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Survey Finds Public Support for State Insurance Exchanges Despite Continuing Party Divisions Over ACA

Public wants action on federal deficit but resists most cuts, especially to Medicare (Jan. 24)

Most Americans put the creation of state-based health insurance exchanges at the top of the priority list for health policy in their state this year, according to a survey released by the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the Harvard School of Public Health.

Fifty-five percent of the public, including majorities of Republicans and Democrats, say that establishing the exchanges — a key element of the Affordable Care Act (ACA) and one whose implementation has divided states along partisan political lines — is a “top priority” for their governor and legislature. So far, 18 states and the District of Columbia have declared that they will create their own state-based exchanges; seven other states have opted to establish exchanges in partnership with the federal government; and 25 others — some driven by resistance to the ACA — appear set to default to a federally run exchange.

“Governors are largely splitting along partisan lines on the exchanges, but the public is not. People like the idea,” said Drew Altman, President and CEO of the Kaiser Family Foundation.

Similarly, while some Republican governors are balking at the optional expansion of Medicaid under the ACA, more Americans (52%) say their state should expand its Medicaid program than not (42%). But on Medicaid, views differ sharply by party, with two-thirds of Republicans saying they prefer to keep their state Medicaid program as is (66%) and three in four Democrats (75%) are seeking a state expansion. Independents are evenly divided.

In the bigger picture, the survey finds that just over half of Americans (52%) — including 78% of Republicans — agree that opponents of the ACA should continue trying to change it so that the law has “less impact on taxpayers, employers, and health care providers,” while 40% agree that “those opposed to the health care law should accept that it is now the law of the land and stop trying to block [its] implementation.”

Meanwhile, policymakers involved in budget deficit negotiations at the federal level face a familiar conundrum. Even as most Americans (65%) say that Washington should act quickly to bring down the deficit, there is little public appetite for major reductions in federal spending on health care. Overall, six in ten (58%) oppose any spending cuts to Medicare, and 46% oppose any cuts to Medicaid.

Only two of six specific proposals asked about in the poll to trim Medicare draw majority support from the public. They would require drug companies to give the federal government a better deal on medications for low-income people on Medicare, and would require high-income seniors to pay higher Medicare premiums — backed by 85% and 59% of the public, respectively. In contrast, 51% oppose gradually raising the age of eligibility for Medicare from 65 to 67 — an idea currently making the rounds in Washington. And 61% “strongly oppose” requiring all seniors to pay higher Medicare premiums. The poll also found a widespread view among the public that cuts to Medicare are not really needed; the public believes that there are other, better ways to reduce the deficit.

Americans were also asked to identify from a list of 15 federal program areas in health and health care (excluding Medicare, Medicaid, and the ACA) which ones they considered to be “one of the top priorities” for federal spending this year, even in the context of the budget deficit. Five were cited by a majority of the public: funding for veterans’ health care (60%); dealing with health problems resulting from natural or man-made disasters (59%); increasing research to find new cures and treatments for major disease threats (58%); preventing the spread of infectious diseases, including providing vaccinations (52%); and preventing chronic illnesses, such as heart disease, cancer, and diabetes (51%).

“These poll results provide more evidence that our nation is on the right track with expanding availability of affordable health coverage, and focusing more on preventing illness before it results in costly treatment,” said David Colby, Vice President for Public Policy at the Robert Wood Johnson Foundation.

Source: Kaiser Family Foundation; January 24, 2013.

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