Released on June 17th, a poll shows massive public support for Governor Gary Herbert’s Health Utah Medicaid expansion plan. In fact, if the poll numbers are to be trusted, legislators with any kind of political self-interest should be scrambling to accept the Medicaid expansion.
On a second look, though, the poll isn’t so helpful as it looks and may actually have methodology problems. Utah policy makers should be wary before accepting the results of the poll. Utahns have a lot still to learn about Medicaid expansion before a decision is made to accept federal dollars.
The Three Expansion Options
When the Utah Legislature declined to accept Obamacare’s Medicaid expansion during the 2014 legislative session, the stage was set for a slow burn showdown on the issue.
While there are those calling for full Medicaid expansion (let’s call them the Democrats), the debate has been primarily between Governor Gary Herbert’s plan, which has been described as a waiver request, and a more amorphous and under-defined plan coming out of the legislature that would use Utah funds, rather than federal dollars, to expand healthcare for the poor (this plan, proposed from the House during the 2014 Legislative Session, would have used Utah dollars instead of federal money, and was rejected by the Governor and the Senate).
According to the Salt Lake Tribune, the Herbert plan will “use $258 million in federal expansion dollars to buy private coverage for the full expansion group — 111,000 Utahns with incomes below 138 percent of the federal poverty level, such as a single person earning less than $15,500.”
On the other hand, many state lawmakers have expressed concern about the open-ended cost of accepting federal matching funds–without any clear idea about the ultimate cost to the state–have put the expansion on hold, along with twenty-four other states.
Additionally, up to 400,000 Utahns could end up losing their private insurance, warned former legislator Dan Liljenquist, as employers push them onto the cheaper government option.
And what do Utahns want?
Problems with the Poll
1. Unorthodox Collection Method
While not necessarily sufficiently problematic to dismiss the poll, the method of data collection is a bit unusual. The poll (you can find the full report below) uses a combination of phone polling and online polling. It’s more common to do all telephone calls and to include cell phone interviews.
2. Leading/Framing Questions
This is the most damning problem with the survey: the order of questions biases the responses given to the core questions of the survey.
Rather than coming later, questions Q10 through Q19 of the survey should probably be asked earlier, opening up the survey. Instead, Q1 through Q9 contain background information that frame the rest of the survey, especially as respondents react to core questions about the Governor’s plan. The questions get the respondents thinking about healthcare coverage for children, low-income, uninsured friends, their own family situation, and so on, and all that context gets wrapped up into the questions about policy.
What if the survey began with questions about Obamacare? With the negative connotations the Obamacare has for voters, it likely would have decreased respondents support for Medicaid expansion. The same if the survey began with questions about government spending or the federal debt.
Question order matters. How big would the difference be if the questions were ordered differently? It’s hard to tell, but burying the lede in the later questions seems likely to influence how respondents answer. Asking them later in the survey–after the core questions–would provide context for analysis, but coming earlier probably distorts opinion.
3. No Opposition Noted
In contrast to the CSED poll I looked at last week, at no point does this poll make a mention that there is opposition to the plan. Questions Q8.1-Q8.3 might have provided more balance by noting, perhaps with something along the lines like “Federal subsidies always come with a loss of control” or “It’s unclear what the cost will be to Utah once the expansion takes full effect” and so on.
4. Using Governor Herbert’s High Favorability
I like Governor Herbert, and so does most of Utah. Healthy Utah takes full advantage of the fact. By tying the survey questions to the Governor’s personal brand, there’s probably another bump going on. Just like we all bought Nike Air’s because Michael Jordan laced a pair up every game, respondents–73% of which likely support Governor Herbert–are going to support what he endorses.
Other surveys will often throw in experiments that give random respondents different versions of the same question to see if there are variations in how they respond. Some survey respondents will get basic policy details, another a question with some branding (“Healthy Utah plan”), and another with branding and a popular politician’s name (“Governor Herbert’s Healthy Utah plan”). Without a doubt, connecting a policy to the Governor–the most popular governor in the country–is going to have a positive effect.
For a contrasting example, the Center for Study of Democracy and Elections at BYU did a similar survey, mixing the types of questions up to vary how the respondents heard the question. While I still take some issue with the poll–primarily in that it’s a very wonky topic and how many voters really understand it enough to register an opinion?–the methodology is more robust. They only found 43% support the Governors poll, a substantially smaller number than the support found under the Healthy Utah poll.
Yes, Healthy Utah is getting some play in the press right now–but with the Governor’s ratings among the highest in the nation, it’s hard not to see an effect on the responses to the survey. But is support for a Medicaid expansion this high? Probably not.
Support for Governor Herbert is high, though, and that’s probably more descriptive of what we’re seeing here than an enormous outpouring of support for Medicaid expansion.
- The Healthy Utah’s Poll Isn’t So Healthy (publiusonline.com)
- Survey shows strong support for governor’s Healthy Utah Plan (good4utah.com)
- Do Utahns Really Want Medicaid Expansion? (utahpoliticohub.com)
- Utah Voters Support Medicaid Expansion (utahdatapoints.com)