Monday, January 22, 2018

What do the polls actually say about whether Idaho supports a health-care expansion?

Idahoans want better and broader health care coverage in the state — but not if you mention "Obamacare"

Posted By on Mon, Jan 22, 2018 at 12:00 PM

click to enlarge The wording in polls like these can matter a great deal. - IDAHO FREEDOM FOUNDATION POLL
Idaho Freedom Foundation poll
The wording in polls like these can matter a great deal.

This week, we have a story about the health-care gap in Idaho, where low-income citizens who don't qualify for Medicaid actually make too little money to qualify for the Affordable Care Act's health-care subsidies.

To attempt to fix that gap, Idaho's Health and Welfare Department is proposing two federal waivers, one that would extend subsidies down to uncovered Idahoans below the poverty level, and another that would put Idaho residents with some of the most expensive conditions on Medicaid.

But to do that,  the waivers first have to be approved by a conservative legislature, skeptical of government health care.

Wayne Hoffman, president of the Idaho Freedom Foundation, an influential libertarian activist group, argued that government-run health care continues to poll very poorly in Idaho. He wants the Idaho coverage gap to actually be bigger.

But Lauren Necochea, director of Idaho Voices For Children, argues that assessment is wrong — that Idahoans consistently support state action to close the health care gap.

So who's right?

Well, that's a tricky question. It depends on what you ask and when you ask it. In 2013, some Americans who opposed "Obamacare" supported the specifics of the "Affordable Care Act." Traditionally, individual components of Obamacare have polled well, while the entire thing has polled poorly.

But after Donald Trump's election, support for Obamacare suddenly skyrocketed. So what's happened in Idaho? Let's look at a couple of polls from the last three years.


Here's the Idaho Freedom Foundation's poll, conducted by computer-assisted live telephone interviewers,  in January 2015.

Under the Affordable Care Act, commonly known as ObamaCare, states have the option to expand Medicaid eligibility to a new class of working-age, nondisabled, mostly childless adults. The Legislature and Governor are deciding whether or not to implement that optional expansion. Knowing what you know, do you support or oppose expanding Medicaid in Idaho?

About 39 percent of those surveyed supported the expansion, while 46 percent opposed it.

But note the way that the question focuses on the fact that the adults who would receive Medicaid are "working-age, nondisabled, mostly childless," instead of focusing on their very low-incomes, or mentioning that the federal government would help defray the cost of the expansion.

And then the poll does something very interesting. It tests a series of arguments against the expansion: That Obamacare cut senior Medicare benefits. That a third of the people eligible for the expansion have been "involved in the criminal justice system."  That it could result in state-funding cuts to "education, public-safety and other health care programs."  That millions more of taxpayer dollars will be spent to administer it. That Idaho may never be able to "legally undo expansion." That it could cause 16,000 able-bodied adults to drop out of the labor force and shrink Idaho's economy."

(Click the links to find what experts say about each of those claims and what has actually happened in other states.)

And then, after all that, the IFF poll asks again, "Knowing what you know now, do you support or oppose expanding Medicaid in Idaho?"

Support drops to 26 percent, and opposition grows to 68 percent.

Finally, the poll asks, after all that priming, "Would you be more or less likely to vote to re-elect your state legislator if he or she supported ObamaCare’s Medicaid expansion in Idaho?"

At that point, 15 percent say it's more likely, and 62 percent say less likely.


But just a few weeks before the Idaho Freedom Foundation's January 2015 poll, Dan Jones & Associates conducted a more simple poll: In December of 2014, the polling question asked, “Do you support or oppose an expansion of federal Medicaid coverage in Idaho?”

Crucially, it did not mention the phrase "Obamacare" or even the "Affordable Care Act."

That poll found about 61 percent of Idaho voters supported an expansion, while 29 percent opposed it.

(About 20 percent of the samples from these polls are made up of opt-in online responses.)

In a similar poll conducted on April of 2016, the question shifted a bit, focusing on the legislatures failure to help low-income families: “The legislature did not expand Medicaid to help families with income levels too low to qualify for subsidized health insurance. Do you agree or disagree with the lack of action?”

And with that wording, 64 percent disagreed with the legislature, and only 30 percent agreed. (In both polls, the margin of error was around 4 percent.)


The most recent data, meanwhile, comes from two Boise State University polls, one in the December of 2016 and the other in the December of 2017.
click to enlarge A Boise State poll suggests Idaho voters want the state to take action to improve Idaho's healthcare system. - BOISE STATE UNIVERSITY POLL
Boise State University poll
A Boise State poll suggests Idaho voters want the state to take action to improve Idaho's healthcare system.

Both asked the same question:

"In Idaho, there are currently 78,000 low-income Idahoans who lack affordable comprehensive health coverage. Would you favor or oppose the governor and state legislature taking action to provide them with access to quality health care?"

In 2016, 70.7 percent of Idaho residents support the legislature taking action, while in 2017, that number grew to 75.7. That same poll found that 77 percent supported an "Idaho solution" to the state's health care woes.

Note, however, that the phrase "Medicaid expansion" isn't mentioned. Nor are any details of the governor's dual-waiver plan. It doesn't mention anything about expanding Obamacare subsidies to those in the coverage gap or putting more people with very high-cost medical conditions on Medicare.

The 78,000 number, according to Idaho Health and Welfare, is likely a bit out of date thanks to Idaho's improving economy. (Still, the agency estimates that at least 50,000 are in the coverage gap.)

The exact terminology is important. Because the same poll also asked this question: "Do you generally approve or disapprove of the 2010 Affordable Care Act, often referred to as Obamacare, that restructured the U.S. health care system?"

In that case, about 58.8 percent disapproved, and only 35.2 percent approved. Other questions suggested that Idahoans opposed charging more for preexisting conditions, but supported leaner health care plans that made maternity and chiropractic coverage optional.

One other weird quirk of the Boise State poll? More voters identified themselves as Independents (39.2 percent) than Republicans (36.6 percent). That was the case for the previous poll too.

Bottomline: What do all these polls suggest for Idaho? Idahoans generally do support increasing health care coverage in their state. As long as you don't call it "Obamacare."

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About The Author

Daniel Walters

A lifelong Spokane native, Daniel Walters is the Inlander's senior investigative reporter. But he also reports on a wide swath of other topics, including business, education, real estate development, land use, and other stories throughout North Idaho and Spokane County.He's reported on deep flaws in the Washington...