New poll offers little help in Medicaid expansion debate

Published January 26, 2023

By Mitch Kokai

The American Cancer Society should have quit while it was ahead.

The group released a poll this month showing widespread support for Medicaid expansion in North Carolina. It should shock no one that 96% of Democrats in the survey supported the Democratic Party’s No. 1 public policy priority item for the past decade. More noteworthy is the poll’s finding that 71% of unaffiliated voters and 64% of Republicans also support Medicaid expansion.

Those are good numbers for expansion advocates. Expansion opponents, including my John Locke Foundation colleagues, cannot refute the fact that the basic idea of Medicaid expansion enjoys clear popularity.

But that piece of information, while useful, offers little to help guide policymakers moving forward. No major player in the Medicaid expansion debate needs to be convinced about the public’s support.

Republican leaders in both the state House and Senate already endorse expansion. They agree with the longtime expansion advocate in the Executive Mansion, Democratic Gov. Roy Cooper.

Medicaid expansion remains unfinished not because of a lack of generic support. The stalemate endures because there’s no agreement on other steps that need to take place for expansion to work.

The rest of the American Cancer Society’s poll does nothing to help inform that discussion. The document instead serves up a textbook example of “push polling.” Pollsters asked questions designed to steer people toward greater support for Medicaid expansion. Results tell us little more than the cancer group’s built-in bias in favor of that outcome.

We’re told 82% of N.C. voters want the General Assembly to finalize an expansion deal. The actual question was “How important is it to you that they come together and get the job done?”

Should we be shocked that most people prefer a lawmaking body that does its work? That people prefer action to gridlock? Of course not.

Results of that poll question tell us nothing about the most appropriate terms for settling the impasse. Voters said nothing to pollsters about what other steps lawmakers should take, if any,  to ensure Medicaid expansion solves more problems than it creates.

Other questions in the American Cancer Society survey offer little reason for surprise. We learn that most people support government programs that help people least able to help themselves, such as children, seniors, those with low incomes, and those with disabilities. We learn that people support preventative health care. We learn that people support veterans having access to care.

Pollsters suggest that Medicaid expansion would further each of those worthwhile goals. Yet there is no evidence that the poll addressed any lingering concerns about expansion.

No one asked surveyed voters whether they would be more or less likely to support expansion after learning that most beneficiaries would be able-bodied, working-age, childless adults. Would they be more or less likely to support expansion if they learned that new Medicaid beneficiaries could limit health care access for the most needy people? Those already enrolled in Medicaid?

We see no questions about the federal government’s long-term ability to fund 90% of the cost of expansion. With a $31 trillion national debt, can the feds realistically cover that obligation indefinitely? If not, would N.C. voters agree to take on billions of dollars in additional spending obligations, along with the tax hikes that would likely result?

There’s no poll question asking whether people understand that Medicaid expansion itself would have absolutely no impact on health care supply in North Carolina. In other words, expanding the number of people using the taxpayer-funded insurance program would do nothing to boost the number of available doctors, nurses, medical facilities, or equipment.

The state Senate’s preferred Medicaid expansion plan addresses those supply-side concerns. Senators have been unwilling to accept expansion unless state government also relaxes rules that restrict health care supply.

The American Cancer Society poll tells us nothing about voters’ response to the Senate’s approach. Do they agree with the goal of pursuing greater access to health care, not just health insurance?

Without that type of information, it’s safe to say that the poll will have little impact on resolving one of North Carolina’s most substantial public policy questions.

My Locke colleagues and I believe Medicaid expansion is bad public policy for North Carolina. We are encouraged that many leading lawmakers refuse to take that step without addressing serious concerns about access to care.

If legislators “come together and get the job done” this year, we all should hope they solve more problems than they create. We don’t need decisions based on polling that misses the mark.

Mitch Kokai is senior political analyst for the John Locke Foundation.