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Richest Republicans View Health Care Far Differently Than Poorest, NPR Poll Finds

A new poll finds that rich people are much happier with their lives than poorer people. They're also far more likely to say they've achieved the American dream, that they're satisfied with their education, and that they're not anxious about the future.

Many people could have guessed all of that without a poll, of course. But the findings also show some striking differences — and some striking similarities — between the very richest and poorest Americans about what it takes to succeed in this country.


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Certain divides are particularly revealing by political party. Sometimes, the richest and poorest members of a party disagree substantially on what it takes to get ahead and how lawmakers should approach an issue. Particularly notable is the Republican divide on the importance of universal health care.

Uniquely, the telephone survey — from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health — has a sizable sample of the "1%," allowing us to see how the beliefs of the highest-earners differ from people of other income levels.

"People have a lot of views about what the experiences of the most successful people in America are. But we've never been, in most cases, able to look at them," said Robert Blendon, professor of health policy and political analysis at the Harvard Chan school.

Should reducing inequality be a priority?

Altogether, the top 1% and the lowest-earning Americans differ only modestly on how big of a problem income inequality is, the poll finds.

Sixty-two percent of people with annual income of $500,000 or more — that is, people in roughly the top 1% — and 75% of people making less than $35,000 a year say they think income differences between the rich and poor are a "very" or "somewhat" serious problem.

There are moderately larger differences, however, on the question of what government should do about it.

Forty-five percent of the very highest earners say it should be a "very" or "somewhat" important priority to reduce that inequality, according to the poll. Meanwhile, about two-thirds of lower-income people believe the same.


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The Republican income divide on health care

The poll comes as Democratic presidential candidates — particularly Vermont Sen. Bernie Sanders and Massachusetts Sen. Elizabeth Warren — invoke inequality and, often, "the 1%" on the campaign trail.

And the survey shows that there are some major differences of opinion between the rich and poor within parties.

Most pointedly, Republican voters vary substantially by income on the question of whether the government should make it a priority to make sure everyone has health coverage. Fifteen percent of Republicans in the top 1% say that this should be a very important priority. Three times as many — 48% — of the lowest-income Republicans agree with that statement.

Meanwhile, around 9 in 10 Democrats, across all income levels, said the same.

This may indicate that Republicans need to address health care concerns among some of their voters, as Democratic presidential contenders continue to champion various paths to universal health insurance coverage.

"If you look at those results, you would think that Republicans are going to have to pay particular attention to our care issue — the fact that they have a core constituency that really worries about they're not having adequate coverage for it," Harvard's Blendon said.

When it comes to being economically successful in America, lower-income Republicans were more likely (60%) than Republicans in the 1% (36%) to believe that "knowing the right people" is "essential" or "very important."

And lower-income Republicans and Democrats alike were more likely than 1-percenters in their own parties to believe that graduating from a "highly ranked college" is "essential" or "very important."

Partisan differences

Altogether, respondents' answers about what it takes to get ahead in America crystallize the vast difference in philosophies between the two parties.

"What you see is that Democrats believe that the environment you live and grow up in really affects whether or not you're going to achieve success in America. And Republicans are more individually focused," Blendon said.


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The poll also shows substantial differences between Democrats and Republicans on the importance of higher education.

Seventy-four percent of Democrats said they believe graduating from college is "essential" or "very important" to being economically successful, compared with 40% of Republicans. Variations were only modest across incomes on that question, for both parties.

One other area where opinions vary greatly between parties: inequality. About 6 in 10 Democrats said it should be a very important priority for Congress and the president to reduce inequality between high- and low-income people. Only 14% of Republicans agree.

(That said, this was another instance in which Democrats were consistent across incomes, while Republicans differed: Less than 1% of Republicans in the top 1% said reducing inequality should be a very important priority, compared with 22% of the lowest-income Republicans.)

This kind of thinking is visible in the Democratic presidential contenders' many policies to try to give more Americans economic opportunities, from New Jersey Sen. Cory Booker's "baby bonds" proposal to entrepreneur Andrew Yang's universal basic income plan.

One area where both parties generally agree: Vast majorities of Democrats, independents and Republicans believe that hard work is "essential" or "very important" for being economically successful.

The landline and cellphone poll was conducted in July and August of 2019, with a sample size of 1,885 adults. The margin of error for the full sample is plus or minus 3.2 percentage points. Read the full results.

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Danielle Kurtzleben is a political correspondent assigned to NPR's Washington Desk. She appears on NPR shows, writes for the web, and is a regular on The NPR Politics Podcast. She is covering the 2020 presidential election, with particular focuses on on economic policy and gender politics.