The political leadership in the five Deep South states is solidly against Medicaid expansion, and has been so for months.
Republican governors in Georgia, South Carolina, Alabama, Mississippi and Louisiana, along with their GOP-controlled legislatures, have bucked proposals to open their states’ Medicaid programs to hundreds of thousands of uninsured people, as outlined under the 2010 Affordable Care Act.
But a newly released survey of adults in those five Southern states shows a different sentiment among the public. Across the region, 62.3 percent of respondents view Medicaid expansion favorably, including 61 percent in Georgia, according to the survey results released Tuesday.
When people were asked a more detailed question about expansion — whether the state should keep Medicaid as it is or expand it to cover more uninsured people, with the state eventually paying part of the cost — the percentages dropped a bit but still showed a majority, 53.8 percent, in favor. Georgia’s favorable figure of 51.6 was the lowest of the five states.
A large majority of African-Americans (78.4 percent) in the survey favored Medicaid expansion, compared to a substantial but smaller number of non-Hispanic whites (44.2 percent). A majority of women favored expansion (57.2 percent), while slightly less than half of men did (49.6 percent).
At the same time, the poll showed that only one-third of adults in the five states view the Affordable Care Act favorably, with 43.8 percent not liking the law. Especially unpopular is the requirement that individuals obtain health insurance or pay a penalty.
But large majorities (75 percent in the region) support ACA provisions for health insurance exchanges, where individuals and small businesses can shop for coverage; and for financial subsidies for people to afford insurance (68.8 percent, and 66.2 percent in Georgia).
“When you talk about the [Affordable Care Act] as a whole, people get into their political mindset,’’ said Cindy Zeldin, executive director of the advocacy group Georgians for a Healthy Future. “But when you take it out of the political context, many of these individual provisions are common sense.’’
Southern states generally need expansion the most because of their large numbers of uninsured, Zeldin said.
The survey shows “strong support for Medicaid expansion,’’ Zeldin added. “Hopefully, our elected officials will see this. It’s clear that this is what Georgians want.’’
The poll was conducted by the Joint Center for Political and Economic Studies, a Washington, D.C.-based think tank that analyzes a broad range of public policy issues of concern to African-Americans and other communities of color. Joint Center officials noted Tuesday that the five Deep South states have a large African-American population, including 30 percent of Georgia residents.
About half the states in the nation plan to expand their Medicaid programs. If Georgia were to expand Medicaid – which the state’s current leadership says it won’t do – more than 650,000 people would be added to the program’s rolls.
Gov. Nathan Deal has remained firm in his opposition to it, citing an estimated $4.5 billion cost to the state over 10 years. And his fellow Republicans in the state’s political establishment are not pushing for it.
Deal, who has voiced skepticism about the law’s federal funding guarantees, says Medicaid expansion would prove too costly to the state in any event, adding to the expense of a financially strapped program.
Deal spokesman Brian Robinson, responding to the survey results in an email Tuesday to GHN, said an expansion would cost the state “vast amounts of money.”
“And it depends on never-ending largesse from a federal government drowning in debt already,’’ Robinson added. “If you asked respondents to write a check for their share of the new costs, I dare say the number of supporters will drop precipitously. It’s the easiest possible thing to be for new entitlements when you’ve come to believe they’re free.”
The survey’s results mirror those in an AJC poll conducted in December, when 65 percent said they believed the state should accept increased federal funding for Medicaid under the Affordable Care Act, often known informally as Obamacare.
The new survey interviewed 500 adults in each of the five states.
Besides racial differences, the survey also found class divisions over the ACA. Respondents who were well educated, earned good incomes, and had health insurance — and whose acquaintances also had health coverage — were cooler to the ACA and its provisions than were those less well-off and those having friends, family, and neighbors who were uninsured.
Separately this week, the Los Angeles Times reported that Republican opposition in many statehouses to expanding Medicaid will likely widen the divide between the nation’s healthiest and sickest states.
Residents of the states that plan to expand — concentrated in the Northeast, upper Midwest and West Coast — currently have better access to doctors and are less likely to die from preventable illnesses.
Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16 percent higher than in pro-expansion states, according to a Times analysis of state health data.
Deaths from breast cancer are 8 percent higher on average in anti-expansion states. And adults under 65 are 40 percent more likely on average to have lost six or more teeth from decay, infection or gum disease.
Yet most state leaders fighting the Medicaid expansion have advanced few alternative plans to tackle their states’ health shortfalls, the L.A. Times article said. That means that, at least in the short term, America’s unhealthiest states could fall even further behind as the Affordable Care Act is implemented, the Times article reported.
The Medicaid program’s conservative critics, who contend it could ultimately sap state budgets, say poor Americans would be better helped by alternative strategies, including limits on government medical aid to encourage people to take responsibility for their own health care.
“If history has proven anything, it’s that there is no such thing as a temporary entitlement program,” South Carolina Gov. Nikki Haley said, thanking state legislators there for rejecting Medicaid growth, which she called a “looming public policy nightmare and fiscal disaster,” the Times article reported.
Yet Ron Pollack of consumer advocacy group Families USA, commenting on the poll results, said Tuesday that a governor who turns down expansion “is committing financial malpractice.’’
Expansion would not only improve many people’s access to health care, but it would also save money for states in covering the cost of the uninsured and would create jobs and boost economic activity, Pollack said. “It’s a win-win-win proposition.’’