Even after the Supreme Court ruled that the Medicaid expansion in the Affordable Care Act must be truly optional for the states, the Medicaid expansion provision in general remains very popular. According to the Kaiser Family Foundation tracking poll 67 percent of Americans hold a favorable opinion of the provision in the Affordable Care Act provision. Opinion are surprisingly different though when people are asked if their individual state should take part in the Medicaid expansion. From the KFF:
As you may know, the health care law expands Medicaid to provide health insurance to more low‐income uninsured adults, including adults with no children whose incomes are below about $16,000 a year. The federal government will initially pay the entire cost of this expansion, and after several years, states will pay 10 percent and the federal government will pay 90 percent. The Supreme Court ruled that states may choose whether or not to participate in this expansion. What do you think your state should do? (READ AND ROTATE)
43% Keep Medicaid as it is today, with no new funding from the federal government and no change in who will be covered by the program (or)
49% Expand Medicaid to cover more low‐income uninsured people, with the federal government initially paying the entire cost of the expansion and your state eventually paying 10 percent
2% Other/Neither (VOL.)
6% (DO NOT READ) Don’t know/Refused
While the general idea of expanding Medicaid is popular, only a narrow plurality support expanding Medicaid in their state, which after the Supreme Court ruling is the question that really matters. The issue of states expanding their Medicaid is highly partisan, with 75 percent of Democrats supporting their states expanding Medicaid, 66 percent of Republicans opposing it, and Independents evenly divided.
Since this is a national poll it is very likely that in some of the more conservative states a plurality of voters are opposed to their state expanding Medicaid. In fact a recent Talk Business poll indeed found a plurality of voters in Arkansas oppose the state adopting the expansion.
If Democrats are simply counting on broad popular support for Medicaid expansion to convince some Republican governors to reverse course and accept the expansion, they are badly miscalculating the situation. The Republican governors who are taking a stance against Obamacare by refusing to expand Medicaid are unlikely to face a political backlash when that their position is not unpopular in their own states.
Since Americans in general strongly support providing poor uninsured adults with basic public health insurance, but they’re much less interested in even partly burdening their state budgets with the cost, it would seem the obvious solution is to make the Medicaid expansion solely a federal program. For basic Keynesian economic reasons the Medicaid expansion should have always been a completely federal program, and now that some states are threatening to exercise their option to not take part, it is the only way to assure all low income Americans get help.