Kaiser survey: Most Americans oppose the idea of converting Medicaid to block grant financing to reduce the federal deficit

From Kaiser Family Foundation:

MENLO PARK, Calif. -- Most Americans oppose the idea of converting Medicaid to block grant financing to reduce the federal deficit, and more than half want to see no reductions at all in Medicaid spending, according to the latest monthly tracking poll by the Kaiser Family Foundation.

The May Kaiser Health Tracking Poll finds that 60 percent of people say they would prefer to keep Medicaid as it is, with the federal government guaranteeing coverage and setting minimum standards for benefits and eligibility. Thirty-five percent would rather change the program so that the federal government gives states a fixed amount of money and each state decides who to cover and what services to pay for. Only 13 percent of Americans say they would support major reductions in Medicaid spending as part of Congress’ efforts to reduce the deficit, while 3 in 10 would support minor reductions and 53 percent want to see no reductions in Medicaid spending at all.

The findings come at a time of intense public debate in Washington about the future of entitlement programs such as Medicare and Medicaid as policymakers attempt to address rising public concerns about the federal deficit. While conventional wisdom and recent public opinion polling has suggested that dramatic changes in Medicare would be politically unpopular, the new poll findings illustrate that major alterations to Medicaid also could strike a negative chord with many Americans.

Support for maintaining the current program may be due at least in part to the public’s personal connections to Medicaid and a strong sense of the program’s importance. About half of Americans say they or a friend or family member has received Medicaid assistance at some point, and a similar share say the program is important to their family. Among the 20 percent of adults who personally have been covered by Medicaid, reported experiences are positive.

"If you watch the debate about the deficit and entitlements, you would think that almost everyone has a problem with the Medicaid program and wants to change it, or cut it -- or both," said Kaiser President and CEO Drew Altman. "The big surprise in this month’s tracking poll is that one group who does not want to cut Medicaid is the American people."

"With about 69 million people expected to be covered by Medicaid this year, it is no longer the -welfare-linked program it once was," Altman added. "Medicaid may not be the lower-hanging fruit that many who want to reduce federal entitlement spending have assumed it is."

Experiences With Medicaid

About half of Americans (51%) report some personal connection to Medicaid, including having received health coverage, long-term care, or Medicare premium assistance from Medicaid themselves (20%), or having a friend or family member who has gotten this type of assistance (31%). In line with this, the poll finds that 49 percent of the public says Medicaid is "very" or "somewhat" important for them and their family.

Those who see the program as important cite a variety of reasons, including knowing that a safety net exists to protect low-income people (71% say this is a major reason) and feeling they or a family member may need to rely on Medicaid in the future (63%). Many who view the program as important also cite the fact that they or someone they know has received health coverage (58%) or long-term care services (43%) from Medicaid.

"Medicaid is a complex program that varies considerably from state to state, but the public’s initial reaction upon hearing about proposed spending reductions and structural changes is negative," said Mollyann Brodie, a senior vice president and director of the Public Opinion and Survey Research group at the Foundation. "Such concerns reflect the fact that the program is important not only to those who have been directly enrolled in it but those with friends and family who have received Medicaid benefits as well."

Among the one in five adults who have personally ever received Medicaid benefits, the vast majority (86%) say that their overall experiences with the program have been positive, including nearly half (45%) who say they were "very" positive. This is very similar to ratings of their current health plan among those covered by private health insurance (89% positive, including 44% "very" positive). As Medicaid is poised to expand under the Patient Protection and Affordable Care Act, eight in ten adults (81%) say that if they were uninsured, needed health care, and qualified for Medicaid, they would enroll in the program.

Despite overall positive ratings, some people do report having experienced problems with Medicaid. Roughly a third (32%) of adults who have ever been on Medicaid say they have had problems at some point finding a doctor or other health care provider willing to accept Medicaid patients. By comparison, 13 percent of those currently covered by private insurance say they’ve had problems finding a doctor who accepts their current plan. About a quarter (26%) of those who have ever been covered by Medicaid say they have experienced problems getting Medicaid to cover or pay for health care services, similar to the share of those with private insurance who say they have had this problem with their current health plan (22%). Although enrollment procedures have changed substantially in the past decade, one in five (21%) of those who have ever been on Medicaid say they have had problems when trying to enroll in the program.

Argument Testing, Partisan Differences

As with other policies tested in Kaiser tracking polls, public opinion about switching Medicaid to block grant financing is somewhat malleable when common arguments for and against it are presented. For example, when the 60 percent who initially oppose the idea are told that supporters say it will "help reduce the federal budget deficit and give states greater flexibility to tailor their Medicaid programs to match their residents’ needs and their own state budgets," 14 percent of them changed their position, so that support for changing Medicaid climbs from 35 percent to 44 percent. That results in more mixed opinion overall: 44 percent support the block grant proposal and 49 percent prefer to keep Medicaid as it is.

On the other hand, when the 35 percent who initially supported the block grant proposal are told that opponents say it will "increase the number of uninsured, increase financial pressure on states and health care providers, and cause more low-income people to go without health care and long-term care services, particularly during tough economic times," 26 percent of them changed their position, resulting in a rise in the share who want to keep Medicaid as is from 60 percent to 69 percent. In this scenario, the share supporting a block grant falls to 25 percent.

The poll findings reveal familiar partisan differences in the public’s reactions to questions about Medicaid funding and block grants. While seven in ten Democrats (69%) and more than half of independents (54 %) want no reductions in Medicaid spending to reduce the deficit, a plurality of Republicans (44%) say they would support minor reductions, and two in ten want major reductions. On the block grant question, eight in ten Democrats (79%) prefer to keep Medicaid as is, while a majority (57%) of Republicans favors the proposed change. Independents mirror the public overall, with six in ten preferring the current Medicaid system and 36 percent wanting to change it to a block grant.

Opinion of Health Reform Unchanged

This month’s survey reveals little change in public opinion about the health reform law. Americans remain divided overall, with 42 percent having a favorable opinion of the law and 44 percent viewing it unfavorably. Three in ten continue to want to see the law expanded, while roughly one in five want it either kept as is (21%), repealed and replaced with a GOP alternative (19%), or repealed outright (19%).

The public by almost a two-to-one margin continues to disapprove of cutting off funding for the law’s implementation. And Americans remain divided on whether they themselves, the country as a whole, and seniors as a group will be better off or worse off under health reform. About 14 percent of Americans feel that they have personally benefited from the law, while 18 percent believe they have been personally harmed by it.

Methodology

This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., including Liz Hamel, Sarah Cho, and Theresa Boston. The survey was conducted May 12 through May 17, 2011, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 197 who had no landline telephone) were carried out in English and Spanish by Princeton Survey Research Associates. The margin of sampling error is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error may be higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. This May tracking poll is focused on Medicaid and the full question wording, results, charts and a brief on the poll can be viewed online at http://www.kff.org/kaiserpolls/8190.cfm. The April poll focused on Medicare and is available at http://www.kff.org/kaiserpolls/8180.cfm.