Majority of Voters Want State Autonomy for Medicaid Programs

Voters wouldn’t mind seeing states have more control over their Medicaid programs without federal meddling, according to the results of a new Morning Consult poll.

Polling data show that when voters are told about how states and the federal government generally share the costs of Medicaid programs, 63 percent of respondents say states should be allowed to administer the programs on their own, without federal oversight over things like which benefits are offered and how much states are spending on them. Twenty-four percent say federal oversight is still needed.

Those views were almost identical to those who weren’t told about the shared cost between states and the feds. Sixty-four percent in that group said states should have the green light to administer Medicaid programs as they see fit, while 24 percent preferred federal involvement.


The poll comes a week after the midterm elections put control of the Senate in GOP hands starting next year, paving the way for potential changes to the Affordable Care Act and how Medicaid is administered. Furthermore, Republicans will occupy the governor’s mansion in Florida, Wisconsin, Kansas and Georgia, tempering any hope of Medicaid expansion in those states.

Sen. Orrin Hatch (R-Utah), who’s slated to become chairman of the Senate Finance Committee, has been vocal about reforming Medicaid. In 2013, he teamed up with House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and put forth a plan that would give states more control over their Medicaid programs. The proposal would eliminate the formulas used by the feds to determine Medicaid funding in favor of a per-capita system. This year, Hatch helped introduce legislation, along with Republican senators Richard Burr of North Carolina and Tom Coburn of Oklahoma, that would replace the Affordable Care Act. The measure included significant changes to Medicaid.

Medicaid spending is expected to increase to $576 billion in 2024, from a 2013 price tag of $267 million, according to a July report from the Government Accountability Office. The GAO cited the expansion of Medicaid under the Affordable Care Act, as well as the rising cost of healthcare, as one reason for the increasing expenditures.

“One of the things that makes the Medicaid program unique is that it gives states the freedom to test policies and to learn from each other’s successes and failures,” Hatch said in a statement the same day the GAO released its findings. “This report illustrates how states have experimented with very different approaches to Medicaid, and have gotten very different results.  Congress needs to use information like this to make sure this vital program actually works for those who need it and is fiscally sustainable in the long term.”

Morning Consult polling found political affiliations influenced on how voters feel about states and the federal government sharing Medicaid costs.


Sixty percent of Democrats who were made aware of the shared costs said states should have autonomy when running their Medicaid programs; 55 percent of independents and 75 percent of Republicans agreed. Without knowing about the shared costs, Democratic support for state autonomy dropped five percentage points. In that same group, Republican support climbed to 78 percent, followed by 61 percent of independents.



Morning Consult