The Three Words That Shift Views On Medicaid

Three little words is all it takes to change voters’ minds about Medicaid expansion.

Morning Consult polling shows using the term “Affordable Care Act” can make a difference in how a voter feels about expanding Medicaid. When asked if Medicaid should be expanded for low income adults below the federal poverty line, 71 percent of registered voters said yes. When asked if Medicaid should be expanded “as encouraged under the Affordable Care Act”, support dropped nine percentage points.

expand medicaid to FPL

The drop in support was strongest among Republicans. More than half of Republicans surveyed, 51 percent, agreed Medicaid should be expanded for low income adults below the poverty line. But when asked if Medicaid should be expanded as encouraged under the ACA, the number dropped 15 percentage points to 36 percent. In comparison, Democrats’ opinions did not change when the question was reworded, with 88 percent saying Medicaid should be expanded. Among independents, 70 percent said Medicaid should be expanded for low income adults below the poverty line. But for the reworded question, the number dropped 13 percentage points to 57 percent.

should all states expand

In addition to splits on policy, our polling found that that voters in states that have not officially expanded Medicaid coverage are more aware of the status of Medicaid expansion than voters in states that have expanded coverage. Sixty-two percent of voters in states that have expanded coverage are aware of that fact, while 71 percent of voters in non-expansion states are aware their state has not expanded coverage. As of now, 28 states have expanded Medicaid and another 21 have decided not to at this time. Utah and Indiana are debating expansion right now.

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These dynamics don’t come as a surprise. Obamacare has routinely elicited strongly negative opinions from right-leaning voters, while support for individual policies is higher. But the distaste for all things Affordable Care Act also has an impact on the ground. In some red-leaning states that expanded Medicaid, agencies made earnest efforts to steer clear of the negative implications the health reform law could carry, right down to their branding strategy and word choice.

“We really tried to avoid politicized terms like Obamacare,” said Gwenda Bond, assistant director of communication for Kentucky’s Cabinet for Health and Family Services when talking about developing communication strategies for Kynect, the state’s exchange website.

Bond said while Kentuckians don’t have as negative of views on Medicaid, the team aimed to be as neutral as possible as they prepared to advertise the exchange. Kentucky has enrolled 324,245 state residents under the expansion as late August according to a cabinet official. Medicaid enrollment takes place year round. But during events promoting the site and encouraging people to enroll, Bond said they found most people weren’t concerned with the politics of the ACA. Most were looking for information.

“We were surprised people didn’t have an entrenched opinion about the ACA…it’s not as polarizing on the ground,” she said. “The anxiety was from not being sure how (the law) would affect them.”

It is a different situation in Arkansas. The state got one of the first waiver approvals from the federal government to use federal Medicaid expansion dollars to purchase private insurance for low-income residents. They’ve enrolled 194, 257 people in the program as of Aug. 31, said a Arkansas Department of Human Services official. But the department wasn’t legally allowed to promote the program. That’s because the state legislature added language that prohibited the department from doing any enrollment advertising related to the Medicaid expansion program. Advertising was left to insurance companies, which often did not emphasize the connection of expanded enrollment with the health reform law.

Julie Schwab, director of medical services for North Dakota’s Department of Human Services said the agency has never used the word “Obamacare” in advertising. But they have mentioned the health reform law by name and enrolled 12,858 people as of Sept. 1 into the expansion program.

“We try to maintain everything as consistent so we don’t have mixed message…we always use ‘Affordable Care Act’,” Schwab said. “We don’t seem to have as much negative politicking as in other states,” she said in an interview.

The politics of Obamacare have shifted as millions of people got access to subsidized health insurance coverage over the past year. But as this polling shows, those three words — Affordable Care Act — are still potent enough to provoke a significant partisan split.


Marissa Evans contributed to this story.

Morning Consult