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Medicaid is the primary program providing comprehensive coverage of health care and long-term services and supports to about 80 million low-income people in the United States. Medicaid accounts for one-sixth of health care spending (and half of spending for long-term services and support) and a large share of state budgets. Medicaid is jointly financed by states and the federal government but administered by states within broad federal rules. Because states have the flexibility to determine what populations and services to cover, how to deliver care, and how much to reimburse providers, there is significant variation across states in program spending and the share of people covered by the program.
Medicaid has been a political touchstone for the past several decades. Republican candidates often run on the promise on cutting back on federal Medicaid spending and giving states more flexibility to administer programs, while Democrats have run on expanding Medicaid coverage to reduce the number of lower-income people who are uninsured. Amidst all of this, large majorities of the public, across partisanship, continue to hold favorable views of the program and most say the current program is working well for most low-income people covered by the program.
Earlier this year, the KFF Medicaid Unwinding Survey found Medicaid enrollees reporting overall positive experiences with their Medicaid coverage even as some of them lost their coverage as states began unwinding their Medicaid enrollment. The latest release from KFF examines the attitudes of the public overall on the future of the Medicaid program, as well leveraging the survey of adult Medicaid enrollees, to better understand how the public’s perception of the program compares to the population who most recently was enrolled by the program.
The Public and Medicaid Enrollees Want Medicaid Financing To Stay As Is
Former President Trump said that he would not cut Social Security or Medicare if elected, but has notably not released any detailed statements on his plans for the future of Medicaid, though his budget proposals as president included plans to cap federal Medicaid spending. One way to do this is through the “block grants” – a recurring Republican proposal that would give a set amount of funding each year (usually lower than anticipated under current law) and in turn states have greater flexibility to administer program but the entitlement to coverage for enrollees and the guarantee of federal of matching dollars to states without a cap would end.
Asked which comes closer to their view of what Medicaid should look like in the future, nearly nine in ten (86%) Medicaid enrollees say “Medicaid should largely continue as it is today, with the federal government guaranteeing coverage for low-income people, setting standards for who states cover and what benefits people get, and matching state Medicaid spending as the number of people on the program goes up or down.” This is more than six times the share of enrollees (14%) who say “Medicaid should be changed so that instead of matching state Medicaid spending and setting certain requirements for health coverage, the federal government limits how much it gives states to help pay for Medicaid and states have greater flexibility to decide which groups of people to cover without federal guarantees.”
While an overwhelming majority of Medicaid enrollees prefer the program to “largely continue as it is today,” somewhat fewer adults overall – though notably still a large majority – say the same (86% vs. 71%).
Among Medicaid enrollees, majorities across gender, age, racial and ethnic groups, and partisanship agree that Medicaid should largely continue as it is today. For example, more than eight in ten Democrats and Democratic-leaning independent enrollees (89%) and Republicans and Republican-leaning independent enrollees (83%) say they want Medicaid to largely continue as it is. One in ten (11%) Democratic enrollees and one in seven (16%) of Republican enrollees would rather move to a block grant system.
While partisans among Medicaid enrollees are in consensus of keeping Medicaid as it is, the public is more divided along party lines. Among all adults, nearly nine in ten Democrats and Democratic-leaning independents say the future of Medicaid should largely continue as it is today (87%) compared to just half of Republicans or Republican-leaning independents (53%).
The Public and Medicaid Enrollees Largely Support Medicaid Expansion
Under the ACA, most states have expanded their Medicaid programs to cover nearly all adults with incomes up to 138% of poverty ($20,783 for an individual in 2024). For states that expand their Medicaid program, the federal government pays for 90 percent of the costs of this expansion with the state paying 10 percent. Under the American Rescue Plan Act states that newly adopt expansion are eligible for an additional 5 percentage point increase in the state’s traditional FMAP (federal medical assistance percentage) for two years, resulting in a temporary net fiscal benefit for these states. Several of the ten states that have not yet expanded their Medicaid programs debated expansion, but ultimately no new states adopted expansion after North Carolina implemented expansion in December 2023.
The KFF Survey of Medicaid unwinding finds that more than three in four (78%) enrollees in a non-expansion state say their state should expand Medicaid to cover more low-income uninsured people. Similarly, our recent KFF Health Tracking Poll found that a majority of adults in non-expansion states support their state expanding its Medicaid program – but to a lesser degree (66%).
Once again, among the public overall, expanding Medicaid is largely split along partisan lines, with eight in ten (83%) Democrats or Democratic-leaning independents saying they want to expand Medicaid, compared to six in ten (58%) of Republicans or Republican-leaning independents who want to keep Medicaid as it is today.
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