South Dakota Voters Pass Medicaid Expansion

Voters in another conservative state -- South Dakota -- have passed a ballot proposition to expand Medicaid. The measure received 56 percent of the vote in the November 8 midterm elections. An overview of which states have expanded Medicaid coverage through the 2010 federal Affordable Care Act, and by which method (governor's executive action, legislation, or ballot proposition), is available here.

Polls on Medicaid Expansion in States That Have Not Participated Thus Far

A recent Vox article, focusing on the Biden Administration's attempts to convince Republican governors and legislators to expand Medicaid in states that have not yet done so, also contains polling data on Medicaid Expansion from eight states (out of the 12 total) not currently participating (link). At least a plurality, if not an outright majority, supports expansion in all of these states. These states (with their support levels, ordered from greatest to least) are Kansas (55%), Georgia (55%), North Carolina (53%), Florida (52%), Texas (52%), Wisconsin (52%), South Carolina (50%), and Alabama (45%). Note that sizable proportions of respondents (17-23%) are undecided in each state, so opposition in the states (23-37%) is well below support.

Lessons from 2009-2010 ACA Public Opinion for Biden's 2021 Agenda

Noting the similarities between 2009 and 2021 -- a new Democratic president taking office with an ambitious policy agenda and his party holding majorities in the House and Senate -- Dan Hopkins examines what lessons President Biden and the Democrats might learn for this year's policy debates (e.g., new COVID-19 economic-relief legislation) from the public's reaction to President Obama's rollout of the Affordable Care Act in 2009-2010. Hopkins focuses on a few major themes, such as how, when a bill has numerous provisions (as the ACA did), the public will likely focus on controversial and unpopular facets of the legislation, rather than its popular parts.

Status of Obamacare as Biden Replaces Trump

This Vox article from the eve of President Biden's inauguration provides a good overview of where things stand at the moment with the 2010 Affordable Care Act (aka Obamacare). The obvious news is that the law survived the Trump presidency largely intact, but there remain some court cases on aspects of it.

Vox Summarizes Recent Missouri and Oklahoma Votes to Expand Medicaid

Medicaid expansion is still undefeated when it has been placed on the ballot for statewide votes, even in very conservative states.* Missouri, two nights ago, and Oklahoma, on June 30, became the most recent states to expand Medicaid. The margin in Oklahoma was only 1 percent, whereas in Missouri it was 6 percent. Vox examines the two results in light of how crisis situations such as the current COVID-19 outbreak and the 2008-2009 Great Recession can dramatically affect public opinion.

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*A Montana initiative that revolved around a tobacco tax to fund the state's portion of Medicaid expansion failed in 2018. Whether this result should be included with straight up-or-down votes on the question of whether or not to expand can be debated.

New Study on Demographic and Political Correlates of Health-Insurance Policy Preferences

Via the Incidental Economist, a team of researchers from Harvard and the Commonwealth Fund have published a (currently free) article based on a 2019 U.S. nationally representative survey, examining how respondents' demographic and political characteristics correlate with their preferences for different types of health-insurance policies and programs. Respondents were asked to choose which option they preferred among keeping and improving the Affordable Care Act, switching to a Medicare for All program, or providing states with federal funding to develop their own programs (based on previous Republican proposals). Most respondents favored either variations on the ACA or Medicare for All.

Many of the findings were what most people would probably expect, such as the belief that "Guaranteeing health care is not [the] responsibility of government" being clearly associated with preference for the state option, or positive views of socialism being linked to support of Medicare for All.

In conclusion, the authors report "our results suggest that current ACA supporters may shift to greater support for Medicare for All if they become disenchanted with their own coverage, or if other circumstances or policies erode enthusiasm for private, employer-sponsored coverage. Views differentiating the third of Americans who favor devolving health care to the states are of a different flavor entirely: they are much more staunchly opposed to growing governmental power and paying taxes to support universal coverage" (pp. 749-750).

ACA at Its All-Time Highest Popularity Per Kaiser Family Foundation Poll

This month's (February 2020) Kaiser Family Foundation monthly tracking poll shows support for the Affordable Care Act to be at the highest level ever recorded by this poll, 55%. Opposition is much lower, at 37%.