Published:Mar 30, 2023 - KFF
The political debate around health care is once again focused on the future of the government health insurance programs and entitlement programs. On February 7, 2023, President Biden placed the future of Social Security and Medicare, the federal government’s two largest entitlement programs back into the political limelight with his State of the Union address. Since then, Republican lawmakers have vehemently denied they wanted to make cuts to the programs, but Republican lawmakers have not made the same claims about Medicaid, the government health insurance program for low-income adults, and many assume the program will be the focus of Republican cuts during upcoming budget debates.
The latest KFF Health Tracking Poll finds all four programs: Social Security, Medicare, Medicaid, and the ACA are viewed positively by a majority of U.S. adults.
Social security and Medicare are both viewed positively by large majorities of Democrats, Republicans, and independents, while a smaller majority of Republicans (65%) and a least three-fourths of independents and Democrats view Medicaid favorably. This month marks the 13th anniversary of the Affordable Care Act (ACA). Views of the ACA are still largely partisan with the vast majority of Democrats holding positive views of the law (90%) as do two-thirds of independents while seven in ten Republicans view the law unfavorably.
Democratic lawmakers hold a slight advantage over Republicans among the public on who they trust to do a better job determining the future of Medicare and Medicaid. Slightly more than half of the public say they trust Democrats to do a better job determining the future of Medicaid (52%) and the future of Medicare (52%). Views on which party would do a better job on the future of Social Security are more evenly divided between Democrats (51%) and Republicans (46%).
More than nine in ten partisans say they trust members of their own political party to do a better job handling each of the programs, with independents giving Democrats a 13 percentage point advantage on Medicare (55% v. 42%) and Medicaid (55% v. 42%), and a seven percentage point advantage on Social Security (52% v. 45%).
Every year, the Medicare Trustees report provides an estimate of when the Medicare Hospital Insurance Trust Fund (Part A) will have insufficient funds to pay full benefits, and the most recent report suggested that 2028 will be the year that the trust fund will be depleted. Concerns about the future of Medicare resonate with the public. Eight in ten adults say they are worried that Medicare will not be able to continue to provide at least the same level of benefits in the future. Democrats, independents, and Republicans all report similar levels of concern around the future of Medicare, as do a majority of adults, regardless of age. Nearly nine in ten (86%) adults ages 50-64, report being worried about the future of Medicare including 44% who are “very worried,” perhaps reflecting they are the group who are closest in age to be relying on the program in the near future.
Echoing this concern about Medicare’s future, roughly three-fourths (73%) of the public say changes need to be made to the Medicare program to keep it sustainable for the future, while only about a quarter (26 percent) say the program will basically be fine if left as is. Adults under age 65 are more likely than seniors to say changes need to be made to keep it sustainable (77% v. 59%).
Yet while the public has real concerns about the future of Medicare, they don’t think Congress has real plans to address the future stability of the Medicare program. Eight in ten say that the accusations around Medicare cuts are more about both sides playing politics with the issue, while one in five (19%) say these arguments are more about actual plans Republicans and Democrats may have. Nine in ten Republicans say the debate is more about both sides playing politics as do more than eight in five independents (85%) and two-thirds of Democrats (67%).
A majority of Democrats (89%), independents (75%), and Republicans (65%) hold positive views of Medicaid, the federal-state government health insurance for certain low-income adults and children. In addition to viewing the program favorably, most Americans say the current Medicaid program is working well for most low-income people covered by the program. More than two-thirds of the public overall (69%) say the program is working well as do large majorities of independents (63%), Republicans (69%), and Democrats (76%).
Two-thirds of adults say they have a connection to Medicaid, either through themselves, a family member, or a close friend receiving benefits, and 75% of them say the program is working well.
This is despite the fact that partisans view Medicaid differently. When asked whether Medicaid is primarily a government health insurance program that helps people pay for health insurance or a government welfare program, a larger share of the public (61%) as well as six in ten independents and eight in ten Democrats (79%) say Medicaid is primarily a health insurance program. A small majority of Republicans (54%) say Medicaid is primarily a welfare program. Click here to see more polling on Medicaid.
More than six in ten Republicans in both expansion (66%) and non-expansion states (61%) say they have a connection to the federal-state Medicaid programs, which mostly mirrors the share of Democrats (69%, 66%) and independents (57%, 69%) who say the same. Yet, Republicans with a Medicaid connection hold different views of the program than Republicans without a Medicaid connection. Seven in ten Republicans with a Medicaid connection view the law favorably, compared to about half (55%) of those without a Medicaid connection who view the law unfavorably. In addition, more than half of Republicans with a Medicaid connection say the program is primarily a government health insurance program that helps people pay for health care (55%), while nearly three-fourths (73%) of Republicans without a Medicaid connection say the program is primarily a government welfare program.
