Do Utahns Really Want Medicaid Expansion?

Medicaid-Expansion-3_jpg_800x1000_q100Do Utahns want state elected officials to expand Medicaid?

Medicaid expansion is a big deal, even if it’s not half as riveting as same-sex marriage or the FIFA World Cup.  It speaks to the question of how we as a state care for our poor when they get sick.  A poll published by Brigham Young University’s Center for the Study of Elections and Democracy concluded that Utahns do want to see an expansion.

But do Utahns understand what that means?

Researchers at Brigham Young University’s Center for the Study of Elections and Democracy recently ran a poll that concluded that Utahns want to see an expansion of Medicaid.

Medicaid, described by the Health Insurance Association of America as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care[,]” is the largest source of funding for medical and health-related services for people with low-income in the country and was expanded dramatically under the Patient Protection and Affordable Care Act (“Obamacare”).  

The states are administrators of the Medicaid and have broad leeway for implementation.  To date, due to the cost increase to states required by the expansion, many states have rejected the expansion, leaving coverage levels at pre-2014 levels.

Survey Concerns: Cost, Voter Information, and Local Government

The BYU study posed four types of plans to their voter pool and asked them which they supported.

  • Obamacare: Full expansion, as contemplated by Obamacare.
  • Governor’s Plan: “Governor Herbert has proposed taking $258 million of the annually available $524 million in federal funds and seeking a waiver allowing the state to provide subsidies to help up to 111,000 low-income Utahns buy private insurance.”
  • Speaker’s Plan: “Utah House Republicans, led by Speaker Lockhart, offered a plan which rejects the $524 million of federal funds and uses $35 million in state money and supplements them with $80 million of federal dollars to extend partial health care benefits to 54,000 or fewer of low-income Utahns.”
  • Maintain the status quo.

None of the questions actually name the plans this way, but provide a very brief description of each plan. None of the questions describe the costs to the state over time.

Responding to the questions without an informed opinion–as I surmise is typical for most respondents–it’s hard to see how any other result would be reached that expansion was a good idea.  The survey does not test voter knowledge and gives no indication of what impact the Medicaid expansion will have on taxes, the state budget, or other existing programs.

If past surveys are indicative, Utahns don’t know a ton about Utah government. How much they know about Medicaid and how it will affect the state is even less clear.

Here’s a few considerations that might have changed how survey respondents might have answer:

  • What is the cost? On the low-end, estimates are that the hit to Utah for the expansion will be $60 million a year, though some have estimated the cost to Utah could be as high as $120M.  Until we get there, it’s hard to know what the actual cost will be.  As noted by a helpful comment below, “by 2022, the state will pay 10% of the cost of the expansion. Currently, the federal government pays 70% of Utah’s Medicaid budget. Using the full federal match, the expansion will be covered by the feds at 100% through 2016, and then the federal contribution drops slightly to 90% by 2022/23. The existing Medicaid population will remain at the 70/30% federal/state split.” But already most of the states that have opted in are seeing much higher costs than predicted.
  • No restrictions on where ACA taxed money taxed goes. In other words: who do you trust more: Utah state government or the federal government?
  • State versus federal balance. By opting into the Medicaid expansion, Utah gives up ability to chart its own path to serve its Utahns. Government control moves from Salt Lake and your local legislator, to Washington, D.C.

Also, this: what do young people think?

  • 43% of respondents were over the age of 55. Would the results have been different if the survey included more young people (under 55) who will have to pay into the system for the foreseeable future?


2014 March UVP Topline

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