STORY THIS WEEK: Republicans' Dual Healthcare Problems: Medicare and Medicaid 

Public Rejects Republicans' Medicare Privatization Schemes

When given two choices, CBS found a large majority of voters would rather keep Medicare the way it is than turn it into "a program that gives senior citizens payments towards the purchase of private insurance" (58% continue as is / 31% private insurance). A few key demographic breakdowns:

• Republicans are split (45% continue / 43% privatize), while Democrats (70% continue / 22% privatize) and Independents (58% continue / 29% privatize) strongly oppose Republicans' proposed changes.
• Only 23% of voters over 55 support privatization, but voters under 55 are not much more supportive: only 35% of them support privatization.

One thing Republicans do understand about Medicare: Americans believe something must change with it. CBS found this week that 53% of voters think it needs fundamental changes, 13% think it needs to be completely rebuilt, and 27% think it needs only minor changes. However, people fundamentally support Medicare and think they are getting good value for their money from the program. Voters overwhelmingly think Medicare is worth the cost to taxpayers (68% worth it / 21% not worth it), with only 10% of voters over 65 saying it isn't worth the money. This likely explains some of the broad resistance to Republican changes.

Republicans' problems on the issue will likely get worse before they get better, and Democrats and Obama may expand their current double-digitadvantages on Medicare. Pew polling shows that the more people know about the privatization proposal, the more they dislike it: voters who have heard nothing at all about the plan are slightly in favor of it (37% favor / 31% oppose), while the 20% of voters who have heard a lot are much more opposed (36% favor / 56% oppose).

How should Democrats talk about Medicare? We found the following to be equally effective hits on the Ryan budget in our polling for the Herndon Alliance and Know Your Care-voters were equally nonplussed by turning Medicare into a voucher program as they were by cutting billions of dollars from it.

1)      The budget cuts billions from Medicare and ends the program as we know it, while protecting billions in tax breaks for big oil companies (59% of people said it made them very concerned about the budget)

2)      The budget cuts billions from Medicare and ends the program as we know it (55% very concerned)

3)      The budget will privatize Medicare, ending Medicare as we know it (53% of people said it made them very concerned about the budget)

Data Looks Similar to Social Security Privatization in 2005

There's also a recent historical precedent to suggest Republicans may not have seen the worst of it yet: six years ago, many of the same Republicans in Congress worked with President Bush to try to repeal another major leg of seniors' social safety net, Social Security. During that political episode, polling went from bad to worse for Republicans as more specifics were rolled out and people became more aware of their plans.

• While a bare majority  approved ofBush's plans for addressing Social Security (44% approve / 50% disapprove) when he rolled out his privatization scheme in January 2005, by July,his approval on Social Security had dropped to 29% approve / 62% disapprove. The Washington Post also showed a similar trend over time on thoughts about the plan.
• Initially, in Social Security polling like in Medicare polling, those that knew the most about privatization plans liked them the least. Pew found in March 2005 that those who had heard a lot or some about privatization opposed it (43% favor / 49% oppose), while those who had heard little or nothing about it favored it (49% favor / 30% oppose). This dynamic portended further slippage in support for privatization as people learned more about it.

Social Security and Medicare are two different things, but generally, the more the public learns about Republican plans to dismantle the social safety net, the more apprehensive they get about those plans.

VotersAlso Soundly Reject Medicaid Cuts in Ryan Budget

The conventional wisdom about Medicare and Medicaid reads something like this:

"Voters love Medicare, which they see as health care for seniors. However, they view Medicaid as health care for low-income people, and they support it much less. Democrats win the publicly-funded health care debate by talking about Medicare, staying away from Medicaid, and hoping voters get confused between the two if they hear Medicaid at all."

However, this is wrong thinking. Democrats should strongly be making the case to support Medicaid by highlighting how it provides coverage  for 80% of nursing-home residents, as well as millions of American children.

First, most people know the difference between Medicare and Medicaid. According to a Kaiser Family Foundation poll, most Americans know generally which program does what:

• Most Americans (65%) understand that Medicare is the primary source of health insurance for seniors regardless of their income, while only 21% think that Medicaid is the primary source of health care for seniors.
• Americans also understand by a wide margin (56% Medicaid / 20% Medicare) that Medicaid is the primary source of health insurance coverage for many low-income families, regardless of their age.

o   17% of people say this role is played by "some other program"-we don't have data, but we suspect many of these people are thinking of a state brand of S-CHIP or Medicaid (e.g. PeachCare in Georgia orBadgerCare in Wisconson)

• Most voters (58%) know that Medicaid is paid for by a combination of federal and state governments. About a third combined think it is fully funded by one or the other (22% federal / 14% state).

Second, not only do voters understand Medicaid, but they also support it.Voters back current levels of spending for Medicaid almost as much as they do for Medicare, according to the same Kaiser Family Foundation poll:

For each area, please tell me if you would support major spending reductions, minor spending reductions, or no reductions as a way to reduce the federal deficit

Similarly, when the Washington Post gave a two-way choice of if they support or oppose cuts to each health care plan, they found people opposed cutting Medicare 78% to 21% and opposed cutting Medicaid  69% to 30%.

Medicaid cuts in the Ryan Budget are a massive overall drag  on voters' support of that budget when they find out about them. Our recent polling for the Herndon Alliance and Know Your Care illustrates this: when given information about the Ryan budget and its impact on health care, 63% of voters said they were very concerned by the budget's cuts to Medicaid that would impact 4/5 of nursing home residents, more than the 55% that said they were very concerned about the fact that the budget would privatize Medicare.

Why are voters so supportive of Medicaid? For one, Medicaid usage is widespread-69 million people were on Medicaid at some point in 2011, compared to 48 million on Medicare.A majority of Americans also benefit from Medicaid over their lives: in 2006, the Kaiser Family Foundation found that 57% of people under 65 years old had either been part of Medicaid in the last 20 years or had a member of their household who had. Kaiser also found that a 59% majority said in January 2011 that Medicaid was very or somewhat important to them and their family-simply put, Medicaid is widely used and relied upon.

PUBLIC POLLING