America’s Agenda Report from a quantitative study of voter attitudes on health care delivery system reforms. 1726 M St., NW Suite 1100 Washington, DC 20036 Phone: 202-776-9066 Fax: 202-776-9074

Methodology Lake Research Partners designed and administered this survey that was conducted by telephone using professional interviewers between October 21-25, 2009. The survey reached a total of 1000 likely voters. Telephone numbers for the sample were generated by a file of likely 2010 voters in 84 Blue Dog districts, DCCC Frontline districts, and swing Republican districts. The margin of error for this survey is +/- 3.1%.

Key Findings: The Context Voters in these Blue Dog and swing congressional districts are closely divided over the health care reform proposals currently being discussed: 36% favor current reform proposals (28% strongly), with 38% opposed (30% strongly), with 26% undecided. The right health care delivery system reform proposal has the potential to break the stalemate on health care reform by giving leaders the ability to demonstrate how these health care delivery reforms, if included in overall reform, will reduce costs and improve the quality of health care. Despite a politically polarized environment surrounding health care reform, voters in these Blue Dog and swing districts solidly support health care delivery system reforms that will improve quality of health care and lower costs by: Establishing personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor. Providing incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases. Eliminating co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor. Developing a national health information technology network of electronic medical records.

Key Findings: The Proposal Voters in Blue Dog and swing congressional districts favor the delivery system reform proposal. Fully 58% of voters support the proposal tested—including 57% of voters in Blue Dog districts, 54% of voters in Frontline districts, and 70% of voters in swing Republican districts. HEALTH CARE DELIVERY SYSTEM REFORM PROPOSAL: Now I would like to read you a proposal that is being considered to reform health care. This proposal aims to reduce costs and improve quality of health care in the following ways: Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients; Ensure that patients receive highly-coordinated, personalized treatment plans based on the latest medical evidence; Eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; Eliminate co-pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on the most effective treatments.

Key Findings: Vote Implications After hearing the proposal, fully half (50%) of voters surveyed would be more likely to support the overall health care reform package being considered by Congress if these reforms were included, whereas just 18% would be less likely to support overall health care reform as a result. Voters from Blue Dog districts are net +32 points more likely to support overall reform with these reforms included, voters from Frontline districts +29 points more likely, with voters from swing Republican districts a net +42 points more likely. Moreover, by a margin of 20 points, voters overall would be more likely to vote for a member of Congress who supported these reforms as part of an overall health care reform package, with 27% saying it would make no difference to them. Voters from Blue Dog districts are net +18 points more likely to support such a member of Congress, voters from Frontline districts +16 points more likely, with voters from swing Republican districts a net +37 points more likely.

Key Findings: Components Many of the proposal’s key components receive solid levels of support from voters in these Blue Dog and swing districts: Fully 67% of the voters give a positive rating (rated 6 to 10 on 10 point scale) to establishing personal medical teams of health professionals coordinated by a family doctor. 66% of voters have a positive view of providing incentives in public and private health plans to reward active patient involvement in preventing obesity and chronic diseases. 65% of voters have a positive view of developing a national health information technology network of electronic medical records. 64% of voters give a positive rating to strengthening the primary health care workforce by providing incentives like increased reimbursements, forgiveness of educational loans, and tuition assistance. 62% of voters provide a positive rating for eliminating co-pays and deductibles for chronic disease treatment.

Key Findings: Messages All messages tested are at least somewhat convincing to two thirds of the likely voters in these districts. The best message themes include: Personal medical teams to keep people healthy are a smart investment and an efficient use of tax dollars. Personal medical teams will coordinate care, testing, and information to cut costs and improve efficiency. Providing needed follow up care when patients are released from the hospital helps to keep patients on track, improving their health and morale, and drives down costs. A personal medical team model that uses the latest information technology, like electronic medical records, will reduce medical errors and costs associated with paper records.

Support for the Health Care Delivery System Reform Proposal There is solid majority support for including the health care delivery reform proposal as part of health care reform.

The Blue Dog and swing congressional district voters surveyed are closely divided over the health care reform proposals currently being considered by Congress. As of right now, do you favor or oppose the health care reform proposals presently being discussed?

Despite a politically polarized environment, voters solidly support health care delivery system reforms that will improve the quality of health care and lower costs. Now I would like to read you a proposal that is being considered as part of the health care reform package being considered by Congress. Would you favor or oppose this proposal, or are you undecided?

Health Care Delivery Reform Proposal Now I would like to read you a proposal that is being considered as part of the health care reform package being considered by Congress. This proposal aims to reduce costs and improve quality of health care in the following ways: Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients; Ensure that patients receive highly-coordinated, personalized treatment plans based on the latest medical evidence; Eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; Eliminate co-pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on the most effective treatments. Would you favor or oppose this proposal, or are you undecided? 11 11

Majorities of all demographic groups except Republicans support the reform proposal. Support is especially high among Democrats and younger voters. Now I would like to read you a proposal that is being considered as part of the health care reform package being considered by Congress. Would you favor or oppose this proposal, or are you undecided? Margin +31% +29% +34% +44% +28% +40% +26% +35% +21% +42% +73% +25% -10%

If the health care delivery reform proposal is included in the overall health care reform package, voters are more likely to support overall reform and more likely to vote for a member of Congress who supports the proposal. And if this proposal I just read were part of the overall health care reform package being considered by Congress, would you be more or less likely to support health care reform, or would it not make a difference? More likely Less likely +32 No difference/ both/ neither/ don’t know And if this proposal I just read were part of the overall health care reform package being considered by Congress, would you be more or less likely to vote for a member of Congress if they supported the health care reform package, or would it not make a difference? More likely Less likely +20 No difference/ both/ neither/ don’t know

Among voters who are undecided on broader health care reform, a majority are more likely to back reform if the delivery reform proposal is included. They are also net +33 points more likely to vote for a member of Congress who supports the proposal. And if this proposal I just read were part of the overall health care reform package being considered by Congress, would you be more or less likely to support health care reform, or would it not make a difference? More likely Less likely +44 No difference/ both/ neither/ don’t know And if this proposal I just read were part of the overall health care reform package being considered by Congress, would you be more or less likely to vote for a member of Congress if they supported the health care reform package, or would it not make a difference? More likely Less likely +33 No difference/ both/ neither/ don’t know

Many of the components of the proposal enjoy broad support, including incentives rewarding active patient involvement in preventing obesity, establishing personal medical teams, and eliminating cost sharing for chronic disease management. Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. Mean Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer. 6.8 Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* 6.8 Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor.* 6.6 Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* 6.7 * Asked of half of sample.

Every component of the reform proposal tested is rated positively by a majority of voters in these districts. Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. Mean Develop a national health information technology network of electronic medical records to enable better care coordination, reduce the medical errors and costs associated with paper records, and provide protections for personal privacy. 6.7 Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor in national health programs like Medicare.* 6.6 Strengthen the primary health care workforce by providing incentives such as increased reimbursements, forgiveness of education loans, and tuition assistance to encourage more primary care family doctors and nurses to enter the field. 6.5 Create incentives, such as bonuses for doctors and hospitals, and insurance discounts for patients who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer. 6.3 * Asked of half of sample.

Messaging on Personal Medical Teams Voters respond to messages that emphasize healthy lifestyle choices, care coordination, follow up care, and use of information technology.

Voters respond to messages that emphasize encouraging exercise and helping people make good lifestyle choices, coordinating care, and health IT that saves money. Now I’m going to tell you more about different aspects of one of the proposals we have discussed, the personal medical team headed by your personal physician. For each aspect of the personal medical team I read, please tell me whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support including the component of a personal medical team headed by your personal physician as part of the health care reform proposal. * Asked of half of sample.

Text of top tier messages [HEALTHY LIFESTYLE] Personal medical teams include programs that help encourage exercise and help people make good nutritional choices, so they stay healthy. [CARE COORDINATION] Frequently, lack of coordination in care means patients have to take multiple, costly and sometimes painful tests over and over. A personal medical team will coordinate care, testing, and information to cut costs and improve efficiency. [SUPPORT POST CARE-COSTS] Too often, patients and their families are on their own after they are released from the hospital with nobody helping them manage the follow up treatment, diet, and medication. Personal medical teams of doctors, nutritionists, and specialists can help patients stay on track, improving their health and morale, and driving down overall costs of care. [HEALTH IT] The personal medical team model uses the latest information technology, like electronic medical records, to reduce the medical errors and costs associated with paper records, while protecting personal privacy. [TAX DOLLARS] Tax dollars should be spent in the most cost effective way possible. Giving everyone the option of a personal medical team to keep them healthy is a smart investment and an efficient use of the tax dollars that we spend on health care.

Also fairly strong are messages geared toward better treatment for seniors and improved chronic care management. Now I’m going to tell you more about different aspects of one of the proposals we have discussed, the personal medical team headed by your personal physician. For each aspect of the personal medical team I read, please tell me whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support including the component of a personal medical team headed by your personal physician as part of the health care reform proposal. * Asked of half of sample.

Text of 2nd tier messages [SUPPORT POST-CARE COMPLICATIONS] Too often, patients and their families are on their own after they are released from the hospital with nobody helping them manage the follow up treatment, diet, and medication. Personal medical teams of doctors, nutritionists, and specialists can help patients stay on track, improving their health and morale, and preventing dangerous complications, which often require hospital readmission. [CHRONIC CARE MANAGEMENT] Personal medical teams will manage the care of people with chronic diseases like heart disease and diabetes more effectively, prevent the need for costly hospitalizations, prevent diseases from progressing, and keep people healthier longer. [SENIORS] Many senior citizens have complex chronic illnesses that are difficult to diagnose and manage by a single family doctor working in isolation. Personal medical teams create safer, more effective, and cost efficient means of treating seniors. [TAX DOLLARS-RETURN ON INVESTMENT] Tax dollars should be spent in the most cost effective way possible. Giving everyone the option of a personal medical team to keep them healthy is a smart investment and an efficient use of the tax dollars that we spend on health care. Over 10 years, the savings generated by personal medical teams is two to four times more than the initial investment. [CHRONIC CARE MANAGEMENT-SPENDING] Seventy-five percent of health care spending in the U.S. is spent on chronic diseases like heart disease and diabetes. Personal medical teams will manage the care of people with chronic diseases more effectively, prevent the need for costly hospitalizations, prevent diseases from progressing, and keep people healthier longer.

Voters are somewhat less responsive to the “quarterback” analogy, community care, and are not as persuaded by claims that personal medical teams will shorten wait times for appointments and give doctors more time to spend with their patients. Now I’m going to tell you more about different aspects of one of the proposals we have discussed, the personal medical team headed by your personal physician. For each aspect of the personal medical team I read, please tell me whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support including the component of a personal medical team headed by your personal physician as part of the health care reform proposal. * Asked of half of sample.

Text of 3rd tier messages [MISTAKES] It’s unfortunate, but independent studies have shown that far too often doctors and hospitals make mistakes in how they treat patients, often doing their patients more harm than good. A personal medical team using the most current scientific information available will reduce the number of costly and harmful errors. [PREVENTION] A personal medical team supports greater emphasis on prevention so people who are at high risk for chronic diseases can be prevented from getting these diseases in the first place. [QUARTERBACK-CARE COORDINATION] In a personal medical team, the family doctor is like a quarterback leading a team of supporting players. This means better coordination of care for patients and more effective, comprehensive, and cost efficient treatment as a result. [COMMUNITY RESOURCES] A personal medical team includes connections to community resources that can keep you healthy, such as a Y.M.C.A. program to support weight management to fight heart disease and diabetes, and parent-to-parent programs to help new parents raise healthy children. [PROVEN MODEL] The personal medical team is a proven model for providing higher quality medical care. It improves the effectiveness of treatment, and it reduces the growth in health care costs. The personal medical team shortens waiting times for appointments and gives doctors and health care providers more time to spend with patients.

Voters who are swing (undecided) respond to the same messages as all voters. Now I’m going to tell you more about different aspects of one of the proposals we have discussed, the personal medical team headed by your personal physician. For each aspect of the personal medical team I read, please tell me whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support including the component of a personal medical team headed by your personal physician as part of the health care reform proposal. * Asked of half of sample.

America’s Agenda Report from a quantitative study of voter attitudes on health care delivery system reforms. 1726 M St., NW Suite 1100 Washington, DC 20036 Phone: 202-776-9066 Fax: 202-776-9074