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12
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1
How are out-of-pocket healthcare costs impacting you as an American on Medicare?
Select the statement that most closely aligns with your views and experiences
With Medicare, I am able to receive the healthcare services I need
With Medicare, I am still unable to receive the healthcare services I need
I am currently not on Medicare
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2
Are you 65 or older?
YES
NO
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3
Are you currently on Medicare?
YES
NO
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4
What is your annual household income?
Below $10K
$11K - 50K
$51K - 100K
$101K - 150K
Over $150K
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5
Do you have access to reliable financial support from a friend or family member?
YES
NO
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6
Are you retired or planning to retire in the next 6 months?
Yes
No
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7
Are you currently suffering from an illness and/or disability?
YES
NO
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8
If you had to choose, would you rather have...
A smaller government providing fewer services
A bigger government providing more services
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9
Which issues most closely align with your political values?
Legalizing abortion, universal healthcare, gun regulation
Lowering taxes, reduced government regulation, increased military funding
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10
How do you feel towards the Democratic (liberal) party?
1
2
3
4
5
Strongly oppose
Strongly support
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11
How do you feel towards the Republican (conservative) party?
1
2
3
4
5
Strongly oppose
Strongly support
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12
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