This article first appeared in the St. Louis Beacon, Dec. 12, 2012 - More than half of Missourians favor Medicaid expansion and embrace the principles behind health insurance exchanges, according to a new poll, financed by the Missouri Foundation for Health and completed in October. It surveyed more than 1,400 Missourians and had a margin of error of plus or minus 2.6 percent.
"Missouri voters want action to ensure access to affordable health care and believe state government should take a leading role in this endeavor -- even if this requires a tax increase," according to the introduction to the poll.
Although the poll shows that the health law continues to enjoy more support among Democrats than Republicans, it also found that 52 percent of Missourians favored expanding Medicaid, and that 53 percent backed health insurance exchanges once they were told what exchanges would do. In addition, 66 percent said they wanted Missouri, rather than the federal government, to set up Missouri’s exchange.
At the same time, the poll indicated that Missourians still liked their private health insurance, continued to be concerned about health costs, and were afraid of things changing too quickly.
Both Medicaid expansion and insurance exchanges are supposed to expand health insurance for the needy and working poor under the Affordable Care Act. GOP lawmakers control the Missouri House and Senate and say Medicaid expansion isn’t going to happen on their watch.
Thomas McAuliffe, policy analyst for MFH, was asked what message the results would send to these lawmakers.
“It is important for participants to know that the Missouri Foundation for Heath is nonpartisan,” he said. “It tries to send out unbiased, quality data and information. This poll is another attempt to do that. We have sent out the polling results to the state legislature. We also know that the governor’s office is aware of some of the results.”
Under expanded Medicaid, people earning up to 133 percent of poverty -- or $30,657 yearly for a family of four -- would be insured through Medicaid in states that agree to expand their programs.
Health insurance exchanges would offer subsidies to make insurance affordable to working poor people whose incomes exceed the 133 percent of poverty threshold, but are no higher than 400 percent of poverty – or $92,200 for a family of four.
Although many state GOP lawmakers say the state can’t afford to expand Medicaid, an expanded Medicaid program would cost Missouri nothing during the first three years, from 2014 through 2016. The state’s share would rise in later years until it is capped at 10 percent of the cost of expansion. The federal government would pay the remaining 90 percent.
Missouri has until early next year to decide whether to set up its own version of an exchange. Nixon has said that's insufficient time to draft a plan. But the real roadblock is Proposition E, approved by 62 percent of those who voted, forbidding the governor from taking any action on the exchange issue without approval from voters or from the General Assembly. Whether Missouri or the federal government sets up Missouri's exchange, the system will not cost Missouri a dime. Federal dollars will cover all costs, including subsidies for those eligible to buy health insurance through an exchange.
Today’s poll was taken before some recent economic arguments were added to the debate. Gov. Jay Nixon and Sen. Claire McCaskill talked about how those benefits would boost the state’s bottom line. Nixon said expanding the program would not only provide health care to an estimated 300,000 uninsured Missourians but would create thousands of jobs and billions of dollars to the state’s economy. Similar points were made in a separate study financed by the MFH and the Missouri Hospital Association, unrelated to comments by Nixon and McCaskill.
Economic arguments for expanding health coverage seemed to make little difference to most Missourians, according to the latest poll. It shows that slightly more people are swayed by a moral argument (49 percent) for expanding Medicaid than by an economic argument (48 percent).
In other findings, the poll showed that the strength of the overall economy was at the top of concerns among Missourians, followed by food and gasoline expenses, the federal budget deficit, and health-care costs.
While expressing concerns about affordable health insurance, Missourians also seem to be easing their opposition to the health reform law. Support for the law rose from 32 percent in November 2010 to 37 percent in October 2012, according to the poll, while opposition declined to 46 percent in October from 50 percent in November 2010.
The poll results are available on the MFH website.
