Support for Medicaid expansion strong among low-income adults

Low-income adults overwhelmingly support Medicaid expansion and think the government-sponsored program offers health care coverage that is comparable to or even better in quality than private health insurance coverage, according to a new study from Harvard School of Public Health (HSPH) researchers.

The study appears online October 8, 2014 in Health Affairs.

"In the debate over whether or not states should participate in Medicaid expansion, we rarely hear the perspectives of those people most directly impacted by policies surrounding Medicaid," said study co-author Benjamin Sommers, assistant professor of health policy and economics at HSPH. "Our survey shows that expanding Medicaid under the Affordable Care Act is quite popular among lower-income Americans and that they generally consider Medicaid to be good coverage."

Under the ACA, states can choose whether or not to expand Medicaid to adults with incomes below 138% of the federal poverty level. So far, 27 states and Washington, D.C. are expanding, while 23 states are not—and the issue is controversial in many of the latter states.

Three states surveyed

Researchers conducted a telephone survey in late 2013 of nearly 3,000 low-income adults in three Southern states—Arkansas, Kentucky, and Texas—that have adopted different approaches to options for Medicaid expansion. Kentucky chose a traditional Medicaid expansion; Arkansas is expanding by using Medicaid dollars to purchase private health insurance for its low-income residents; and Texas is not expanding.

In all three states, nearly 80% of those surveyed said they favored Medicaid expansion, and approximately two-thirds of uninsured adults said they planned to apply for either Medicaid or subsidized private coverage in 2014. Roughly three-quarters of those surveyed described Medicaid as equal to or even better than private insurance in terms of the quality of health care. Favorable views toward Medicaid were most common among racial and ethnic minorities, people with less education and lower income, and those in worse health. However, the respondents' awareness of their state's actual expansion plans was low.

The results also showed that respondents have significant medical needs, with high rates of chronic diseases and many financial barriers to care, meaning that Medicaid expansion has all the more potential to benefit them.

The authors said it's significant that the study found a high level of support for Medicaid expansion in three Southern states that are more conservative, on average, than the rest of the country. "If anything, support for Medicaid expansion is likely to be even higher in many other states," said Sommers.