Americans want their governors and state lawmakers focused on creating health insurance marketplaces in the current legislative sessions, according to a poll released Thursday by the Kaiser Family Foundation, while a solid majority of the public also wants their state to expand Medicaid under the Affordable Care Act (ACA).
More than half of those polled (55 percent) said creating the marketplaces, formerly known as ‘exchanges’, should be “a top priority” for their state governments. Another 31 percent said it should be an important, if not top, priority. Only 5 percent said it shouldn’t be a priority at all.
While the polling would suggest that residents want their states to have an active hand in the marketplaces, which are expected to sell health coverage to up to 20 million people, it might be too late -- at least for 2014, the first year the exchanges will be open. States already had to apply to run a state-based exchange in December and must decide by Feb. 15 if they want to partner with the feds to oversee the marketplaces. Otherwise, the U.S. Department of Health and Human Services (HHS) will run the show. However, the Obama administration has also left open the possibility that states could assume more responsibility for exchange operations in later years.
The other big health reform question before state lawmakers is whether or not to expand Medicaid -- and, according to the Kaiser poll, the public wants them to do it. Again, more than half (52 percent) of those polled said their state should expand Medicaid. The numbers split predictably along party lines, with most Democrats supporting, Republicans opposing and independents split down the middle.
A few tweaks in how the question was worded yielded some interesting results. When told that foregoing the expansion would mean low-income people would remain uninsured and their state would be giving up federal dollars, an additional 12 percent said they’d support expansion. When told that the Medicaid expansion would result in higher revenue for health-care providers, an additional 11 percent switched to supporting expansion. The latter could become a talking point for industry lobbyists, which have already been forceful advocates for expansion in statehouses.
On the flip side, when told that expansion could result in their state spending more money in the future after the 100 percent federal match phases down, 14 percent went from supporting to opposing the expansion.
Overall, the Medicaid expansion wasn’t as big of an issue for those polled compared to the health exchanges, though they still suggested it should be strongly on state legislators’ minds. Thirty percent said the expansion should be “a top priority” for states, while 35 percent said it should be an “important, but a lower priority” and 21 percent said it shouldn’t be a priority at all.
As Governing reported in its December issue, the final decisions about the expansion will be made during the legislative sessions that began this month.