Kaiser Family Foundation Releases National Survey of the Public’s Views about Medicaid

WASHINGTON, June 29 -- The Kaiser Family Foundation releases a National Survey of the Public’s Views about Medicaid:

-- Despite Concerns about State Budgets and Policymakers’ Frustrations with Costs of Medicaid, Americans View Program Positively, Are Reluctant to See State and Federal Cuts --

Perhaps surprisingly given years of debate about Medicaid, frequent references to the program as the “Pac Man” of state budgets, and periodic calls for reform, public attitudes toward Medicaid are remarkably positive, and opposition to cuts is reasonably strong, according to a new public opinion survey released today by the Kaiser Family Foundation http://www.kff.org/medicaid/pomr062905pkg.cfm .

While two-thirds of the public think their state has major budget problems, a substantial majority are reluctant to cut Medicaid to balance state budgets, and a majority think the federal government should maintain (44 percent) or increase (36 percent) federal spending on Medicaid; only 12 percent of the public prefer seeing federal funding of Medicaid cut.

Attitudes Towards Medicaid

Nearly three-quarters (74 percent) of adults say Medicaid is a “very important” government program, ranking it close to Social Security (88 percent) and Medicare (83 percent) in the public’s mind, equal to federal aid to public schools (74 percent), and above defense and military spending (57 percent). About 8 in 10 Democrats (82 percent) and Independents (79 percent) view Medicaid as an important government program, while fewer, but still 6 in 10 Republicans (61 percent) express that view.

A majority of Americans (56 percent) report having some interaction with Medicaid, either having been enrolled themselves at some point (16 percent) or knowing a friend or family member who has received health coverage or long-term care assistance through the program (40 percent). Additionally, if they needed health care and were eligible, nearly 8 in 10 Americans (78 percent) say they would be willing to enroll in Medicaid. This view is consistent across different party identifications.

“We expected Medicaid to be relatively unpopular with the public, much like welfare was. But we found that Medicaid ranks closer to popular programs like Medicare and Social Security in the public’s mind. The fact that so many Americans have had some kind of contact with Medicaid themselves or through family and friends is one factor that could help explain this result,” said Mollyann Brodie, Ph.D., Vice President and Director of Public Opinion and Media Research for the Foundation.

Budgets and Medicaid

Almost two-thirds of the public think that their state’s budget is either in crisis or has major problems, and about a third believe that Medicaid costs are a major reason for those budget problems. However, half (52 percent) say they “strongly” oppose and another 22 percent “somewhat” oppose cutting back on their state’s Medicaid program to balance the budget. Just 2 in 10 either “strongly” (5 percent) or “somewhat” (17 percent) support Medicaid cuts to help balance state budgets. Majorities of Democrats (65 percent strongly, 16 percent somewhat), independents (52 percent strongly, 23 percent somewhat), and Republicans (36 percent strongly, 29 percent somewhat) say they would oppose such cuts.

“This poll shows that Americans across the political spectrum value the role Medicaid plays in our health care system,” said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the Kaiser Commission on Medicaid and the Uninsured. “As with the rest of the health care system, much of the political debate surrounding Medicaid these days focuses on controlling costs, but proposals to cut funding for the program or scale back the coverage it offers do not appear to be popular with the public.”

While the public seems reluctant to see state Medicaid funding cut, they are divided on the best way to grapple with their state’s budget problems. Nearly a quarter (24 percent) say their state should cut funding for programs other than Medicaid (like education, prison systems, and transportation); 21 percent say that their state should raise taxes and the same number say that the state should cut Medicaid funding to address the budget problems. Twenty-three percent of the public volunteered that the budget problems should be addressed in some other way.

Half (50 percent) of the public feels the federal government should put more money into the Medicaid program to help states with budget problems, but 43 percent think the federal government cannot afford to do this right now given its own budget problems.

When asked more generally about approaches to federal spending on Medicaid, 44 percent would retain current levels, 36 percent prefer to see an increase in spending, and 12 percent say that federal Medicaid spending should be cut. Democrats (49 percent) are more likely than Independents (35 percent) or Republicans (22 percent) to support an increase in spending, while Republicans (54 percent) and Independents (50 percent) are more likely than Democrats (36 percent) to prefer that spending be maintained at its current level. About 1 in 5 Republicans (19 percent), and 1 in 10 Democrats (9 percent) and Independents (9 percent) would cut federal spending on Medicaid.

Perceptions About A Medicaid “Crisis”

About 6 in 10 believe that the Medicaid program is either in financial crisis (22 percent) or has major problems but is not in a financial crisis (39 percent), while three in ten say it has minor problems (27 percent) or no problems (3 percent). The public believes rising prescription drug costs (83 percent), growing long-term care and nursing home expenses (73 percent), and higher payments to doctors and hospitals (70 percent) are major reasons why Medicaid spending has recently increased. Many also believe that fraud and abuse in the program (67 percent), greater enrollment (61 percent) and poor management (61 percent) are major reasons for Medicaid spending growth.

Despite concerns about Medicaid’s financial problems, none of the proposals to address the program’s problems that the public was asked about garnered support from a majority of the public. For example, about 4 in 10 say they favor reducing the number of people qualifying for the program (44 percent), lowering payments by Medicaid for prescription drugs (42 percent), lowering payments to doctors and hospitals (41 percent), increasing co- payments and deductibles that enrollees pay (41 percent), and eliminating the ability of middle class elderly to transfer their assets to children in order to qualify for Medicaid (37 percent).

One Medicaid restructuring proposal being discussed by policymakers is increased state flexibility in determining which benefits are offered in a particular state. Nearly 6 in 10 people (58 percent) believe that all states should be required to offer the same set of core health care benefits to receive federal funding, while nearly 4 in 10 (39 percent) say states should be able to decide their own benefits. More than 8 in 10 people think that the following benefits (some of which are optional under current law) are essential in Medicaid coverage: hospital stays (87 percent), prescription drugs (87 percent), medical equipment like wheelchairs and artificial limbs (85 percent), mental health services (83 percent ), emergency room visits (82 percent), nursing home care (82 percent), physical therapy (81 percent), and doctor visits (81 percent). Less than half of the American public views coverage for chiropractor visits (43 percent) and travel to and from doctor visits (38 percent) as essential. Public Knowledge About Medicaid

While most Americans point to the importance of Medicaid, and many have a basic understanding of this complex program, about half tend to be less familiar with the program’s specific details. More than half (53 percent) do not know that Medicaid is the insurance program for many low-income families regardless of their age, and more than 6 in 10 (62 percent) do not understand its role for low-income people who need nursing home care or home health care. Nearly half the public (47 percent) does not know that Medicaid is funded by both the federal and state government and more than half (55 percent) don’t realize that it covers more people than Medicare. While low-income children and their parents account for three-quarters of Medicaid’s total enrollees, 54 percent of the public does not know that low-income families make up most of Medicaid’s enrollees. Further, although 70 percent of program spending is for the elderly and individuals with disabilities, 46 percent do not recognize that most of program spending is for those groups.

A chartpack, toplines, and related material are available at http://www.kff.org/medicaid/pomr062905pkg.cfm

METHODOLOGY

The Kaiser Family Foundation National Survey of the Public’s Views about Medicaid was designed and analyzed by researchers at the Kaiser Family Foundation. Fieldwork was conducted by telephone by Princeton Survey Research Associates between April 1 and May 1, 2005, among a nationally representative random sample of 1,201 respondents 18 years of age and older. Results have been weighted to be representative of the U.S. population by sex, age, education, race, Hispanic origin and region.

The margin of sampling error for the survey is plus or minus 3 percentage points for total respondents. For results based on subsets of respondents the margin of error is higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.

Near the beginning of the survey, but after basic knowledge questions were asked, all respondents were read the following common definition of Medicaid: “Medicaid is a government program for low-income people whose costs are shared by both the federal government and state government. It provides health insurance and long term care assistance to eligible children and their parents, elderly, and people with disabilities.” For complete question wording, please see the survey topline document.

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The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The foundation is not associated with Kaiser Permanente or Kaiser Industries.

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Kaiser Family Foundation

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