Is Medicaid Health Insurance or Welfare? Poll Finds Americans' Views Divided

A new Kaiser Health Tracking Poll delves into Americans’ attitudes about Medicaid: its importance to their family, how it should be funded, and whether it is more similar to health insurance or welfare programs.

The poll was conducted May 16-22, after the House passed the American Health Care Act (AHCA). If made law, the AHCA would restructure how Medicaid is paid for by reducing funding for expansion and moving to a block grant system. The Americans surveyed differed in their opinions of whether these changes would benefit or harm their family.

Nearly 6 in 10 Americans (58%) reported that Medicaid is at least somewhat important for their family, with 40% deeming it very important. The share of respondents who considered Medicaid important differed by political affiliation, with Democrats most likely to agree, followed by independents, then Republicans.

Those who considered Medicaid important for them were more likely to predict the AHCA would have detrimental effects on their healthcare costs, access to coverage, and quality of care. For instance, 53% of those who said Medicaid was important for them felt the cost of healthcare for their family would worsen if the AHCA is passed, compared with 33% of those who said Medicaid was not important. Americans were least concerned about the quality of their healthcare worsening with the AHCA’s passage, with 41% of those considering Medicaid important and just 25% of those not considering it important predicting this outcome.

The poll found support for continuing Medicaid expansion was highest among residents of states who had expanded the program under a Democrat or Independent governor and states that had not expanded Medicaid, tied at 85%. Those in a state that had expanded Medicaid under a Republican governor were slightly less likely to support expansion, as 82% said it was at least somewhat important for a replacement plan to maintain expansion funds.

Support for switching Medicaid’s funding to a block grant system was highest among Republicans, who were nearly evenly split in their views; 48% supported changing to block grants while 47% supported staying with the status quo. Among the total group of 1205 respondents, 26% favored switching to a block grant system.

Shortly before the House voted to pass the AHCA on May 4, House Speaker Paul Ryan (R-Wisconsin) released a statement saying the bill “reforms Medicaid so that it is flexible and responsive to those it was created to serve.” In particular, the choice for states to select either a block grant or per-capita funding model “maximizes state flexibility.”

Besides gauging respondents’ opinions on upcoming legislation affecting Medicaid, the poll also revealed partisan divides in the perceived role of the Medicaid program as a whole. Over half of Republicans (52%) reported that Medicaid is more similar to welfare programs that provide financial assistance to the poor, such as food stamps. Meanwhile, nearly three-fourths (73%) of Democrats said that Medicaid is more like other health insurance programs, like Medicare, that help people afford healthcare. Overall, 6 in 10 of the survey sample agreed with the perception of Medicaid as more like health insurance, while 37% felt it was more like welfare.

Senate Republicans will continue to debate the role of Medicare in federal health legislation, among other issues like essential health benefits, as they work to revise the AHCA into a bill at least 50 Senators can agree on.