Yes, Florida Voters Oppose ObamaCare’s Medicaid Expansion

Bloomberg’s Josh Barro criticizes the James Madison Institute’s poll showing that 65 percent of Florida voters oppose implementing ObamaCare’s Medicaid expansion. Barro is mostly wrong. But even when he’s right, he’s still wrong. Disclosure: I helped JMI formulate their poll questions.

Barro complains that JMI conducted a “push poll.” His first complaint is:

It starts by priming respondents with questions about the national debt and the size of Florida’s existing Medicaid budget.

Then it gives an inaccurate description of the terms of the expansion. Poll respondents were told that Medicaid currently covers people earning up to 100 percent of the federal poverty line. That’s not true: In Florida, the limit for adults is 56 percent of FPL, and you must have dependent children to qualify.

Though Barro slightly mischaracterizes the poll question, he is basically correct, and the inaccuracy is my fault.

The folks who originally drafted JMI’s poll questions aren’t health care wonks, so they ran their questions by me. This question was originally worded the way Barro claims the final question was: “Medicaid coverage is currently available for those with incomes up to 100% of the poverty line.” I hurriedly emailed the JMI folks, “Florida does not offer Medicaid coverage to everyone below 100 percent of poverty. See page 2 and table 3 of this report. You might replace ‘currently’ with ‘generally.’” So that’s what JMI did. In retrospect, Barro is right. “Generally” gives the impression that Medicaid is available to more Floridians below the poverty line than is actually the case, and I should have offered a better edit. Mea culpa.

His next complaint is not accurate:

Respondents also heard that after three years, the state would be on the hook for “more than 10 percent” of the cost of newly eligible adults. That’s not true, either: The state’s share would be exactly 10 percent.

Under current law, for the first three years the feds pay for 100 percent of the cost of claims for newly eligible adults. They do not pay 100 percent of the administrative costs of covering those adults. States have to pick up much of that cost (as well as other costs related to other parts of the expansion). So the question is accurate and Barro is wrong. He’s not a health care wonk, though, so he can be forgiven for this one.

But Barro’s third complaint is the real doozy:

Finally, instead of asking for a straight yes-or-no answer, the pollster asked if respondents favored Medicaid expansion “even if it results in tax hikes and spending cuts.” This isn’t a poll designed to figure out how Floridians feel about the Medicaid expansion; it’s one designed to get them to say they oppose it, so the organization commissioning the poll can say it’s unpopular.

Actually, the poll ties the Medicaid expansion’s benefits to its costs, which include (but are not limited to) higher taxes and/or spending cuts. Medicaid expansion is not a benefits-only proposition. When a poll only asks voters about benefits, the results are meaningless. Yet to my knowledge, JMI’s poll is so far the only poll that has asked voters about both costs and benefits. All other polls—for example, the hospital-industry poll Barro cites—ask only about benefits, as if the costs don’t exist or shouldn’t influence voters’ evaluation of the expansion. Those polls are “push” polls, while JMI’s poll is the only honest poll in the field. Barro doesn’t complain about JMI’s representation of the costs. He’s just an economics blogger who doesn’t think costs should be part of the question at all.

And that’s why Barro is wrong even when he’s right. He’s correct that the above-mentioned Medicaid-eligibility language was inaccurate. But it was inaccurate in a way that understated both the expansion’s benefits (coverage for more Floridians) and its costs (taxes, etc.). If we had represented each more accurately, both the costs and benefits would have been higher. At the margin, as an economics blogger like Barro certainly knows, benefits decline and costs rise. So if we had represented the costs and benefits as being higher, probably even more Floridians would have voiced opposition to expansion.