Utah Medicaid Expansion Polls: The False Dichotomy Problem

Capitol at night
Stars & Stripes along with the Utah state flag fly outside the Utah State Capitol building. Copyright © 2014 Jeff McGrath. All photos are Copyright protected. Use of images is prohibited without written consent of the Copyright owner.
Stars & Stripes along with the Utah state flag fly outside the Utah State Capitol building.
Copyright © 2014 Jeff McGrath. All photos are Copyright protected. Use of images is prohibited without written consent of the Copyright owner.

If there’s one thing that the pollsters who have raised their collective fingers to the wind of Utah public opinion in recent months can agree upon, it’s that Utah voters don’t know much about Medicaid expansion. 

That’s a problem, not only for making public policy, but for trusting the polls to determine what the public supports. 

After a meeting between the Governor and US Secretary of Health and Human Services (“HHS”) Sylvia Burwell, Utah Political Capital reported that Herbert had speculated that a deal on Medicaid expansion was just a couple weeks away. While such a timeline seems a bit heavy on the optimistic side–it would require that A) HHS sign off on the proposed deal, B) Governor Herbert to call a special session, and C) the Utah Legislature agrees with the Governor’s plan, all by next week–if such is possible, the debate will move away from the Governor’s office and negotiations with Washington to the State Legislature.

And if there’s one thing that legislators allegedly respond to, it is to public opinion.

Queue the polling.

Given only one choice, voters like it

In a piece titled “Utahns Don’t Know Much About Healthy Utah, But They Prefer It Over Medicaid Expansion,” Utah Policy announced poll results that seemed to indicate some favorable response to the Governors proposed Medicaid expansion. It also conceded an issue that deserves its own examination: almost no one in Utah understands that plan.

In a follow-up piece, Bob Bernick explained how their polling firm, Dan Jones, explained Healthy Utah to those polled:

Jones explained the plan like this:

“Governor Herbert’s Healthy Utah plan utilizes the private insurance market to provide health insurance for Utahns living at or near the federal poverty line. If implemented, the plan would return to Utah nearly 250 million dollars paid by Utahns to the federal government each year.

“Under the Healthy Utah plan, this money would be used to assist more than 55,000 low-income Utahns who currently lack access to affordable health insurance.

“Funds would either purchase insurance from the private insurance market or support participation in current state health insurance programs.

“Do you support or oppose Governor Herbert’s Healthy Utah plan?”

After this paltry explanation, respondents said they supported the plan.  Bernick declared “Utahns[…] Support It” in a headline.

Admittedly, Jones has only a few seconds to explain a complex law with a whole panoply of possible ramifications to the random unlucky person who answered the phone at home while America’s Got Talent was on commercial break.Of course, he waters it down to a point where almost no one would say its a bad idea.  Of course he’s not going to tell them about the other proposals out there.

“Do you want your tax money back?”

“YES! (Can I go now? America’s Got Talent is back on.)”

Maybe Utahns will support Healthy Utah. Maybe they won’t. But at this point, it seems a bit inaccurate to say that anyone can support it without more information.

If you want to examine the poll closer, Utah Policy released the toplines, which you can find here. A majority of respondents were over the age of 45 (60%), female (54%), not Republican (57%), conservative (55%), LDS (64%), and had an associates degree or more education (78%), none of which seems problematic.

Meanwhile, across town…

The conservative Sutherland Institute also did a poll on Medicaid expansion in Utah, but they added in some of the other proposals as well. (What? Utah Policy didn’t mention there were other proposals to the respondents they polled? But…but $250M back to Utah!)

Like the Utah Policy poll, Sutherland wanted to find out what respondents thought as they learned more about the plan. Their plan was to “see what Utah voters thought about Medicaid expansion when they were given more complete information about the costs, enrollment, and uncertainties of Medicaid expansion than provided in the previous polls.”

They were referring to a poll I looked at earlier this year, as well as another conducted by BYU.

None of the plans that Sutherland surveyed garnered more than fifty percent approval, which is unsurprising since there’s a low level of voter knowledge about any of them.

The False Dichotomy Problem

This is what is called the false dichotomy problem, but I like to think of it as the “In ‘n Out Burger Problem.”

In n’ Out Burger only has a couple of menu options, so you really only have to decide between a burger and a cheeseburger. Not a tough choice. It’s a lot easier for a majority of the people to support one of the options when their options are few. It’s something akin to a false dilemma choice, or a false dichotomy. There are more choices, but when given only two — no healthcare or the Healthy Utah plan — people will choose what looks more favorable.  When those options increase or are more complex, they find it more difficult to settle on one plan, which, to be frank, is okay. Having more choices is how people become educated.

This bears out with Sutherland’s poll. After having all of the choices for Medicaid expansion explained to them, an average of 30% of respondents still didn’t support or oppose any of the options.

What is notable in the Sutherland poll is that more people supported not expanding Medicare than expanding it with any one of the other options.  With the percentage who oppose expansion at 45%, legislators should pause as they consider whether to  agree to the Governor’s plan.  It may be a good plan, but is it really the best plan?

Why don’t voters know what they want?

On this question, the Sutherland poll is more helpful.

The simple answer is: while important, Medicaid expansion just isn’t sexy.  However that may be, until we get serious about both understanding and educating the public on the ramifications of Medicaid expansion, we’re likely to end up saddled with a plan that is decidedly un-sexy and, in the long-term, potentially unsuccessful, both at protecting our most vulnerable citizens and protecting future generations from unending debt.

The well meaning effort to help the vulnerable is a serious and laudable cause. But it should not be done in the absence of careful education of the public about the ramifications of public policy changes.

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