Americans who live in the two biggest states that haven’t expanded Medicaid have more complaints about health care costs and quality, according to a new survey released by the Texas Medical Center Health Policy Institute in Houston. They’d also like their states to expand Medicaid.
The survey, conducted by marketing research firm Nielsen, assessed attitudes about the health care system, and possible solutions, in five populous states: Texas, California, Florida, New York and Ohio.
The 5,000 respondents also were asked about their party affiliation and insurance status — and height and weight. Those measurements were used to estimate the rates of obesity, for questions about interventions.
The Affordable Care Act allowed states to expand Medicaid to cover more poor adults, but 19 states — including Kansas and Missouri — still have not done so.
In California, New York and Ohio, politicians took advantage of federal funding in the law to expand Medicaid. The survey showed most residents in those three states approved of that decision.
The Republican leaders of Texas and Florida refused to expand Medicaid. However, the survey showed two-thirds of people in those two states wanted them to do it anyway.
“Both Texas and Florida, the residents there are hurting and are turning to the idea of Medicaid expansion,” said Dr. Tim Garson, director of the Health Policy Institute.
Garson noted that more residents in Texas and Florida complained about the quality of health care and felt it was worse than two years ago. Texas was also the state with the most people — 65 percent — saying they were paying more out-of-pocket for health care than two years ago and were cutting down on other expenses to do so.
“This isn’t necessarily a political statement, this is simply, ‘What’s the data?’ And the data are Texas and Florida, the two without Medicaid expansion, are having perceived problems with cost and quality worse than the other three,” Garson said.
The survey did not ask Texans or Floridians if they thought those problems were because political leaders had not expanded Medicaid.
But 63 percent of Texans and 68 percent of Floridians did favor expansion.
Over all five states, the cost of health care was a common complaint, with 58 percent of respondents reporting that they paid more out-of-pocket for health care than they did two years ago.
“Clearly, we as a country, we as a state — couldn’t we find ways to decrease the overall cost of health care?” Garson asked.
The ACA has helped 20 million additional Americans get insurance, but Garson says the law didn’t do much to control the prices being charged in the health care industry. Consumers feel the financial pressure in their deductibles, copays and monthly premiums.
“Of the uninsured, 87 percent said when they went to the exchange they couldn’t afford it,” Garson said, referring to the online marketplaces where people can buy individual or family insurance plans if their employers don’t provide coverage.
The survey did not ask respondents if they liked the idea of a government-funded “single-payer” system. But many did say universal coverage was important.
“One of my biggest surprises is that 85 percent of everybody asked was looking for ‘coverage for all,’” Garson said. “They are worried about their sisters and brothers. And I think that, at some point, is going to show up in the voting rolls.”
But Ross Baker, a political scientist at Rutgers University in New Jersey, is skeptical about the power of health care as a campaign issue. Baker is not connected to the survey but examined it at the request of Houston Public Media.
Although candidates will talk about Obamacare and health costs, Baker is not convinced it’s the kind of pivotal issue that will motivate voters to choose one presidential candidate over another.
“One of my biggest surprises is that 85 percent of everybody asked was looking for ‘coverage for all.’ They are worried about their sisters and brothers.”- Dr. Tim Garson, director of the Health Policy Institute
“Generally, people are mindful of the health care issues because they are very practical, day-to-day concerns,” he said. “But whether or not they would get out of bed on Tuesday morning in November, and go to the polls based on their feelings about whether or not Medicaid should be expanded in their state is, I think, subject to challenge.”
Rather, the expected contest between Clinton and Trump will probably be decided on their personality differences, Baker said.
The poll also asked about emergency room usage and interventions to combat obesity.
Forty-six percent of respondents admitted they had gone to an ER even when they knew it wasn’t an emergency. The primary reason they gave was the doctor’s office was closed, Garson said.
Respondents also answered questions about extra taxes on sugary drinks and fast food, with more than half of people in all five states saying they would favor such taxes. That held true even in the two more conservative states of Texas and Florida.
The majority of people picked a 25 percent tax as “reasonable,” while almost half (44 percent) said the tax could be as high as 50 percent on sugary drinks.
Politicians should take note that such taxes, often called “fat taxes,” might be acceptable to their constituents as an effective obesity intervention, Garson said.
It’s worked before, he noted: “When you go and look back and ask the World Health Organization about smoking, what was it that really led to the real decrease in smoking? It was the cigarette tax,” Garson said.
— This story is part of a reporting partnership among Houston Public Media, NPR and Kaiser Health News.