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Do Americans Support Work Requirements? Depends on How You Ask.

A new poll shows strong opposition to the new Medicaid policy being pushed by the Trump administration. But it contradicts other recent surveys.

Health Overhaul Iowa Republican
Citizens fearful of losing their health care react during a town hall meeting last year in Iowa.
(AP/Charlie Neibergall)
The Trump administration has opened the door for states to add work requirements to Medicaid, the government-run insurance program for low-income people.

Supporters believe public assistance should encourage employment, while critics believe health care is a key to people getting and keeping jobs. 

President Donald Trump, House Speaker Paul Ryan and some Republican governors want Medicaid work requirements, but what does the American public think? It depends on how you ask.

This week, a poll from the liberal Center for American Progress (CAP) found that 61 percent of registered voters oppose work requirements for non-elderly adults on Medicaid. Several other polls, though, have found just the opposite, as illustrated in the table below. 

Source Dates % Support  % Oppose  Sample 
Center for American Progress  Jan. 24-29, 2018  39  61  2,350 Registered Voters
POLITICO/Morning Consult  Aug. 10-14, 2017  51 37   1,997 Registered Voters
POLITICO/Harvard T.H. Chan School of Public Health  Aug. 30- Sept. 3, 2017  72 24   1,016 Adults
Kaiser Family Foundation  June 14-19, 2017  70 28   1,208 Adults
Although all four polls ask about requiring Medicaid recipients to work, they use different wording to describe the context and the purpose of the proposal.

In a preface to its work requirement question, CAP said the policy was part of "Republican efforts to restrict eligibility and reduce overall spending on government assistance programs for low-income people." By contrast, the Kaiser Family Foundation listed the work requirement as one of many "specific changes to Medicaid currently being considered by Congress and the Administration."

“It makes sense that we got rather different results,” says Ashley Kirzinger, a senior survey analyst for the Kaiser Family Foundation. “We do know that framing of these issues matter.”

In the actual question, the CAP poll asked voters if they support "allow[ing] states to deny Medicaid health coverage to recipients ages 18 to 64 who do not have a job with a certain amount of hours and do not participate in state-approved work programs." That question emphasized the possible negative consequence of failing the requirement (losing health care), whereas other recent polls described work as a condition of keeping health care.

CAP also found that when it asked about denying coverage to those who "cannot find a job" (instead of "do not have a job"), opposition rose from 57 percent to 61 percent. 

The choice was intentional, says Rebecca Vallas, vice president of the center's Poverty to Prosperity Program. 

“Prior polls have generally used language like ‘work requirements,’ mirroring what Republicans use when they’re trying to dress up what are 'cuts' to popular programs,” she says. “That’s what generates some level of support. That [support] then evaporates when people understand the consequences.”

The poll also found that most voters oppose cuts to a variety of programs and services for low-income households, including Medicaid, food stamps, home energy assistance and affordable housing. And they’re less likely to vote for candidates who support cuts to those programs.

What pollsters call Medicaid can also affect public support. 

The Kaiser Family Foundation found that Americans disagree about whether Medicaid is a welfare program: Most Democrats and independents said Medicaid was primarily a government health insurance program, but nearly half (46 percent) of Republicans thought of it as a welfare program. And while only 12 percent supported spending cuts to Medicaid, more than twice that many (32 percent) favored cuts to welfare programs.

It's not clear yet how far the Trump administration's push for work requirements will go.

Some programs, such as food stamps and family cash welfare, already have work requirements. Since January, the Centers for Medicare and Medicaid Services has approved waiver requests from both Kentucky and Indiana to try work requirements with Medicaid. The U.S. Department of Housing and Urban Development has reportedly drafted legislation that would add work requirements to Section 8 rental vouchers as well.

In the meantime, health groups have sued the Trump administration in an attempt to stop Kentucky from implementing the new policy.

J.B. Wogan is a Governing staff writer.
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