The document summarizes research from a progressive messaging group on how to frame the health care debate. Key findings include: - Voters prefer a progressive plan (Candidate A) over a conservative plan (Candidate B) and believe Candidate A is more likely to guarantee coverage. - Attacks on Candidate A raise some doubts but attacks on Candidate B's lack of regulation raise more widespread doubts. - The best messaging focuses on guaranteeing affordable coverage and criticizes insurance industry practices.

1. Progressive Messaging for the Health Care Debate Prepared by Lake Research Partners for Health Care for America Now! [email_address] February 2008 1825 K Street NW – 4 th Floor Washington, DC 20005 Health Care for America Now ! 1726 M Street, NW, Suite 500 Washington, DC 20036 tel. 202/776-9066 fax 202/776-9074

2. Methodology: Focus Groups Lake Research Partners designed and conducted six focus groups among voters: Richmond, VA : January 27, 2008 Proper Patriots, women Marginalized Middle Agers, mixed gender Denver, CO: January 28, 2008 Proper Patriots, women Proper Patriots, men Philadelphia, PA : January 29, 2008 Marginalized Middle Agers*, women Proper Patriots*, men *Marginalized Middle Agers and Proper Patriots are segments of the American electorate defined as swing voters on health care reform using the values based segmentation system developed by American Environics.

5. Health Care & the Health Insurance Industry Voters have overall feelings of frustration with the health insurance industry and are in the mood for change.

6. As the economy continues to get worse, voters have become more tax-sensitive. However, a solid majority still favors health care for all Americans even if it means raising taxes. Favor Oppose September 2007 February 2008 64% 27% 69% 28% Do you favor or oppose providing access to affordable, quality health care for all Americans even if it mean raising your taxes? Do you feel strongly or not strongly about that choice?*

7. Voters are becoming more comfortable with a government role in health care reform, possibly as a result of the current presidential campaigns, though intensity is down. Favor Oppose September 2007 February 2008 69% 66% 28% 23% Do you favor or oppose providing access to affordable, quality health care for all Americans even if it mean a major role for the federal government? Do you feel strongly or not strongly about that choice

8. Voters strongly identify the health insurance industry with negative traits of putting profits ahead of people and being greedy, not caring, and bureaucratic. Terms like reliable and unreliable are more middling .

10. Health Care Reform Proposals The progressive health care reform plan beats out the conservative plan both in focus groups and in the survey.

11. Text of Candidate A’s Progressive Plan Americans would be guaranteed to have a choice of health plans they can afford, either from a private insurer, or from a public plan. Everyone would pay on a sliding scale based on income. To maintain quality and allow fair cost comparisons, health insurance companies and the public plan would be required to provide at least a standard, comprehensive package of benefits including preventive care and all needed medical care. Employers and individuals could choose to keep their current health plans. The public plan would be paid for through a modest payroll tax on employees and employers and by rolling back tax breaks for those who make over $200,000 a year. Small businesses would pay a lower rate. No insurer could deny coverage or charge higher premiums to people with pre-existing conditions.

12. Nearly two-thirds of voters rate Candidate A’s plan (the progressive plan) a six or higher. 34% 65%

14. Focus group participants liked that under Candidate A’s plan they would have choices in their health care and that they would not have to fear being denied.

15. Text of Candidate B’s Plan The proposal would level the financial playing field for all health purchasers, so individuals and families can purchase their own health insurance with a universal refundable tax credit of 2,500 to 5,000 dollars in place of the current employer sponsored health insurance tax exclusion. Access to Health Savings Accounts would be expanded and improved by streamlining rules and regulations, allowing families to maximize the value of health services tailored to their needs. Families would be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will reduce overhead, administrative, and excessive compensation costs from the system. Low-income families would receive supplemental aid through their state's Medicaid funds and states could choose to allow the use of private insurance in Medicaid.

16. Voters are less favorable toward Candidate B’s plan (the free market approach) with a majority rating it a five or less. 51% 47%

18. When asked to choose between the two plans, a majority opt for Candidate A’s progressive plan including 2-in-5 who say they strongly support it. 55% 28%

19. Though voters prefer Candidate A across age groups, the margin is smaller among voters ages 40-49. +28 +13 +34 +28 Margin for Candidate A Candidate A Candidate B

20. Republican men and independent men are the most likely to support Candidate B, but both groups are still net supportive of Candidate A. Margin for Candidate A Candidate A Candidate B +51 +36 +11 +37 0 +23

21. White women solidly support Candidate A’s plan but the margin of support is smaller among white men and African Americans. Even small business owners prefer Candidate A’s plan. Margin for Candidate A +16 +37 +26 +13 Candidate A Candidate B

22. Married voters and widowed voters (both groups more likely to have health coverage) support Candidate A by smaller margins than single or separated/divorced voters. Margin for Candidate A Candidate A Candidate B +22 +43 +37 +25

23. Voters in all regions support Candidate A’s plan, most strongly in the South Atlantic and with the smallest margin in the West North Central. +21 +40 + 28 +7 +15 +29 +30 Margin for Candidate A Candidate A Candidate B

24. Voters overwhelmingly believe Candidate A’s plan will be more likely to guarantee them health care. 53% 25%

25. Voters are split however on which plan will cost them more money. 37% 37%

26. Republicans are most likely to think Candidate A’s plan will cost them more money, but minority voters and Democrats think Candidate B’s plan will be more costly.

27. White women are particularly likely to think Candidate A’s plan is more likely to guarantee health care, but on cost, they are divided similar to white men and African Americans. +23 +36 +20 +7 +1 -4 Margin for Candidate A More likely to guarantee you health care: More likely to cost you more money:

28. Unmarried voters are more likely to say Candidate A’s plan will guarantee them health care and cost them less money than Candidate B’s plan. +23 +45 +37 +25 +3 -7 -15 +4 Margin for Candidate A More likely to guarantee you health care: More likely to cost you more money:

29. Attacking the Proposals Candidate A’s plan stands up to attack, while support for Candidate B’s plan suffers after attack.

30. A “Big Government” attack on Candidate A’s plan raises doubts among 55% of voters. 55% Doubt Candidate A’s plan sounds good, but it just won’t work. It will be just another big government bureaucracy like the IRS and the DMV, operating inefficiently and costing taxpayers hundreds of billions of dollars. We will end up paying higher taxes and getting low quality health care with long waiting lines to get treatment and lots of red tape and paperwork. Instead of a big government program to bring socialized medicine to America, we need to give consumers more of their own money back, and more options to choose the health insurance plan that’s right for them. Does that raise SERIOUS doubts, SOME doubts, MINOR doubts, or NO real doubts in your mind about the health care proposal from Candidate A?

31. Candidate A’s proposal is subject to doubt among Republicans and older voters. The attack on Candidate A is particularly persuasive among: Strong Republicans (53% serious doubts) Republican men (53%) Voters 75 and older (48%) Republicans (47%) Widowed voters (42%) Small Business owners (41%) White blue-collar men (41%)

32. The attack on Candidate B’s plan is farther reaching, raising doubts among over three quarters of voters. 77% Doubt Candidate B’s plan is misleading. Candidate B doesn’t tell you that with those Health Savings Accounts you will need to buy a health care plan with deductibles of 11 hundred to 11 thousand dollars. He doesn’t tell you that even if you do manage to get a tax deduction or credit it will pay for only a quarter to a half of your cost of health insurance. And his plan doesn’t do anything to regulate insurance company practices, like not covering pre-existing conditions, denying claims or restricting your choice of doctors. And there’s nothing in the plan to control skyrocketing premiums or insurance company profits. We don’t need a plan that leaves us on our own with the insurance industry. We need a guarantee of quality affordable health care for all of us. Does that raise SERIOUS doubts, SOME doubts, MINOR doubts, or NO real doubts in your mind about the health care proposal from Candidate A?

33. The attack on Candidate B is particularly persuasive among: Voters 75 and older (60%) Women 50 and older (58%) Democratic men (58%) Separated/widowed/divorced (58%) Weak Democrats (57%) Members of union households (57%) Voters with Medicare (57%) Unmarried women (56%) Seniors (56%) Blue collar voters 50 and older (56%) Older voters and Democrats are particularly likely to be skeptical of Candidate B’s plan after attack.

34. After attacks on both sides, voters continue to favor Candidate A’s plan and the margin increases from +27 to +32. 55% 23%

35. Messaging: Supporting Candidate A’s Progressive Plan The strongest messages are positive about guarantees against insurance company practices and affordability

36. All messages generated solid ratings, with the strongest response to the “Guarantee” message.

37. Similar messages test well with swing voters 1 , but they are even more supportive of government involvement.

40. Messaging: Opposing Candidate B’s Plan Voters respond to a message uncovering deception and greedy motivation behind Candidate B’s plan. They also respond strongly to messages that attack Candidate B’s plan for being written by the insurance companies to help the insurance companies.

41. Attacks on Candidate B’s plan are consistently effective, though no message is a silver bullet.

43. Following all messages, support for Candidate A’s plan increases slightly and the margin expands to +38. 59% 21%

44. As voters learn more through the survey, Candidate A gains some additional support and Candidate B’s support slowly erodes – margins grow from 27% to 32% to 38%. Margin for Candidate A Candidate A Candidate B Initial Post-Attack Final Post-Messaging +27 +32 +38

45. Notably, some Republican groups and small business owners shift toward Candidate A. Candidate A Candidate B

49. Central Message Health Care for America Now! Quality, Affordable Care We Can All Count On

50. Supportive Message # 1 We need guaranteed affordable health care for all. In our plan, people can keep the insurance they have and everyone will have the choice between private insurance and public insurance, with standard, comprehensive benefits that meet our needs, paid for on a sliding scale based on income

51. Secondary Message #2 It’s getting tougher to get good, affordable health care, no matter how hard we work, even when we take responsibility for our care and make good choices for ourselves and our families. We need an American solution to the health care crisis that guarantees quality, affordable care we can all count on.

52. Supportive Message # 3 We need an end to the greedy practices of the health insurance industry that puts profits before people. We need to set and enforce the rules to make insurers offer quality coverage at affordable cost, stop them from denying claims when people have paid their premiums, and prohibit them from denying coverage for pre-existing conditions. We need a choice of private and public insurance plans so we're not left at the mercy of the profit-driven insurance companies that got us into this mess.

53. Supportive Message #4 Don’t be misled by health care proposals that leave us on our own to fend for ourselves in a bureaucratic health insurance market. The insurance companies and their supporters are pushing plans that offer us tax credits that cover only a fraction of our health insurance costs, have deductibles as high as $10,000 and that would make us pay taxes on our employer-paid health benefits. Tax credits don’t guarantee health care.

54. Let’s Make 2009 the year we finally guarantee quality, affordable health care we all can count on!