Nearly 50 years after President Johnson signed the law that created them, Medicare and Medicaid have become part of the fabric of the US healthcare system. A Kaiser Family Foundation poll finds little support for proposals to alter the basic structure of the programs.
On the eve of their 50th anniversary, Medicare and Medicaid enjoy broad support among the American public, although support for Medicare, which virtually everyone will use if they live long enough, is stronger than the program designed to help the poor, according to a new poll.
The Kaiser Family Foundation poll, conducted ahead July 30, 2015, gauged support for the healthcare programs that formed the foundation of President Lyndon Johnson’s Great Society initiative. Among other purposes, Johnson sought close the gap between the “haves” and the “have nots,” starting with the ability to obtain healthcare.
Medicaid, paid for jointly by federal funds and the states, enjoys less support nationally and within some locales, as the Kaiser poll found that support weakens among Republicans.
Strong majorities believe Medicare is very important (77%) and say that the program should remain as it is, a defined benefit program (70%). This support was consistent, with 2-to-1 margins of Democrats, Republicans, and independents, although adults under age 65 are somewhat more open to the idea of changing the design of Medicare than those older than 65.
Support for Medicaid was not quite as strong, with 63% saying it was very important. Unlike Medicare, which enjoyed broad support among all political affiliations, support for Medicaid differed by party. Among Democrats, 78% found it “very important,” as did 62% of independents. However, only 47% of Republicans found it “very important,” and 14% deemed it “not very important” or “not at all important.”
Despite this divide, 85% of respondents say they would enroll in Medicaid if they needed it, and 88% would enroll a child if circumstances called for it.
Medicare and Medicaid were the most significant efforts to expand healthcare before the Affordable Healthcare Act passed in 2010, and their creation established an infrastructure that drives healthcare policy and spending for all Americans. Because the programs are so large, commercial payers often follow the lead of CMS, the agency that runs both.
Medicare, which is funded entirely by the federal government and provides basic healthcare for those age 65 and older, has become so entrenched that efforts to rein it in invariably hit roadblocks in Congress. In the poll, only 26% agreed that the program should be altered to give beneficiaries a fixed amount toward their healthcare costs; this would changing the program from a “defined benefit” to a “defined contribution” or “premium support” program. Some have proposed this concept as a way to hold down Medicare’s rising costs as baby boomers age.
A small majority agreed with raising premiums for wealthy Medicare beneficiaries (58%), which is happening and will expand as part of reforms passed this spring to eliminate the sustainable growth rate and bring value-based payment reforms to physician reimbursement. There is less support for raising the eligibility age to 67 (only 39% support), or raising premiums (only 31% support), and even less for increased cost-sharing (just 24% support).
While some think tanks and governors have suggested giving states block grants for Medicaid, the public opposes this concept, by a margin of 62% to 32%.
So how does the public propose reining in costs? Consistent with a prior Kaiser poll, the public wants the government to negotiate bigger discounts with drug companies (87%). This solution enjoys support across all age groups and party lines.