concerned, somewhat concerned, not very concerned, or not at all concerned?” Very concerned Somewhat concerned Not very concerned Not at all concerned All Voters 43% 27 17 13 Party Registration Dem Rep Ind 51% 32% 43% 27 26 29 12 23 18 10 19 10 Region Race/Ethnicity CV SF LA OC/SD IE Asians Blacks Latinos Whites 44% 39% 50% 23 33 22 39% 44% 29 21 51% 30 74% 13 62% 23 35% 28 22 16 15 17 13 10 8 11 20 11 12 13 15 22 9 5 4 17 The Health Care System While they were busy making health policy at the ballot box in November, about half of California voters thought that the health care system today is worse than it was 10 years ago. Only 15 percent thought that it is in better shape today. Democrats were much more likely than Republicans to say that the health care system is worse off now. While there are no major differences in general perceptions of negative trends in the health care system across regions or racial/ethnic groups, we find that pessimism does increase with age, higher income, and college education. Kerry voters (59%) were more likely than Bush voters (36%) to believe that the health care system today is in worse shape than it was 10 years ago. How did this negative perception relate to voter choices on health policy at the ballot box? Those who thought the health care system is in worse shape today than it was a decade ago were -26- among the stronger supporters of Proposition 61 (Children’s Hospital Bonds), 68%, Proposition 63 (Mental Health Expansion), 64%, and Proposition 71 (Stem Cell Research Bonds), 65%. However, those who perceived the health care system as deteriorating supported Proposition 72—Health Care Coverage Requirement—by only a narrow margin (53% yes, 46% no). In fact, those who voted yes on Proposition 72 were only slightly more likely than those who voted no to say that the health care system is worse today than it was in the past. For whatever reasons, many voters who found fault with the current system were not strongly drawn to this legislative effort toward health policy reform. Table 37 “Compared to 10 years ago, do you think the health care system today is better, worse, or is it about the same as it was 10 years ago?” Better than 10 years ago Worse than 10 years ago The same as 10 years ago Don’t know All Voters 15% 49 Party Registration Dem Rep Ind CV 11% 18% 16% 19% 60 37 49 43 Region Race/Ethnicity SF LA OC/SD IE Asians Blacks Latinos Whites 12% 14% 54 53 18% 45 18% 47 17% 40 21% 49 18% 54 14% 49 27 20 36 25 32 23 24 29 30 29 24 22 29 9 9 9 10 6 11 9 8 5 14 6 6 8 Vote YES on Proposition 72 Vote NO on Proposition 72 Table 38 Health care system is worse Health care system is better Health care system is same Don’t know Health care system is worse Health care system is better Health care system is same Don’t know All Voters 53% 14 24 9 48% 16 30 6 -27- Appendix A. Health Policy Ballot Measures Propositions 61, 63, 67: Percentage Vote Yes, No, No Vote, by County Actual Vote Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin Prop. 61 -Children's Hospital Y 69% 56% 45% 48% 44% 44% 65% 48% 45% 56% 42% 52% 66% 49% 52% 60% 49% 46% 63% 54% 60% 50% 55% 57% 40% 51% 63% 58% 45% 52% 42% 46% 59% 51% 60% 57% 56% 71% 57% N 31% 44% 55% 52% 56% 56% 35% 52% 55% 44% 58% 48% 34% 51% 48% 40% 51% 55% 38% 46% 40% 50% 45% 43% 60% 49% 37% 42% 55% 49% 58% 55% 41% 49% 41% 43% 44% 29% 44% NV 10% 8% 8% 7% 7% 9% 8% 6% 10% 9% 7% 8% 7% 6% 6% 8% 5% 6% 11% 6% 11% 18% 8% 8% 6% 10% 9% 8% 9% 9% 8% 7% 7% 8% 10% 7% 11% 14% 7% Prop. 63 - Mental Health Services Y N NV 66% 34% 9% 57% 43% 8% 45% 55% 6% 49% 51% 6% 46% 54% 6% 37% 64% 7% 56% 44% 8% 53% 47% 7% 43% 57% 7% 49% 51% 8% 39% 61% 8% 61% 39% 7% 55% 46% 10% 48% 52% 7% 42% 58% 6% 47% 53% 7% 57% 43% 5% 44% 56% 5% 58% 42% 10% 47% 53% 6% 63% 37% 8% 48% 52% 16% 65% 35% 7% 48% 52% 8% 36% 64% 5% 51% 49% 8% 59% 41% 7% 56% 44% 7% 49% 51% 5% 43% 57% 9% 41% 59% 6% 47% 53% 5% 48% 52% 6% 50% 50% 7% 53% 47% 6% 47% 53% 7% 50% 50% 10% 74% 26% 11% 50% 50% 7% Prop. 67 -Emergency Medical Service Y N NV 34% 66% 10% 29% 71% 7% 18% 82% 7% 19% 81% 8% 20% 80% 6% 16% 85% 6% 31% 69% 10% 25% 75% 6% 20% 80% 8% 24% 76% 9% 15% 85% 5% 28% 72% 9% 33% 67% 7% 25% 75% 5% 21% 79% 6% 21% 79% 6% 27% 73% 5% 18% 82% 5% 32% 68% 11% 20% 80% 7% 35% 65% 10% 22% 78% 18% 33% 68% 8% 21% 79% 7% 15% 85% 5% 28% 72% 9% 38% 62% 7% 32% 68% 8% 22% 78% 7% 29% 71% 8% 18% 82% 7% 22% 78% 5% 25% 75% 5% 21% 79% 7% 27% 73% 6% 24% 76% 6% 25% 75% 10% 34% 66% 16% 23% 77% 7% -29- Actual Vote San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba State Totals Prop 61 – Children’s Hospital Y 49% 64% 57% 63% 64% 43% 46% 42% 61% 56% 52% 43% 43% 46% 53% 50% 54% 55% 46% 58% N 51% 36% 43% 37% 36% 57% 54% 58% 39% 44% 49% 57% 57% 54% 47% 50% 46% 45% 54% 42% NV 10% 13% 10% 11% 9% 7% 7% 10% 7% 9% 7% 8% 6% 7% 7% 8% 8% 8% 8% 10% Prop 63 – Mental Health Services Y N NV 50% 50% 8% 61% 39% 11% 54% 47% 8% 56% 44% 8% 66% 34% 7% 46% 54% 5% 47% 54% 6% 50% 50% 9% 55% 45% 6% 63% 37% 8% 50% 50% 6% 38% 62% 7% 45% 55% 5% 52% 48% 5% 44% 56% 6% 49% 52% 6% 47% 53% 7% 56% 44% 8% 44% 56% 6% 54% 46% 8% Prop 67 Emergency Medical Service Y N NV 28% 72% 10% 33% 67% 12% 34% 66% 10% 31% 69% 9% 38% 62% 10% 15% 85% 5% 24% 76% 5% 22% 78% 9% 24% 76% 7% 36% 64% 8% 21% 79% 7% 17% 83% 9% 14% 87% 5% 21% 79% 5% 23% 77% 6% 21% 79% 7% 25% 75% 10% 31% 69% 7% 19% 81% 8% 28% 72% 9% -30- Propositions 71, 72: Percentage Vote Yes, No, No Vote, by County Actual Vote (SOV) Alameda Alpine Amador Butte Calaveras Colusa Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Actual Vote (SOV) Prop. 71 Stem Cell Y N VN 68% 32% 6% 59% 41% 8% 48% 52% 4% 53% 47% 4% 50% 50% 3% 42% 58% 4% 66% 34% 5% 50% 50% 5% 49% 51% 4% 48% 52% 6% 42% 58% 5% 58% 42% 6% 50% 50% 8% 53% 47% 4% 45% 55% 4% 45% 55% 5% 58% 43% 4% 41% 59% 4% 65% 35% 7% 43% 57% 4% 66% 34% 7% 48% 52% 15% 60% 40% 5% 45% 55% 5% 37% 63% 4% 59% 41% 6% 66% 34% 4% 64% 36% 4% 51% 49% 4% 52% 48% 5% 47% 54% 4% 49% 51% 3% 54% 46% 4% 53% 47% 5% 62% 38% 4% 52% 48% 4% 59% 42% 6% 71% 29% 9% 51% 49% 5% 56% 44% 5% 70% 30% 7% Prop. 71 - Stem Cell Prop. 72 – Health Care Y N VN 64% 36% 9% 49% 51% 8% 34% 66% 5% 41% 59% 6% 36% 64% 5% 33% 67% 5% 52% 48% 8% 44% 57% 7% 33% 67% 6% 42% 58% 8% 33% 67% 6% 50% 50% 8% 56% 44% 9% 39% 61% 6% 39% 61% 5% 42% 58% 6% 46% 54% 5% 38% 62% 5% 57% 43% 10% 37% 63% 5% 52% 48% 10% 37% 64% 18% 53% 47% 7% 45% 55% 6% 29% 71% 4% 42% 58% 8% 54% 46% 5% 48% 52% 7% 36% 64% 5% 38% 62% 7% 32% 68% 6% 34% 66% 5% 43% 57% 5% 45% 55% 6% 47% 53% 7% 45% 55% 6% 44% 56% 9% 69% 31% 12% 48% 52% 6% 41% 59% 8% 55% 45% 11% Prop. 72 - Health Care -31- Santa Barbara Santa Clara Santa Cruz Shasta Sierra Siskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba State Totals Y 58% 66% 70% 44% 46% 42% 61% 63% 46% 44% 44% 50% 42% 51% 57% 57% 45% 59% N 42% 34% 30% 56% 54% 58% 39% 37% 54% 56% 56% 51% 58% 49% 43% 43% 55% 41% NV 6% 5% 4% 4% 4% 7% 4% 5% 4% 6% 3% 3% 4% 4% 4% 5% 4% 6% Y 46% 53% 57% 35% 35% 40% 54% 52% 42% 35% 36% 37% 36% 37% 42% 52% 38% 49% N 54% 47% 43% 65% 65% 60% 46% 48% 58% 65% 65% 63% 64% 63% 58% 48% 62% 51% 9% 8% 7% 5% 6% 9% 5% 8% 6% 7% 5% 4% 5% 5% 6% 7% 4% 8% -32- Appendix B. Survey Methodology The PPIC Statewide Survey is directed by Mark Baldassare, research director and survey director at the Public Policy Institute of California, with assistance in research and writing for this report from Renatta DeFever, Kristy Michaud, and Kim Curry, survey research associates, and Jennifer Paluch, PPIC research associate. Darshan Goux moderated the focus groups that informed the survey design and analysis. Jon Cohen assisted with the survey design and analysis, and Max Neiman and Paul Lewis reviewed an earlier draft of this report. The survey was conducted with funding from The California Endowment and benefited from discussions with its staff and grantees and its colleagues at other institutions and from focus groups with voters; however, the survey methods, questions, and content of the report were determined solely by Mark Baldassare. The findings of this survey are based on a telephone survey of 2,500 California voters in the general election between November 4 and November 18, 2004. Interviewing took place on weekday nights and weekend days, using a computer-generated random sample of telephone numbers that ensured that both listed and unlisted telephone numbers were called. All telephone exchanges in California were eligible for calling. Telephone numbers in the survey sample were called up to six times to increase the likelihood of reaching eligible households. Once a household was reached, an adult respondent (age 18 or older) was randomly chosen for interviewing by using the “last birthday method” in order to reduce selection biases in age and gender. Eligible respondents were those who reported that they had voted in the November 2nd general election either at their local polling place or by absentee ballot. Each interview took an average of 20 minutes to complete. Interviewing was conducted in English, Spanish, Chinese, Korean, or Vietnamese. We chose these languages because Spanish is the dominant non-English language in the state and these three Asian languages account for most of the non-English speaking Asian adults in California. Publication Services translated the survey into Spanish. Schulman, Ronca & Bucuvalas, Inc. translated the survey into Chinese, Korean, and Vietnamese and conducted the telephone interviewing. We used the PPIC Statewide Survey data base to compare the demographic characteristics of California’s likely voters to the characteristics of the survey sample. We also used voting statistics from the California Secretary of State and the Los Angeles Times exit polls to compare with the current survey results. The survey sample of voters’ characteristics was closely comparable to the state figures. The survey data in this report were statistically weighted to account for demographic, political, and vote differences. The sampling error for the total sample of 2,500 voters is +/- 2 percent at the 95 percent confidence level. This means that 95 times out of 100 the results will be within 2 percentage points of what they would be if all voters in California were interviewed. The sampling error for subgroups is larger, such as the political groups, age and income brackets, health insurance status, and the regional and ethnic/racial categories that are reported in text and tables. Sampling error is only one type of error to which surveys are subject. Results may also be affected by factors such as question wording, question order, and survey timing. 33 Throughout the report, we refer to five geographic regions. “Central Valley” includes Butte, Colusa, El Dorado, Fresno, Glenn, Kern, Kings, Madera, Merced, Placer, Sacramento, San Joaquin, Shasta, Stanislaus, Sutter, Tehama, Tulare, Yolo, and Yuba Counties. “SF Bay Area” includes Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, and Sonoma Counties. “Los Angeles” refers to Los Angeles County, “Inland Empire” includes Riverside and San Bernardino Counties, and “Orange/San Diego” refers to Orange and San Diego Counties. These five regions represent the major population centers of the state, accounting for approximately 90 percent of the state population. We present specific results for respondents in the four self-identified racial/ethnic groups of Asian, black, Latino, and non-Hispanic white. We also compare the opinions of registered Democrats, Republicans, and independents. The “independents” category includes only those who are registered to vote as “decline to state.” We use earlier PPIC Statewide Surveys to analyze trends over time in California and use the Kaiser Family Foundations and ABC News/Washington Post surveys for national comparisons. 34 Appendix C. Survey Questions and Responses PPIC STATEWIDE SURVEY: SPECIAL SURVEY ON CALIFORNIANS AND HEALTH POLICY NOVEMBER 4—NOVEMBER 18, 2004 2,500 CALIFORNIA VOTERS IN THE NOVEMBER 2ND ELECTION ENGLISH, SPANISH, CHINESE, KOREAN, AND VIETNAMESE INTERVIEWS MARGIN OF ERROR +/- 2% AT 95% CONFIDENCE LEVEL FOR TOTAL SAMPLE 1. For president, did you happen to vote for [rotate] (1) George W. Bush, the Republican [or] (2) John Kerry, the Democrat? 44% George W. Bush and Dick Cheney 54 John Kerry and John Edwards 2 other answer 2. Which one issue was most important to you in deciding how to vote for president? 23% Iraq situation, war in Iraq 14 moral and family values 12 economy, jobs, unemployment 8 terrorism, security issues 4 abortion 4 against Bush 4 foreign policy in general 2 environment, pollution 2 health care, health costs, HMO reform 1 crime, gangs 1 education, schools 1 gay rights, gay marriages 1 government regulations 1 immigration, illegal immigration 1 party allegiance 1 social security 1 taxes, federal budget, deficit spending 1 women's rights 11 other 7 don’t know 35 3. Is there another issue that was almost as important? 20% Iraq situation, war in Iraq 17 economy, jobs, unemployment 9 moral and family values 9 terrorism, security issues 6 health care, health costs, HMO reform 6 taxes, federal budget, deficit spending 4 education, schools 4 foreign policy in general 3 abortion 3 gay rights, gay marriages 3 government regulations 2 environment, pollution 2 immigration, illegal immigration 2 social security 2 stem cell research 1 against Bush 1 women's rights 6 other 4. And how important were the candidates' positions on health care in deciding your vote— very important, somewhat important, not too important, or not at all important? 40% very important 36 somewhat important 14 not too important 9 not at all important 1 don't know 5. For U.S. Senate, did you happen to vote for [rotate] (1) Barbara Boxer, the Democrat [or] (2) Bill Jones, the Republican? 58% Barbara Boxer, the Democrat 38 Bill Jones, the Republican 4 other answer [question 6 deleted] Thinking more generally just about the state of California, 7. Do you think things in California are generally going in the right direction or the wrong direction? 53% right direction 35 wrong direction 12 don't know 36 8. Turning to economic conditions in California, do you think that during the next 12 months we will have good times financially or bad times? 52% good times 34 bad times 14 don't know I would like you to rate your satisfaction with conditions in your part of California today in some different areas. For each one, please tell me if you are very satisfied, somewhat satisfied, not too satisfied, or not at all satisfied. How about … [rotate questions 9a to 9c] 9a. The availability of health care in your part of California? 35% very satisfied 40 somewhat satisfied 14 not too satisfied 10 not at all satisfied 1 don't know 9b. The affordability of health care in your part of California? 13% very satisfied 33 somewhat satisfied 27 not too satisfied 24 not at all satisfied 3 don't know 9c. The quality of health care in your part of California? 35% very satisfied 42 somewhat satisfied 13 not too satisfied 8 not at all satisfied 2 don't know 10. Turning to your own life, how concerned are you about being able to afford necessary health care when a family member gets sick—very concerned, somewhat concerned, not very concerned, or not at all concerned? 43% very concerned 27 somewhat concerned 17 not very concerned 13 not at all concerned 37 As I read the following list of issues, please tell me if each is a big problem, somewhat of a problem, not much of a problem, or not a problem at all. [rotate questions 11a to 11d] 11a. How about the number of people without health insurance? 58% big problem 26 somewhat of a problem 6 not much of a problem 4 not a problem at all 6 don't know 11b. How about the availability of public mental health services? 30% big problem 25 somewhat of a problem 14 not much of a problem 10 not a problem at all 21 don't know 11c. How about the availability of emergency medical care? 25% big problem 27 somewhat of a problem 20 not much of a problem 23 not a problem at all 5 don't know 11d. How about the availability and quality of specialized children's hospitals? 14% big problem 23 somewhat of a problem 23 not much of a problem 22 not a problem at all 18 don't know 12. Compared to 10 years ago, do you think the health care system today is better, worse, or is it about the same as it was 10 years ago? 15% system is better than 10 years ago 49 system is worse than 10 years ago 27 system is about the same as 10 years ago 9 don't know [rotate questions 13 and 14] 13. In general, how much trust and confidence do you have in the state government when it comes to making public policy—a great deal, a fair amount, not too much, or none at all? 6% a great deal 42 a fair amount 39 not too much 12 none at all 1 don't know 38 14. Thinking about the role of the public in politics, how much trust and confidence do you have in California's voters when it comes to making choices on election day—a great deal, a fair amount, not too much, or none at all? 14% a great deal 41 a fair amount 33 not too much 10 none at all 2 don't know Turning back to the recent election, the California ballot included 16 state ballot measures. 15. Do you think that the citizens' initiative process that allows state voters to vote directly on citizen-sponsored policies is a good thing or a bad thing for California? 78% good thing 15 bad thing 7 don't know 16. Do you think public policy decisions made through the initiative process by California voters are probably better or probably worse than public policy decisions made by the governor and state legislature? 61% probably better 22 probably worse 6 same 11 don't know 17. Thinking specifically about health policy, which do you most prefer: [rotate] (1) that the governor and state legislature make state health policy [or] (2) that California voters make state health policy at the ballot box? 32% governor and state legislature should make health policy 58 California voters should make health policy 2 other 1 both 1 neither 6 don't know [question 18 deleted] 19. Proposition 61 proposed 750 million dollars in state bonds to fund children's hospitals. Did you vote yes or no on this measure? 58% voted yes [ask q. 20a] 42 voted no [ask q. 20b] 20a. Did you vote yes because of ... 52% your general support for children 31 your thinking children's hospitals need to be strengthened and expanded 10 your direct experience with children's hospitals 3 for some other reason (specify) 3 all of the above (volunteered) 1 don't know 39 [go to q. 21] 20b. Did you vote no because of ... 44% the state's budget situation 32 your general opposition to state bonds 2 your direct experience with children's hospitals 8 some other reason (specify) 1 all of the above (volunteered) 3 money is not used as it should be(volunteered) 4 there is no need for children’s hospitals (volunteered) 4 didn’t want any new taxes (volunteered) 2 don't know 21. Proposition 63 proposed an additional 1 percent tax on taxable incomes over 1 million dollars to pay for mental health services. Did you vote yes or no on this measure? 54% voted yes [ask q. 22a] 46 voted no [ask q. 22b] 22a. Did you vote yes because of ... 54% your thinking there are too many homeless mentally ill people 17 your direct experience with the public mental health system 13 your not being in that tax bracket 4 some other reason (specify) 3 all of the above (volunteered) 3 help is needed (volunteered) 2 rich people can afford it (volunteered) 4 don’t know [go to q. 23] 22b. Did you vote no because ... 43% you generally oppose new taxes 21 you think this new tax would drive entrepreneurs out of California 13 you think these programs haven't been proven to be effective 9 some other reason (specify) 3 all of the above (volunteered) 8 it is not fair (volunteered) 1 money will not be spent as it should be (volunteered) 2 don’t know 23. Proposition 67 proposed to raise the telephone surtax to pay for emergency medical services and the 911 response system. Did you vote yes or no on this measure? 28% voted yes [ask q. 24a] 72 voted no [ask q. 24b] 40 24a. Did you vote yes because of ... 33% your thinking emergency rooms are too crowded 30 your thinking there are too few emergency rooms 15 your direct experience with emergency medical care 5 some other reason (specify) 5 all of the above (volunteered) 7 there is a need for emergency services (volunteered) 5 don’t know [go to q. 25] 24b. Did you vote no because of ... 43% your general opposition to new fees and surcharges 29 your not wanting higher phone bills 4 your direct experience with emergency medical care 14 some other reason (specify) 2 all of the above (volunteered) 3 not clear where the money would go (volunteered) 3 did not want new taxes (volunteered) 2 don’t know 25. Proposition 71 proposed 3 billion dollars in state bonds to fund stem cell research in the state. Did you vote yes or no on this measure? 59% voted yes [ask q. 26a-1] 41 voted no [ask q. 26b] 26a-1. Do you have any friends or family members you think might benefit from stem cell research? 44% yes 54 no 2 don't know 26a. Did you vote yes because of ... 75% your thinking this research will lead to medical advancements 11 the lack of federal dollars for stem cell research 6 your thinking this will lead to good business opportunities and jobs 2 for some other reason (specify) 6 all of the above (volunteered) [go to q. 27] 41 26b. Did you vote no because ... 42% stem cell research is against your beliefs 24 of the state's budget situation 10 you generally oppose all state bonds 13 for some other reason (specify) 2 all of the above (volunteered) 6 it is not the government’s role (volunteered) 2 no accountability (volunteered) 1 don’t know 27. Proposition 72 proposed that medium and large employers in California be required to provide health insurance for their employees. Did you vote yes or no on this measure? 49% voted yes [ask q. 28a] 51 voted no [ask q. 28b] 28a. Did you vote yes because ... 54% you think all employers should provide health insurance to their employees 37 you think the number of Californians without health insurance is too high 2 some other reason (specify) 6 all of the above (volunteered) 1 don’t know [go to q. 29] 28b. Did you vote no because ... 66% you think it would be a burden to businesses 16 you think it would create another government-run program 6 Governor Schwarzenegger's opposition to the measure 8 some other reason (specify) 3 all of the above (volunteered) 1 don't know 29. Regardless of how you voted, before deciding how to vote on these five health-related propositions, how closely were you following news about these measures—very closely, fairly closely, not too closely, or not at all closely? 28% very closely 49 fairly closely 17 not too closely 6 not at all closely 42 30. Which one or two of these five health measures were you most interested in? 49% Proposition 71, stem cell research bonds 16 Proposition 72, health care coverage referendum 12 Proposition 61, children's hospital bonds 8 Proposition 63, mental health services 8 Proposition 67, emergency medical services 2 did not pay attention to any of these measures 3 all equally (volunteered) 2 don’t know 31. I am going to read different ways people learn about ballot propositions. Please tell me the top one or two that you found most helpful in deciding how to vote on these five healthrelated propositions in the last election. [rotate] 47% the official voter information guide and sample ballot 15 news and media coverage 11 the opinions of friends and family members 9 advertisements on radio or television or in the mail 9 newspaper endorsements such as columns or editorials 5 endorsements by interest groups, politicians, or celebrities 3 something/someone else (specify) 1 don’t know 32. On another topic, prior to the election, did you happen to go on-line to get information about the presidential election? 34% yes 65 no 1 no on-line/internet access [go to q. 34] 33. Did you go on-line to get information about any of the 5 health-related ballot propositions? 18% yes [ask q. 33a] 82 no [go to q. 34] 33a. Did you ever go to an independent website called healthvote2004.org? 5% yes [ask q. 33b] 88 no [go to q. 34] 7 don't know [go to q. 34] 33b. Was this web site very helpful, somewhat helpful, not too helpful, or not at all helpful to you in deciding how to vote on these propositions? 16% very helpful 53 somewhat helpful 23 not too helpful 8 not at all helpful 43 34. Overall, did you feel that you had enough information to make good choices on these five health-related ballot measures? 81% yes [go to q .35] 18 no [ask q. 34a] 1 don't know [go to q. 35] 34a. What additional sources or types of information would you have liked to make good choices on these measures, or did you just not have enough time to go through the already existing information? 49% just didn't have enough time 26 wanted something else (specify) 6 impartial information 6 more information 4 clear information/wording 2 more debate 7 don't know 35. In the recent election, California voters passed the children's hospital bonds, the expansion of mental health services initiative, and the stem cell research bonds, and they rejected the emergency medical services and health care coverage measures. Do these new state policies make you more optimistic about the state’s health care system, more pessimistic, or do you feel about the same as you did before the election? 27% feel more optimistic 16 feel more pessimistic 55 feel about the same 2 don't know And regardless of how you voted … [rotate questions 36 and 37] 36. Do you think that the current level of state funding for mental health programs is more than enough, just enough, or not enough? 8% more than enough 20 just enough 55 not enough 17 don't know 37. Do you think the federal government spends too much, the right amount, or too little on medical research using embryonic stem cells? 19% too much 13 the right amount 52 too little 4 federal government should not fund stem cell research (specify) 12 don't know 44 [rotate questions 38 and 39] 38. Do you think that the financial cost of requiring large and medium employers to provide health care benefits for their employees is a big problem for those employers, somewhat of a problem, not too much of a problem, or not a problem at all? 37% big problem 40 somewhat of a problem 13 not much of a problem 8 not a problem at all 2 don't know 39. How important is it to you that large and medium employers provide health care benefits for their employees—very important, somewhat important, not too important, or not at all important? 58% very important 27 somewhat important 7 not too important 7 not at all important 1 don't know [questions 40 and 41 deleted] [rotate questions 42 and 43] 42. Which would you prefer: [rotate] (1) the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance [or] (2) a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers? 45% current system 47 universal health insurance program 8 don't know 43. Would you be willing to pay more—either in higher health insurance premiums or higher taxes—in order to increase the number of Americans who have health insurance, or not? 52% yes, willing to pay more 43 no, not willing to pay more 5 don't know 44. Are you registered to vote as a Democrat, a Republican, another party, or as an independent? 45% Democrat 40 Republican 13 independent 2 other 45 45. Regardless of your current voter registration status, generally speaking, do you usually think of yourself as a Democrat, a Republican, independent, or what? 42% Democrat [go to q. 46b] 36 Republican [go to q. 46c] 17 independent [ask q. 46a] 5 other [ask to q. 46a] 46a.Do you think of yourself as closer to the Republican Party or Democratic Party? 31% Republican party 45 Democratic party 21 neither 3 don't know [go to q. 47] 46b.Would you call yourself a strong Democrat or not a very strong Democrat? 64% strong 35 not very strong 1 don't know [go to q. 47] 46c.Would you call yourself a strong Republican or not a very strong Republican? 67% strong 30 not very strong 3 don't know 47. On another topic, would you consider yourself to be politically: [rotate] 12% very liberal 22 somewhat liberal 26 middle-of-the-road 26 somewhat conservative 13 very conservative 1 don't know 48. Generally speaking, how much interest would you say you have in politics—a great deal, a fair amount, only a little, or none? 34% a great deal 47 a fair amount 17 only a little 2 none 49. Was this November the first time you voted? 8% yes [skip to q. 50] 92 no [ask q. 49a] 46 49a. How often would you say you vote? 70% always 18 nearly always 2 part of the time 1 seldom 8 first-time voter 1 don't know 50. Did you vote at your local polling place or by absentee ballot? 69% local polling place 30 absentee ballot 1 early voting 51. On another topic, are you, yourself, now covered by any form of health insurance or health plan? 90% yes [ask q. 51a] 10 no [skip to q. 55] 51a. Which type of health insurance do you now have? Is it a plan through your or your spouse's employer, a plan you purchased yourself, or are you covered by Medicare or Medi-Cal, some other government program, or do you get your health insurance from somewhere else? 72% private plan through your or your spouse's employer 14 plan purchased yourself 8 Medicare 2 Medi-Cal 3 some other government program 1 somewhere else 52. Overall how do you feel about your current health insurance policy—are you very satisfied, somewhat satisfied, not too satisfied, or not at all satisfied with your coverage? 45% very satisfied 42 somewhat satisfied 9 not too satisfied 3 not at all satisfied 1 don't know [question 53 deleted] 54. At any time in the past 12 months, have you or a family member been without health insurance? 17% yes 83 no 55. Are you or is anyone in your immediate family a member of a labor union? 15% yes, respondent 11 yes, another person in family 3 yes, both 70 no 1 don't know [56-70 : demographic questions] 47 PUBLIC POLICY INSTITUTE OF CALIFORNIA Board of Directors Cheryl White Mason, Chair Chief, Civil Liability Management Los Angeles City Attorney’s Office Edward K. Hamilton Chairman Hamilton, Rabinovitz & Alschuler, Inc. Gary K. Hart Founder Institute for Education Reform California State University, Sacramento Arjay Miller Dean Emeritus Graduate School of Business Stanford University Ki Suh Park Design and Managing Partner Gruen Associates Constance L. Rice Co-Director The Advancement Project Walter B. Hewlett Director Center for Computer Assisted Research in the Humanities David W. Lyon President and CEO Public Policy Institute of California Thomas C. Sutton Chairman & CEO Pacific Life Insurance Company Raymond L. Watson Vice Chairman of the Board Emeritus The Irvine Company Carol Whiteside President Great Valley Center Advisory Council Mary C. Daly Vice President Federal Reserve Bank of San Francisco Clifford W. Graves General Manager Department of Community Development City of Los Angeles Daniel A. Mazmanian C. Erwin and Ione Piper Dean and Professor School of Policy, Planning, and Development University of Southern California Dean Misczynski Director California Research Bureau Elizabeth G. Hill Legislative Analyst State of California Rudolf Nothenberg Chief Administrative Officer (Retired) City and County of San Francisco Hilary W. Hoynes Associate Professor Department of Economics University of California, Davis Andrés E. Jiménez Director California Policy Research Center University of California Office of the President Norman R. King Executive Director San Bernardino Associated Governments Manuel Pastor Professor, Latin American & Latino Studies University of California, Santa Cruz Peter Schrag Contributing Editor The Sacramento Bee James P. Smith Senior Economist RAND Corporation PUBLIC POLICY INSTITUTE OF CALIFORNIA 500 Washington Street, Suite 800 O San Francisco, California 94111 Phone: (415) 291-4400 O Fax: (415) 291-4401 www.ppic.org O info@ppic.org" ["post_date_gmt"]=> string(19) "2017-05-20 09:37:48" ["comment_status"]=> string(4) "open" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(10) "op_205mbop" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2017-05-20 02:37:48" ["post_modified_gmt"]=> string(19) "2017-05-20 09:37:48" ["post_content_filtered"]=> string(0) "" ["guid"]=> string(52) "http://148.62.4.17/wp-content/uploads/OP_205MBOP.pdf" ["menu_order"]=> int(0) ["post_mime_type"]=> string(15) "application/pdf" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" ["status"]=> string(7) "inherit" ["attachment_authors"]=> bool(false) }