Short Takes On News & Events

Survey: Even In Southern States, Medicaid Expansion Is Popular

By Karl Eisenhower

May 21st, 2013, 2:50 PM

Alabama, Georgia, Louisiana, Mississippi and South Carolina have a lot in common: The summers are hot and the political climates are conservative. These are states where Mitt Romney handily beat Barack Obama in the 2012 presidential election, so it’s not surprising to learn that the president’s signature health law is unpopular there.

But despite the law’s unpopularity, its expansion of Medicaid is supported by almost two-thirds of adults in these states, according to a survey by the Joint Center for Political and Economic Studies, a left-leaning think tank.

The survey found only 33 percent of adults in the five states have a favorable opinion of the 2010 health law — ranging from a low of 31 percent in Louisiana to a high of 35 percent in Alabama. Yet 62 percent say they support expanding Medicaid to cover more low-income, uninsured adults — ranging from a low of 59 percent in Mississippi to a high of 64 percent in Alabama.

By comparison, an April poll by the Kaiser Family Foundation found that Americans overall support the Medicaid expansion by only a 50 percent to 41 percent margin. (KHN is an editorially independent program of the foundation.)

The Supreme Court ruled last year that the federal government cannot force states to expand their joint federal-state Medicaid programs for the poor. According to health care consultant group Avalere Health, none of the five states in this survey plans to expand its Medicaid program under the health law.

The survey found even stronger support for the law’s creation of health insurance marketplaces — also called exchanges — for small businesses and individuals. Three-quarters of respondents expressed a favorable opinion of the marketplaces, ranging from 73 percent in Louisiana and Georgia to 77 percent in Mississippi. All five of these states have chosen not to build their own online insurance marketplaces, so the federal government will be running the marketplaces in these states.

Not all provisions of the law were regarded favorably, however. By a 65 percent to 31 percent margin, respondents had an unfavorable opinion of the law’s individual mandate that will require all Americans as of 2014 to either sign up for health insurance or pay a penalty.

The Joint Center’s poll surveyed 500 people in each of the five states for a total sample of 2,500 adults.  It was conducted between March 5 and April 8 and has a margin of error of +/- 2 percentage points for the full sample and +/- 4.4 percentage points for each of the state samples.

6 Responses to “Survey: Even In Southern States, Medicaid Expansion Is Popular”

  1. larry says:

    According to Republican Governor Tom Corbett, Pennsylvania will not participate in the Medicaid Expansion. Medicaid Expansion would have meant that about $4 billion federal dollars would have funded Pennsylvania’s Medicaid Expansion in 2014 alone and that the entire Medicaid Expansion program would have been 100 percent funded for three years with no less than 90 percent federal funding thereafter. Since we can’t crawl inside the governor’s brain, nobody is really sure of the reasons for this decision. What we do know is that Corbett’s decision is a huge mistake. Even GOP legislators in the state have supported the Medicaid Expansion because they know that it would mean a massive influx of jobs and it would be a major boost to the state’s economy. Moderate Republicans are not happy! We all see the need for the Medicaid Expansion to stimulate our economy. We all see that the Medicaid Expansion is a win-win situation. In my opinion, his decision to reject the Medicaid Expansion is the reason why Corbett’s favorability rating has recently dropped like a rock. According to one poll, Corbett’s favorability rating has not changed in over two months, having stayed the same at 32 percent. Pennsylvania is a swing state and the 2014 election is just around the corner. If I were to guess, I’d say that Pennsylvania’s governorship will probably swing back to a Democrat in 2014. Corbett’s Medicaid Expansion decision will be the key. Yet, I’m not sure he’s smart enough to realize it.

  2. wilson says:

    Maybe Tom Corbett is governor of the wrong state? Maybe he’d be more popular as governor of Alabama, Georgia, Louisiana, Mississippi or South Carolina? States where Mitt Romney was the big winner? Huh?

  3. WellRead29 says:

    The biggest fear fueling reluctance to expand Medicaid in our state has to do with new standards on network adequacy for Medicaid embedded in the Act.

    The fear is, expand Medicaid and draw in another 300-400,000 people and the existing Medicaid network will clearly be overwhelmed. The state will instantly fall below the new network adequacy standards (meaning queueing times for care get unacceptably long). The only way to actually resolve the network issues here (and we’ve done TONS of research on it) is to increase reimbursements to providers somewhere in the neighborhood of 10-15%.

    Now, if you could isolate the 10-15% increase to the 400k expansion population, no problem. But Medicaid doesn’t work that way. You will have to increase reimbursements to the providers taking care of the OTHER 1.3 million folks on Medicaid in the state, and at current FMAP the state would bear a minimum of 40% of these new costs.

    So, even though the Fed’s offer is generous, enough state funds to actually draw down the Federal funds does not exist today, and some of the proposals to raise the additional funds (to cover the 10% extra FMAP, new higher reimbursement levels, and administer the entire expansion) are downright scary in a state with relatively low incomes already.

    I recommend all the states, ours included, come up with 3 different proposals to raise the required additional revenue, and put all 3 to a vote of the general public. If the citizens of the state agree to the extra taxes, fees, cuts or combinations of the 3, then Medicaid expands.
    If not, then it doesn’t. The people have spoken.


  4. Healthcare Guy 2013 says:

    This is not unlike the 1960′s when Medicare/Medicaid became law. The states were also up in arms claiming that the program would bankrupt the country and end the free market system. The last state to adopt the system was Arizona in 1982. What has happened since then in the realm of public and elder health has been remarkable and encouraging. Those two programs cover more people and are more popular than any other managed healthcare program.

    Here is what is unusual about those states that do not want to expand Medicaid; 1) They are some of the poorest states in the union outside of their “metro” areas and; b) The majority of the population that would stand to benefit from the programatic expansion are in their rural areas where there are significant gaps in care today. The leaders of these states are listening to the fringe 10% that would rather see anyone that is not making $200K or more per year either leave the country or die off so te remainder would not have to help them.

    Additionally, several of these states either have Medicaid Managed Care programs (Louisiana & Georgia), were considering Medicaid Managed Care (Alabama & Mississippi) or had programs that they abandoned (South Carolina). Pennsylvania also has a Medicaid Managed Care program. The states that do have Medicaid Managed Care for more than 2 years, have saved billions of dollars since the inception of their programs WITH JUST THE TANF AND CHIP POPULATIONS (Mom’s & Babies), where only 35% of the money in Medicaid is spent. Just think how much more they would save if they included the sickest populations (ABD/SSI/Long Term Care).

    The states will come around late this year and early next year. They couldn’t be seen as capitulating to the Federal government so soon after the 2012 elections. They will also ask HHS to make their decisions retroactive to 1/1/14 and HHS will agree to keep the peace and make sure people are covered. It will happen either through; a) pure expansion of the FFS Medicaid State system, b) Expansion through Medicaid Managed Care for all populations, c) An Arkansas type waiver to expand via the Exchanges or c) A State specific waiver program (newly developed or already in place) that can be expanded, reformatted and approved by CMS to cover everyone in line with or above the federal requirements. Since HHS & CMS are showing a great level of design flexibility, there is a flavor here for everyone to choose from.

  5. Joy Payne says:

    In response to Healthcare Guy’s post, Mississippi does have a Managed Care program that has been in place for two and one half years. I am also skeptical of his statistics on the amount of money these programs have saved. While I support the managed care model, I challenge his statement that billions of dollars have been saved. I don’t think the actual numbers support that statement. I also find it interesting that he finds it “unusual” that some of the “poorest states” are not expanding Medicaid. Sir, are you aware that taxpayers bear the burden of Medicaid? In these “poorest states” the tax rates are already ridiculous, and the expansion of Medicaid also means raising taxes and diverting monies from other vital programs. I also would like to question the source of the polling that shows public support for expansion of Medicaid in these states. One would be lead to believe the poll was representative of the entire populations of these states. Research tells me that the poll was commissioned by The Joint Center for Political and Economic Studies, which is a non-profit institution that conducts research on political, economic, and social policy concerns to African Americans. The inference should not be made that only African Americans would benefit from the expansion, but the poll results were probably biased from the beginning. And admitting that I have no idea what questions were asked , how they were presented and what kinds of answers were permitted (yes/no/discussion), one cannot determine if it was no more than a push poll. In Mississippi, the disabled population was the only covered entities in managed care the first year. The second year it was opened to include moms, babes, and children. While I have no idea what the numbers are for that state, I do know that the Division of Medicaid appear to be happy with the results.

  6. T.E. Smith says:

    I am sorry to see that about 75% of people support the exchanges, where the vast majority of enrollees will have access to subsidies, while 65% oppose mandatory enrollment. To me, the main story here seems to be that people do not understand that the success of the new insurance market depends on everybody’s participation.