Public Opinion Polls and Medicaid Expansion

PUBLIC OPINION POLLS AND MEDICAID EXPANSION:

INFORMATION TOINFORM IOWA POLICY

February 13, 2013

One of the questions Iowa lawmakers are likely asking this year is whether the state’s residents support expanding Medicaid. This is a key decision before the Iowa General Assembly.

Three recent polls—one focused on Iowa, one on Florida and one on the U.S. as a whole—show strong support for expanding Medicaid to cover adults up to 138 percent of poverty.

The American Cancer Society poll occurred in Iowa between Dec. 13 and Dec. 22, 2012, and included 808 survey respondents. It showed 57 percent of Iowans in favor and only 30 percent of Iowans opposed to accepting federal funds to expand Medicaid, based on the following question:

Under the new federal health care law, 145,000 people in Iowa who are uninsured right now could get health care coverage through Medicaid starting in 2014. The governor and state elected officials can choose to accept federal dollars that have been allocated to cover these people in Iowa, or to turn the money down and not cover these people. The federal dollars cover 100% of the costs in the first few years, and 90% of the costs after that. Based on what you know right now, what would you like your state to do: Accept the money or turn the money down?

The Florida poll, covering the period from Jan. 15-17, 2013,and sponsored by the Florida Hospital Association, found 62 percent of Floridians supported, and only 34 percent opposed, expanding Medicaid when asked the following question:

In order to cover more uninsured adults, the federal government would cover all of the increased costs to expand health care coverage through Medicaid for the first three years. The federal government would then cover 90 percent of the increased costs permanently with the state of Florida paying 10 percent. Knowing this, would you say the state should or should not accept the federal money to expand health care coverage through the Medicaid program to cover more uninsured adults?

Breakdowns showedstrong support among a number of major demographic groups: younger voters (76 percent), self-identified moderates (72 percent), women (69 percent), seniors (63 percent), and political independents (61 percent). While support also breaks along party lines, even a majority self-identified “moderate/liberal Republicans” (52 percent) support accepting federal funds for coverage.

A national poll conducted by the Kaiser Family Foundation right after the Supreme Court decision, in July 2012, found that two-thirds of all Americans favored the provision in the Affordable Care Act regarding Medicaid expansion. When asked about the specific provision that “will expand the existing Medicaid program to cover more low-income, uninsured adults,” 41 percent indicated they were “very favorable,” with 26 percent “somewhat favorable,” 14 percent “somewhat unfavorable,” 16 percent “very unfavorable,” and 4 percent “don’t know” or “refused to answer.” This represents a more than 2-to-1 margin in favor of Medicaid expansion.

Moreover, when asked about Medicaid expansion in their own state and informed that not expanding Medicaid “would mean many low‐income people in your state would be left without health insurance, and your state would be giving up additional federal dollars for covering its uninsured residents,” 59 percent favored Medicaid expansion and only 31 percent opposed it—similar to findings in the Florida poll. The Kaiser Family Foundation also concluded that, the more specifics people know about Medicaid expansion, the more likely they are to support it.

A fourth, just-released Iowa poll sponsored by the Des Moines Register (polling from Feb. 3-6, 2013)sets the question in a different context: support or opposition to the Governor’s position. The Register’s question stated:

The new federal health care law allows states to expand their Medicaid programs, which in Iowa would provide health care coverage to tens of thousands more poor adults. Governor Branstad wants to opt out of this program, saying even though the federal government will pay at least 90% of the new cost, it is still expensive for the federal government and ultimately for Iowans. Do you agree with Governor Branstad’s position or do you think Iowa should opt in to the expanded Medicaid program?

By including the Governor’s position and argument, this question is not purely about Medicaid expansion. Good poll questions generally ask about only one issue, so results can be interpreted about that specific issue.

Despite that, a slight majority (47 percent to 46 percent) disagreed with the Governor’s position. The same poll also showed an overall approval rating for Gov. Branstad of 56 percent to 33 percent—indicating that Medicaid expansion is an area where a significant number of individuals who generally support the Governor oppose him.

Public opinion polls are not static, but change in relation to public information about an issue. As the public learns more about the specific impacts of Medicaid expansion, the Kaiser poll in particular suggests that support for Medicaid expansion will rise.

In assessing public opinion regarding Medicaid expansion in Iowa, policy makers—and the public—need as much factual information as possibleabout the impacts of that expansion on Iowans.

Every Child Counts is the advocacy initiative of the Child and Family Policy Center. For more information, contact: Danielle Oswald-Thole () or Charles Bruner () or call 515-280-9027.