Bill McInturff, Partner, Public Opinion Strategies Glen Bolger, Partner, Public Opinion Strategies

1. Blue Cross/Blue Shield Association Key Findings from surveys conducted on behalf of Blue Cross/Blue Shield Association Bill McInturff, Partner, Public Opinion Strategies Glen Bolger, Partner, Public Opinion Strategies Geoff Garin, President, Hart Research Associates

2. Methodology Key findings are based on recently conducted surveys: • Questions from an Election Night Survey A national phone survey of 800 actual voters conducted on November 2nd, 2004, election night. The margin of error on this survey is +3.5%. This survey was conducted by Public Opinion Strategies. • A National Survey of Registered Voters A phone national survey of 1000 registered voters conducted November 4, 6-7, 2004, with a margin of error of +3.1%. This survey was conducted by Public Opinion Strategies in conjunction with Hart Research. BCBSA Reseach Project 2

3. Methodology Key findings are based on recently conducted surveys: (cont.) • An Internet Survey of 500 Physicians An internet survey of 500 physicians conducted November 3-4, 2004. The margin of error on this survey is +4.4%. This survey was conducted by Cooper Research in conjunction with Blue Cross Blue Shield Association. The physicians survey used a fax/internet methodology to recruit and interview the respondents. The sampling frame was a list of over 342,000 practicing U.S. physicians in The Little Blue Book Physician Master File. Two systematic random samples of 10,000 physicians each were drawn from the total file. Only one physician from each office was eligible to participate. Physicians were invited to take part in the survey via broadcast faxes which were sent out on two successive waves on November 3rd and 4th. The invitation asked the physician to participate in a major non-partisan survey on critical election issues related to health care. Each physician was given the survey URL as well as and a unique login code to access the site. If a physician encountered problems in either accessing or completing the survey he/she could receive assistance via a toll free help line. Hourly reports of completed interviews by years in practice, geography, and medical specialty were monitored to ensure the interviews were well balanced. Responses were cut off when 501 interviews were completed. BCBSA Reseach Project 3

4. Understanding the impact of health care in the 2004 election 4

5. Health care concerns ranked third behind Iraq and the economy in what issues were important to voters when deciding how to vote for President.

6. 64% 51% 45% 23% 28% 57% Presidential Ballot By Respondent’s Top TWO Most Important Vote Issues Kerry Advantage Bush Advantage 11% HOMELAND SECURITY (BUSH 82% - KERRY 18%) 14% MORAL VALUES (BUSH 75% - KERRY 24%) 13% WAR ON TERROR (BUSH 72% - KERRY 27%) 31% IRAQ (BUSH 38% - KERRY 61%) 23% ECONOMY (BUSH 35% - KERRY 63%) 15% HEALTH CARE (BUSH 21% - KERRY 78%)

7. Voters were asked, based upon what they heard during the presidential campaign, whether they thought President Bush and Senator Kerry each had a plan to “make health coverage more affordable.” Among those voters who recalled either candidate having a health care plan, we asked voters to describe what they remember and whether this plan made them more or less likely to vote for that candidate. 7

8. Recall of President Bush’s health care plan. Asked of those who recalled President Bush having a health care plan Just over one third (35%) of voters said they thought President Bush had a plan “to make health coverage more affordable” during the campaign. What voters recall most about President Bush’s plan was his proposal to make health care more affordable and more accessible for everyone, especially seniors. In addition, voters were aware of his stand against frivolous lawsuits and his support for decreasing government control and emphasizing health care delivered by the private sector. Some respondents also mention Bush’s support for health savings accounts and the preservation of Social Security. And did George W. Bush’s affordable health coverage plan or proposal make you more likely to vote for him, less likely to vote for him or did it not really make a difference in your vote?

9. Recall of Senator Kerry’s health care plan. Asked of those who recalled Senator Kerry having a health care plan Almost half of the electorate (47%) said they thought Senator Kerry had a plan “to make health coverage more affordable.” What voters recall about Senator Kerry’s plan was his proposal to make health care more affordable and available to seniors and the poor in particular, by getting rid of tax breaks for the upper income bracket. Voters also cite his idea to offer the health care coverage congressional members have to every American. Some respondents also mention his proposal for increasing government control and creating a “national health care” plan. And did John Kerry’s affordable health coverage plan or proposal make you more likely to vote for him, less likely to vote for him or did it not really make a difference in your vote?

10. Looking forward to 2005 10

11. When voters are asked to select their two most important domestic issue priorities, they select “the economy and jobs” and “health care and prescription drug prices.”

12. Almost two thirds of those with private health insurance say their out-of-pocket costs have gone up over the past year.

13. Given the concern about cost, we asked voters to rate on a scale of one to five, with five being the most important,multiple factors to learn more about what they believe contributes to rising healthcare costs. The findings highlight the focus on prescription drug costs, the cost of hospital care, and medical malpractice costs. “Profits in the health care industry” scores in the middle rank of the other factors tested. 13

14. Top factors voters believe contribute to rising healthcare costs.

15. Looking forward to the next Congress, we asked people to rate on a scale of one to five, with five being the most important, how important it was to them that Congress make progress on this issue over the next two years. Interestingly, there is not one key health care issue that voters feel is most important for Congress, but rather a variety of issues that require attention. 15

16. Issues Congress should make progress in the next two years.

18. Looking across partisan lines, there is some agreement on the top five issues that are most important for Congress to address – specifically “slowing down the steep rise in health care costs” and “making sure people have access to affordable prescription drugs.” 18

19. However, it is clear that Republicans are more focused on the medical malpractice issue while Democrats feel more attention should be given to government programs.

20. We tested ten different programs that we told participants could be sponsored by health insurance companies and asked people how important a priority each should be. The findings broadly mirror the results of the other portions of the study. 20

21. The clear message across multiple questions and multiple scales is a concern about the need to deal with the cost of prescription drugs.

23. The message from physicians 23

24. There’s one overall finding that dominates the response from the physicians surveyed: Fix the medical malpractice liability system.

25. There’s one overall finding that dominates the response from the physicians surveyed: Fix the medical malpractice liability system.

26. Verbatims When asked at the end of the internet study, “to tell us what you think are the one or two most important things that could be done to reduce the rising cost of healthcare,” there are three broad physician messages; however, by a ratio of approximately three-to-one physicians cite the medical malpractice issue: • Limit frivolous lawsuits and support legal reform. Physicians believe that by limiting lawsuits and putting a cap on the amount of money awarded to injured patients, the cost of healthcare will significantly decrease. • Preventive medicine and patient responsibility in health care was another top mention. Physicians say individuals need to take better care of themselves and become more educated about health issues in general. • A national/universal health care plan would lower costs and increase quality and coverage.

27. Verbatims • “Reform of liability insurance to minimize defensive medical practice. fair reimbursements to physicians. limit percentage of settlement that lawyers can reap from suits. physicians improve policing themselves. avoid punitive response to reporting of medical errors in health care system . this would allow for better identification of problem areas and targeted improvement.” YEARS PRACTICE:10-14 SPECIALITY:OB/GYN • “Make people responsible for their health--if overweight, they must demonstrate some weight loss; if smoker, they must stop. perhaps the cost of their copay would go up if they don't try to improve their health? Make a connection between the care received and the cost of that care. Too many people insist on MRI when they don't require one.” YEARS PRACTICE:10-14 SPECIALITY: Rheumatology • “Reduce malpractice costs which include extra tests and care performed to protect care providers reduce cost of medicine and medical products including product liability costs.” YEARS PRACTICE:10-14 SPECIALITY: Anesthesiology • “Universal healthcare or insurance rates based on patient's healthy or unhealthy lifestyles.” YEARS PRACTICE:10-14 SPECIALITY: Family/General Practice

28. When presented with the same list of ten items health insurers could sponsor, physicians’ priorities for health insurers differ from the public as physicians put the highest emphasis on preventive care and working to have people adopt a healthier lifestyle.

29. Bill McInturff, Partner, Public Opinion Strategies bill@pos.org/703-836-7655 Glen Bolger, Partner, Public Opinion Strategies glen@pos.org/703-836-7655 Geoff Garin, President, Peter D. Hart Research Associates ggarin@hartresearch.com/202-234-5570