The results from five Southern states whose leaders oppose the reform law also reveal stark racial and class divisions.
The poll by the Joint Center for Political and Economic Studies included 500 respondents each from Georgia, South Carolina, Alabama, Mississippi and Louisiana, five states whose leaders oppose expanding their Medicaid program under the Affordable Care Act.
When asked, about a third in Georgia and South Carolina had a favorable opinion of the health care law. But 61 percent in Georgia and 65 percent in South Carolina favored expanding Medicaid, according to the poll.
More popular were other features of the reform law. When asked about them separately, 73 percent in Georgia and 75 percent in South Carolina favored the health insurance exchanges that will begin enrollment in October, offering health insurance and subsidies to buy insurance for those in low- and middle-income families. Not so popular was the requirement to have health insurance or pay a tax, which was viewed unfavorably by about two-thirds of those polled and was unpopular across all groups.
But the poll also revealed sharp differences across racial and economic lines, which is important because all five of those states have a “significant portion” of blacks, said Ralph Everett, the president and CEO of the center, which is nonpartisan but focuses on issues of importance to blacks and people of color. For instance, a majority of blacks, at 53.3 percent, had a favorable opinion of the health care reform law while a majority of whites, 54.1 percent, had an unfavorable opinion. A majority of both favored Medicaid expansion, but black support was at 85 percent vs. 53 percent for whites. Support for expansion tended to decrease as income rose among respondents.
The states who are so far choosing not to expand Medicaid tend to have higher rates of uninsured and worse health outcomes to start with, and the fact that blacks are “disproportionately concentrated” in those will only exacerbate existing problems, said Brian Smedley, the vice president and director of the Health Policy Institute at the center.
“If these states choose not to accept the Medicaid expansion, the existing racial and health inequities, the disparities in health status between these populations, and health insurance coverage and access to care, will likely widen,” he said.
These states already set Medicaid eligibility limits for adults so low – in Georgia it is 50 percent of the federal poverty level or $11,775 a year for a family four – that few can qualify and adults without children are effectively excluded from coverage, said Ron Pollack, the executive director of the advocacy group Families USA, which favors the expansion and promotes the health care reform law.
“They can literally be penniless and they are ineligible for Medicaid,” he said.
The fact that the federal government will fund 100 percent of the first three years of the expansion and no less than 90 percent after that makes it “fiscal malpractice” to turn down the expansion, Pollack said.
Georgia Gov. Nathan Deal has consistently opposed the Medicaid expansion. His spokesman, Brian Robinson, has said the state cannot afford it in its proposed form and that the Obama administration should just give Georgia its share and let it have flexibility on how it administers the program. Robinson did not return an e-mail Tuesday afternoon seeking further comment.