Medicaid may be more popular than you realize

"Increased support for primary care providers who participate in Medicaid is one lever for securing more capacity in the program."

Nearly half of Americans (47%) oppose spending reductions for Medicaid, according to an April 2011 survey of 1502 adults conducted by The Kaiser Family Foundation and the Harvard School of Public Health.

Robert Blendon, ScD, professor of health policy and political analysis at the Department of Health Policy and Management at the Harvard School of Public Health in Boston and director of the Harvard Opinion Research Program, which assesses attitudes about major domestic public policy issues, says he wasn't too surprised by this finding.

"Medicaid has broader support than people in the field might realize," says Dr. Blendon. "It's not that people don't value this program. When Medicaid was associated much more narrowly with public assistance, it was less popular."

There is now a significant appreciation for the program, says Dr. Blendon, because Medicaid covers a much wider range of people, including nursing home residents, the disabled, and the newly unemployed. "At the moment, I believe Medicaid is much more popular than many other functions in the state, with the exception of public education," says Dr. Blendon.

Make it personal

Dr. Blendon says that although people do not want cuts to Medicaid, they also don't want their taxes raised. "If you are a Medicaid director, the good news is that people don't want to hear about cuts," he says. "That doesn't mean they are willing to see their sales tax or income tax rise."

Dr. Blendon recommends sharing stories of how the Medicaid program has helped individuals in your state. "The more you describe them on a personal basis, the more concerned people will be about cuts," he says. "Talk about the people who are helped by the program, not the aggregate program."

Medicaid directors should convey the image of a popular program that is helping many people in their state, Dr. Blendon advises. "Directors often talk about these things as if it's just a budget number," he says. "They should lead with their strength, of how many individuals in the state are getting help."

At the end of the day, however, people will still be against tax increases, according to Dr. Blendon. "These are popular programs, but you need a lot of money raised to keep them going," he says. "So there will be battles, but the Medicaid director should know that they are at least leading with a program that's popular."

Cuts may be moderated

Evidence of public support for Medicaid can potentially save the program from being cut, at least in some cases, according to Dr. Blendon. "Legislative people have some sense of things that are less popular or more popular. In general, things that are more popular do better," he says, giving the example of the National Institutes of Health.

"They had a cut, but nowhere near that of other agencies, and part of that is because medical research is very popular in the U.S.," says Dr. Blendon. "Also, a lot of groups will lobby for services, so states will feel a lot of pressure."

Dr. Blendon says, though, that as either the second or third largest program in the state, and possibly the fastest growing program in the state, Medicaid is simply too big to ignore. "You may have a program that is more popular than you thought it was, but people are still going after it because they can't make up for it without a tax increase," he says.

Medicaid is so large within the state's budget, says Dr. Blendon, that public opinion can only moderate cuts to some degree. "It isn't as though you can close down state institutions and not cut Medicaid," he says. "If you really have a large shortfall, and if you are not going to raise revenues, it's hard to find other things that are large enough to balance the budget."

Contact Dr. Blendon at (617) 432-4502 or rblendon@hsph.harvard.edu.