The Nation’s Pulse: The Texas Medical Center's Consumer & Physician Survey

• Blue states have significantly higher proportion of insured consumers, with government insurance being much more common there than in red states (#36)
• Having health insurance is very important or absolutely essential to 9 in 10 consumers across red and blue states (#37)
• Overall, insured consumers value having insurance significantly more than the uninsured, though most uninsured say it’s very important or absolutely essential (#38)
• Virtually all Trump and Clinton voters in red and blue states recognize the importance of having health insurance for themselves and their families (#39)
• Consumers in blue states place more importance on all US citizens having health insurance (#40)
• The vast majority of insured and uninsured consumers agree it is important for all U.S. citizens to have health insurance (#41)
• Across all states, consumers who voted for Clinton are significantly more likely to consider it important that all US citizens have health insurance (#42)
• Expanding state insurance system is the top choice in all states, but particularly in blue states; red states more often than blue prefer to give people money to buy insurance or say it is not government’s job (#43)
• There are no major differences in preferred ways to expand health insurance for insured vs. uninsured consumers (#44)
• Those who voted for Trump are much more likely to say it is not the government’s responsibility to expand insurance; they are also much less likely to favor the expansion of state insurance (#45)

• Consumers feel they are paying more out-of-pocket now compared to two years ago, especially in red states (#47)
• Trump voters in blue states are notably more likely to agree out-of-pocket expenses have increased (#48)
• Consumers in red states (about half) are significantly more likely to have to cut down on other expenses to pay for healthcare (#49)
• Slightly over half of consumers in red and Swing Non-Expansion states agree that they have to cut down on other expenses to pay for healthcare (#50)
• In blue states, Trump voters agree that they have had to cut down on other expenses to pay for healthcare; most Clinton voters disagree (#51)

• Around two-thirds of insured consumers report paying 5% or more in out-of-pocket expenses; at least one-third find this unaffordable, leading them to cut back on savings, clothing, and food (#52)
• Compared to red states, many more consumers in blue states report paying only 2% in out-of-pocket expenses; however among those who pay 5% or more at least one-third find it unaffordable (#54)
• Among lower income categories, roughly around half of insured consumers report that their out-of-pocket healthcare expenses are unaffordable; out-of-pocket expenses of 5% or more are affordable by less than one-quarter (#55)
• Affordability clearly increases with income, yet no more than four in ten insured consumers with income of $75K+ find out-of-pocket expenses of 5%-20% to be affordable (#56)
• 2/3 of insured pay 5% or more in Out of Pocket expenses; as expenses increase from 2% to 20% of income, affordability decreases,
  prompting cut-backs. (#57)

• More than half of insured consumers say they are paying more out-of-pocket vs. 2 years ago (#59)
• Nearly half of insured consumers in red states have cut down on other expenses to pay for healthcare (#60)

• Data: Affordability of out-of-pocket healthcare expenses by income – uninsured respondents (#62)
• Expense is, by far, the main reason for being uninsured, especially in red states (#63)
• Similarly, expense is the main reason for being uninsured in the non-expansion states; ineligibility for Medicare/Medicaid is a very distant second, but is significantly more often mentioned in the swing states (#64)
• While there are no overwhelming motivation for buying insurance, roughly four in ten consumers say they would buy insurance if they could afford it (#65)
• Most uninsured consumers say 2% of their monthly household take home pay would be affordable for out-of-pocket health expenses (#66)
• Across all states, at least two-thirds of uninsured consumers are paying more out-of-pocket this year vs. two years ago (#67)
• Around three-quarters of uninsured consumers have had to cut down on other expenses to pay for healthcare (#68)

• Consumers in red states are much more willing than those in blue states to receive care from small group of PCPs or specialists to reduce cost of health insurance (#70)
• Uninsured consumers in red states are much more willing to receive less expensive coverage for accidents, pregnancy and other chronic conditions (#71)
• Consumers in non-chronic illnesses households are much more willing to receive less expensive, but more restrictive coverage, and travel longer distances for care in order to reduce healthcare insurance costs (#72)
• About half in all states support increasing the price of insurance for smoking or ER use for non-emergencies; about one-quarter, however, feel that insurance cost should not increase (#73)
• Chronically ill are significantly more likely to support increasing insurance for smoking and ER use for non-emergencies, and are less likely to support an increase of health insurance for any reason (#74)
• Consumers in red states are more likely to say eating healthy is too expensive while blue states are more supportive of “fat taxes”; both support menu labeling & higher insurance for people with poor health habits (#75)
• Consumers with no chronic illnesses are much more likely to support higher insurance for people with poor health habits, higher prices for foods that lead to obesity and taxes on sugary drinks (#76)
• About six in ten consumers support charging people with poor health habits more for insurance (#77)
• Many, especially in blue states, support charging more for foods that lead to obesity (#78)
• About half support taxing sugary drinks, especially in blue states (#79)
• Three-quarters of consumers across all states support menu labeling (#80)
• Just under two-thirds of consumers in red states find eating healthy to be too expensive (#81)

• As expected, more voted for Trump in red states and Clinton in blue states (#83)
• Blue and swing states lean more Democrat in 2018 Midterm elections; consumers in red states are split (#84)
• Over half of consumers across all states report that candidate’s stance on healthcare will greatly impact their mid-term vote (#85)
• Even in red states, only a small proportion of consumers say that Trump is doing a good job on healthcare (#86)
• Knowing what they know now about Trump’s healthcare plans, many consumers, particularly in blue and Swing states, would not vote for Trump (#87)
• Some see increasing price of insurance for those who smoke, are morbidly obese, or non-adherent as options to decrease costs; others support an affordable health plan that covers major illnesses and accidents (#88)
• Consumers blame drug companies, insurance companies, and government for rising costs; government is blamed significantly more often in red states vs. blue and Swing states (#89)

• Increasing the price of insurance for smokers, morbidly obese, or non-adherent is physicians’ top choice to decrease costs; consumers agree, but they also support a plan for major illnesses and incidents, and decreasing payments for expensive drugs (#98)
• Physicians primarily blame insurance companies for rising healthcare costs while consumers feel that drug and insurance companies, followed by the Federal government deserve the most blame (#99)

Online method details (#105-106)

• Physicians’ ideal compensation is high fixed salary with low incentives, followed by a fixed salary only (#14)
• With a guaranteed salary plus quality incentive, a sizeable minority of physicians would spend more time with patients, and feel more satisfaction with their practices (#15)
• Most physicians are neutral on allowing CMS to give bonuses to plans when >50% of physicians have a fixed salary component (#16)

• For the 2018 Mid-term elections, votes are split almost evenly between Democrat and Republican (#19)
• More than half of physicians say a candidate’s stance on healthcare will greatly impact their mid-term vote (#20)
• Physicians do not think President Trump is doing a good job on healthcare (#21)
• About one in four Trump voters think the President is doing a good job on healthcare; the rest are uncertain or negative (#22)
• Half of all physicians would not vote for President Trump now knowing his plans for healthcare (#23)
• Only half of Trump voters say they would vote for the President now knowing his plans for healthcare; virtually none of Clinton voters would vote for him (#24)
• More physicians, both Generalists and Specialists, voted for Clinton than for Trump in the 2016 Presidential election (#18)
• Among both physicians and consumers, more voted for Clinton than for Trump; the only exception is consumers in red states (#91)
• Overall, physicians tend to be evenly split between Democrat and Republican in 2018 Midterm elections; consumers lean more Democrat (#92)
• Over half of physicians and consumers across all states agree that candidate’s stance on healthcare will greatly impact their mid-term vote (#93)
• Only a small proportion of consumers and even fewer physicians think that Trump is doing a good job on healthcare (#94)
• Among physicians, only one-quarter of Trump voters think the President is doing a good job on healthcare; notably more Trump voters among general public (45%) share the same opinion (#95)
• There is a consensus among roughly half of physicians and consumers that they would not vote for Trump now knowing his plans for healthcare (#96)
• Among Trump voters, just under five in ten physicians and four in ten consumers say they would not vote for Trump now knowing his plans for healthcare (#97)

• Increasing insurance costs for smokers, obese, or non-adherent is seen as likely to reduce healthcare cost (#25)
• Physicians, particularly Generalists, tend to blame health insurance companies and other payers for rising healthcare costs (#26)

• Demographics (#100-104)