GOP Governors Who Block Medicaid Expansion May Be at Odds With Their Own Party, Poll Shows

The employer and individual mandates, not Medicaid expansion and state-run exchanges, are what raised the ire of Republicans who gave opinions on the ACA in the most recent Kaiser poll.

A number of red state governors, including some from the poorest states, have trumpeted their opposition to the Affordable Care Act (ACA) by refusing to set up state-run exchanges where consumers can by coverage, or allowing Medicaid expansion for the working poor, who earn up to 138% of the federal poverty level.

It turns out, according to the latest Kaiser Health Tracking Poll on public sentiment on the ACA, that most Republicans like these aspects of law. It’s the part where the government forces people and businesses to buy insurance or pay a fine—the individual and employer mandates—that most rile Republicans, in part because most Americans don’t understand how these requirements help hold down the cost of care overall.

The latest Kaiser poll, taken December 2-9, 2014, and released today, is the most recent test of the public pulse on ACA and once again found attitudes on the law divided along partisan lines, with 74% of Democrats wanting the law expanded or left alone and 78% of Republicans wanting it scaled back or scrapped entirely.

But as it always does, the Kaiser poll sought to get at which aspects of the law truly divides the public, and it is requirements that Americans must have coverage and that employers must provide it—not the opportunities for those less well off to gain access to care—that most upset the law’s opponents.

Pollsters gauged support for various aspects of the law, and responses among Republicans were as follows: for creating exchanges/marketplaces, 66%; for subsidy assistance to individuals, 55%; for Medicaid expansion, 52%; for the employer mandate, 34%; and for the individual mandate, 17%.

Among Democrats, support for the elements was stronger across the board: for creating exchanges/marketplaces, 91%; for subsidies, 90%; for Medicaid expansion, 90%; for the employer mandate, 78%; for the individual mandate, 53%.

Among independents, support for the elements fell in between: for creating exchanges/marketplaces, 79%; for subsidies, 78%; for Medicaid expansion, 78%; for the employer mandate, 61%; for the individual mandate, 31%. Overall support for the individual elements roughly tracked that of independent voters.

Advocates for the ACA have watched with frustration as a number of governors, particularly in the South, have refused to expand Medicaid, leaving federal funds on the table and thousands of poor consumers with no way to access the law’s benefits, as they make too much money to qualify for standard Medicaid in their states, yet not enough to get onto the plans available on the exchanges, where subsidies would be available. An earlier Kaiser Family Foundation report estimated that 4 million people fell into this coverage gap, with 86% of them in the South. As noted earlier this year in Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care, 7 of the top 10 states with incidence of diabetes have not expanded Medicaid under the ACA.

The stakes became higher this fall when the Supreme Court agreed to take up a challenge to involving a drafting error in the ACA that opponents of the law say makes consumers in the 36 states using the federal exchange ineligible for subsidies. If the court wiped out the subsidies, it would be akin to wiping out the law, unless those governors moved in the interim to set up exchanges.

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Kaiser Health Policy Tracking Poll, December 2014

The Coverage Gap: Uninsured Poor Adults in States that do not expand Medicaid: an update

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Medicaid Expansion Choices Mean Different Care for Poor Diabetics Depending on Where They Live