Governors have their work cut out for them in convincing the public to accept fundamental changes in Medicaid that could trim benefits and raise co-payments for the poor, disabled and elderly, a new nationwide poll shows.
Nearly three-fourths of those polled opposed cuts in state Medicaid programs to help balance state budgets, even though two-thirds said their state was in fiscal crisis or had major budget problems, according to the survey released June 29 by the Henry J. Kaiser Family Foundation , a nonpartisan philanthropy that focuses on health care issues.
When asked about reforms similar to those proposed by the National Governors Association to trim Medicaid's runaway costs, 54 percent opposed charging higher co-payments and deductibles for services such as doctor's visits, 65 percent opposed limiting the prescription drugs Medicaid covers, and 55 percent objected to curtailing elderly people's ability to transfer wealth and assets to qualify for taxpayer-funded health care.
Although governors strongly support changes to reduce Medicaid costs for long-term care for the elderly, 82 percent of respondents said it is essential that Medicaid cover nursing home care. Six in 10 people said states should be required to offer the same set of core benefits to receive federal funding, contrary to governors' suggestions that states be given significantly more flexibility over which services and populations to cover.
The survey, conducted between April 1 and May 1, is the first comprehensive assessment of public opinion in recent years on Medicaid, a 40-year-old program that now covers 53 million people. Kaiser polled a nationally representative sample of 1,201 persons. The poll has a margin of error of 3 percentage points in either direction; certain questions asked to a smaller sample have a margin of error of plus or minus 4 percentage points.
"This poll shows that Americans across the political spectrum value the role Medicaid plays in our heath care system," said Diane Rowland, executive vice president of the foundation. "Much of the political debate surrounding Medicaid these days focuses on controlling costs, but proposals to cut funding for the program or scale back the coverage it offers do not appear to be popular with the public."
Medicaid's $329 billion annual tab, driven up by rising health care costs and swelling participant rolls, has propelled the nation's biggest health care program into the spotlight both in state capitols and in Washington, D.C. Congress in April called for $10 billion in cuts to the program over five years, less than those proposed by President Bush.
Virginia Gov. Mark Warner (D) and Arkansas Gov. Mike Huckabee (R) on June 15 presented to Congress a package of reforms that they said had the support of all 50 of the nation's governors. Governors are hoping to turn the focus to long-term, policy-driven reforms, rather than short-term budgetary fixes.
According to the Kaiser survey, the public opposes both federal and state cuts to the program. But there is less consensus on how to fix state budgets plagued by Medicaid bills that in 2004 for the first time eclipsed total state spending on elementary and secondary education to account for the largest single portion of state budgets.
When asked to name the best way to fix their state's budget problems, 21 percent chose cuts in the Medicaid program, 21 percent selected a tax increase and 24 percent preferred cuts in other programs, such as education, prisons and transportation.
About 80 percent of respondents supported increasing or maintaining the current level of federal Medicaid funding, while only 12 percent supported reducing federal funds for the program.
The survey also indicates that 74 percent of the public considers Medicaid a "very important" government program, behind only Social Security (88 percent) and Medicare (83 percent).
Democrats were somewhat more likely to designate Medicaid "very important" -- 81 percent -- compared to 79 percent for Independents and 61 percent for Republicans. Democrats also were more likely to oppose cuts to Medicaid and support increasing federal spending on the program.
In another Medicaid development that could have political fallout for states, a June 28 report from the Government Accountability Office, the investigative arm of Congress, found that 34 states in 2004 paid consultants to help them glean more federal Medicaid money, in some cases exploiting federal Medicaid rules.