Opinion: Poll shows most groups prefer state control of health care

The Georgia Capitol, not the U.S. Capitol, is where control over an issue like health care belongs. (AJC Photo / Bob Andres)

In Tuesday’s post about the Graham-Cassidy health bill, I argued the biggest gain from passing the bill would be shifting more health policy out of the federal level, where it is destined to remain intractably contentious, to the states. Turns out, that’s the most preferred option for the public as well.

One of the findings of a new poll for Morning Consult and Politico is that Americans generally don’t want to give more control over health care to the private sector or the federal government. But they do generally support giving more control to the states. Here’s the breakdown:

  • On whether they generally support giving more or less control on the health-care system to the private sector, 28 percent said more and 32 percent said less — a gap of minus-4 points.
  • Regarding the federal government, 26 percent said more control and 39 percent said less control — a gap of minus-13 points.
  • Regarding state governments, 33 percent said more and 27 percent said less — a gap of plus-6 points.

The federal government was also the least likely to have respondents say it should have about the same amount of control it has now: just 21 percent, compared to 24 percent for the private sector and 26 percent for state governments.

The cross-tabs show why the latter is likely the only change of direction that would prove durable. Poll respondents who identified themselves as Democrats were minus-27 points on giving more control to the private sector and plus-13 points on giving more control to the federal government. Self-identified Republicans were the opposite: plus-20 points for the private sector, and minus-37 points for the federal government. In both cases, an ideological predisposition to each option is strong — there’s more than a 45-point swing between the parties on each of those choices — and unlikely to change. (Independents were down on both options: minus-4 for the private sector and minus-17 for the federal government.)

But when it comes to giving more control to the states, all three groups were positive: Democrats plus-9, independents plus-6, Republicans plus-5. It was the preferred option of those who say health care is their No. 1 issue, and it was the top choice in all four regions of the country (Northeast, Midwest, South and West), for every racial/ethnic group, and at every income level except one (those who earn more than $100,000 per year would prefer the private sector take more control).

Given the contentiousness the Obamacare and now anti-Obamacare debates have generated, it’s pretty remarkable to see that kind of consensus for a direction for health-care policy. The bottom line appears to be that people have more confidence in their state governments to do the right thing by them when it comes to health care than either private companies or Washington. As a practical matter, that probably means we would have a mix of states that choose less centralized, more market-oriented systems and states that choose the opposite. Which is probably a better and less volatile outcome than trying to make 320 million people move in either of those directions all at once.

I should note here that Graham-Cassidy does not take a full step in the direction of federalism. Washington would still be distributing much of the money and would retain say-so over how much states could deviate from the Obamacare status quo. The bill would be improved by, among other things, taking away so much discretion for the secretary of Health and Human Services to deny state waivers to Obamacare’s regulations.

But even pointing us in the correct direction makes this bill markedly better than what we have now.

Reader Comments 0

156 comments
peyaxeb
peyaxeb

$89 an hour! Seriously I don't know why more people haven't tried this, I work two shifts, 2 hours in the day and 2 in the evening…And i get surly a chek of $1260......0 whats awesome is Im working from home so I get more time with my kids.Here is what i did??????see more information>>>>>>>>>> >>>>$$$$$

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Kathy
Kathy

The only people getting 'entitlements' is Congress and their millionaire friends. Free plane rides all over the world. And, who knows how many vacations. All citizens pays taxes every time they go to a store, make a purchase, etc.

darbyisone
darbyisone

If left up to the states, coverage for pre-existing conditions would be a joke.  The Ga Legislature cannot even decide on whether everyone in Georgia should have two or twenty guns!!!!!  Pre-existing conditions would not even be recognized by the present Georgia Legislature.

ATLAquarius
ATLAquarius

Kyle


Not trying to be snarky here....but in any scenario do you see our conservative state government either universally covering everyone or willingly expending more dollars on healthcare? Remember that beyond insurance there is already a hospital crisis in rural Georgia due to the inadequacies of Medicaid funding....is the state really going to address the root of that issue? I see a race to the bottom where you have insurance that doesn't cover anything of note (unless your employer is so generous) and where the full financial burden is shifted back to the consumer who will ultimately be overwhelmed by the intricacies of making a sound decision of said insurance due to complexity or catastrophic injury/illness and has no buying power to negotiate drug prices. Now you may say that the federal government has no constitutional authority to dabble in that (SSDI, Medicare, Medicaid, and Tricare nonwithstanding) but the idea that the consumer will not suffer due to this ideology misses the point. Do the feds get right all the time? Absolutely not. Does the state of Georgia care to pick up the slack? I am thoroughly unconvinced. This is too serious of a subject to handle in the way it is currently being handled and is akin to trying to solve traffic congestion by telling people to telecommute. Government will have a real role to play in this and I'm not sure the conservatives are being realistic about that.

Hedley_Lammar
Hedley_Lammar

The GOP replacement plan polls at around 10 - 15 % support. Americans dont want it.


Honestly Trump doesnt care about any of this. He has two goals here


1. Undo anything the black Muslim President accomplished. 


2. Support any repeal plan that will make him and his NYC Wall St buddies millions.


If millions of Americans are hurt in that process so be it.

BeOfService
BeOfService

Clearly, Republicans are going to prefer state control in Republican states, and vice-versa.  As a liberal I certainly do not want the redneck power brokers at the GA statehouse having more control than they do now.  This is the group that refused to accept HUNDREDS of MILLIONS of dollars for Medicaid expansion because it had been touched by Barack Obama's hands. 

Visual_Cortex
Visual_Cortex

@BeOfService

you forgot to add, "and because they are psychopaths who take pleasure by inflicting harm to others."

SGTGrit
SGTGrit

The left's angst is reaching a fever pitch. If the Graham/Cassidy bill passes congress and gets to Trump, their heads will explode.

DeepStateDawg
DeepStateDawg

@SGTGrit Not really. 


IMHO, the 2nd best thing would be for the GOP to do something like they're doing; in a rush, in secret, with no hearings and no budget scoring. 


Of course the best option, which would be to repeal it outright. 


In either case, millions of Americans will get a better read on the situation in reality, as opposed to the overheated rhetoric coming out of the Right. 


We'll see. 

Eye wonder
Eye wonder

Mueller. Inching closer to Pres Lyingscumbag every day.

You know what happens with some things that go “tick tock”? Eventually they go “kaboom.”

Activist
Activist

I worked with the state legislature my entire career on health care and I can tell you that the "oh let's just let the states handle it" may sound good but it's not a viable solution. Do you people having to move in order to get the health care they need? Do you realize that states will still be dependent on the federal government for an appropriation? This means it will still be hotly debated in Congress. The amount of money being appropriated now is not adequate. There are thousands on waiting lists for Medicaid waiver programs. And what about when Medicaid is eliminated, as planned under this bill? The state will have to either raise taxes or let people die. In fact, the CBO stated in their last report on the impact of Trumpcare that savings would occur due to premature deaths. These are just a few of the many, many issues that need to be considered.

As someone who has worked on implementing legislation I can tell you that the more time that goes in to thoughtfully and thoroughly writing legislation and considering its impact, the better off we all will be. This bill is being rushed through without opportunities for governors, seniors, health care professionals and many others to share how various options will affect them and make recommendations. A bill like this that affects every American deserves to be studied and vetted from every angle. As the president said, its complicated, and there are no easy or simple solutions.

Visual_Cortex
Visual_Cortex

@Activist

may sound good

yeah, to whom?

Sounds like sheet-wearin' "States Rats" garbage to me. No surprise it only gets 33% approval in this poll, which is supposed to be supportive of this bloody abortion of a bill.

jhgm63
jhgm63

@Activist It will end up like any other block grant program. The money will end up in the hands of the most needy (greedy) donors ...

BeOfService
BeOfService

@Activist I agree 100%.  "Let the states deal with it." is just kicking the can down the road, and in most cases just handing it over to the good old boys to play with (siphon off).

Visual_Cortex
Visual_Cortex

 Jimmy Kimmel is an ignorant liar.

Kimmel has outlined what's FUBAR about Miss Lindsey's bill better than any TeeVee pundit I've seen or heard so far. He's got your side pegged.

As for "ignorant liars," you're thinking of Cassidy, the guy who's getting deservedly pounded for being such a pathetic BS artist.

Patiently documented here, in typical PolitiFact style that bends over backwards to make right wingers seem far saner and less psychopathic than they really are.

http://www.politifact.com/truth-o-meter/statements/2017/sep/20/bill-cassidy/bill-cassidy-offers-misleading-defense-face-jimmy-/

breckenridge
breckenridge

Robert Mueller certainly has a long shopping list of documents he is interested in. If Andy were still around the death threats would be flying all over the place.

DonJM
DonJM

Republicans are trying to pass this bill too fast, with no discussion or debate.  And with no score from the CBO.  Too many people's lives will be affected for this bill to be passed this quickly with so little knowledge of what its impact will be.  The Republicans are trying to do this strictly for political purposes. 

TomGaff
TomGaff

@DonJM Exact same thing the DEMS did with OBama Care. Payback is a B, right!

BuckeyeGa
BuckeyeGa

This rush job and secrecy should alarm people

DonJM
DonJM

@TomGaff @DonJM Not true.  The ACA had many committee hearings and was fully debated for over a year before it was passed.  And it was scored by the CBO.  Telling such an obvious lie, which is so easily disproven, proves you're not exactly the sharpest knife in the drawer.

RoadScholar
RoadScholar

@DonJM But but but the repubs talked to their big donors! What could go wrong?

Visual_Cortex
Visual_Cortex

@TomGaff @DonJM

Absolute lie.

And you've been told this time and time again and still you spread this BS. The PPACA was debated over the course of a year, went through committee hearings, Republicans were able to add amendments, etc.

Y'all doing this just so you can claim you "did something," damn the consequences, damn 1/6 of the economy being altered so that a few elected Republicans could claim they'd kept some stupid promise that the vast majority of Americans do not want them to keep.

Billisnice
Billisnice

Everyone that buys stuff or pays taxes pays for others care. Federal, State and WallyWorld workers. Time to use that money to help you buy healthcare not others. 

Takit Itzfre
Takit Itzfre

@RoadScholar @Billisnice Why should I have my hard earned money taken from me in order to help pay for the costs of others healthcare, in addition to the many other things that the entitlement class already takes?

JohnA1
JohnA1

Ask anyone who gets medicare if they are happy and you will get near unanimous approval.  The federal government keeps your mother and father well.  Doctors  are happy because they get paid,  kids who have autism get treatment,  Lets look at people not the almighty buck.  I have no idea where kyle gets his numbers from,  but one thing is sure he does not mention any thing about people and their healthcare.



Billisnice
Billisnice

@JohnA1 I doubt it happening. Why? Wall Street healthcare makes congressmen millionaires fast and congress is greedy. 

Billisnice
Billisnice

Congress want states to cut healthcare for millions hoping not to blame them. 

Billisnice
Billisnice

@Wascatlady @Billisnice In the end GOP states will receive junkcare knowing their jobs are secure and Democrat states will receive excellent healthcare.

Wascatlady
Wascatlady

Apparently the people surveyed are too young to remember how well the states handled the right to vote (literacy tests, poll taxes, requirement for students to buy their textbooks), equality of educational funding (white schools got new books, black schools got worn out or no books; new schools in white neighborhoods, falling-apart schools in black neighborhoods.)


This would be more of the same.


Disgusting!

SGTGrit
SGTGrit

Jimmy Kimmel is an ignorant liar. Does this television personality/fool think he's the only one who has had a son or daughter in dire heath conditions. Fortunately, Kimmel and other far more reasonable people are the receivers of the best healthcare in the world.

Starik
Starik

@SGTGrit  It is not the best healthcare in the world until it's available to everybody. The infant mortality and life expectancy numbers prove it. 

breckenridge
breckenridge

@SGTGrit 

You sound very angry. But I have noticed your demonizing of the left has been reduced since Trump made the Dreamer deal with the Dems. 

Donald Trump.  Not a republican.  Not a democrat.  But he is a draft dodger.

TomGaff
TomGaff

@breckenridge @SGTGrit A lot of people chose not to go in the military.  All are not shamed by the ones that did go in. Did you Mr Breckenridge? Tom Gaff, USAF, Viet Vet 1965-69

Starik
Starik

How to pay for single payer? Take the money we currently spend on Medicare, Medicaid, the VA system, insurance premiums for individuals, insurance premiums for businesses, plus pay more reasonable prices for drugs, hospital care, and all the other aspects of medical care. That would be a start.  

viraavi
viraavi

Once single payer comes into effect 500 billion dollars to the insurance companies would vanish. Those politicians who oppose single payer system are on take with the insrance companies. It's not rocket science, folks.

JohnnyReb
JohnnyReb

AvgGeorgian writes-- So is Medicare 3rd rate? And is it okay for other folks to pay your health care ins. costs?

It really gets my attention when someone tries the line that if one is on Medicare others are paying for his insurance as if it is similar to Obamacare or single payer.

Nothing could be further from the truth.

I paid toward Medicare from the time I was 16 until 65 never missing as I was fortunate to never be unemployed.

I pay a penalty or surcharge now to be on Medicare based on my income - means testing.

I pay for a supplemental policy so that services resemble pretty much what I had under employer insurance.

So no, I don't feel guilty because someone else is not paying for my insurance/medical costs.

I paid, I still pay because besides the above I still draw a paycheck with the standard deductions just like others, and it will hopefully be years before it even comes close to costing taxpayers what I contributed all those years.

Starik
Starik

@JohnnyReb  So why not extend something like Medicare to everybody? I prefer Medicare advantage, which resembles single payer, and it's even better. 

SGTGrit
SGTGrit

@Starik @JohnnyReb 

No single payer doesn't resemble Medicare Advantage at all. Why you ask, well because you pay for your Medicare Advantage as an individual choice.. It isn't a true entitlement. You say everyone will need to pay for a single payer. You bet and the population here in America won't tolerate it. The quality of healthcare will degrade because providers will become sub-par and we'll end up with a downgraded Medicaid for all system.

AvgGeorgian
AvgGeorgian

@JohnnyReb

You are a silly Reb.

If your family is deep in debt having spent all the mortgage money, utility money, grocery money, car payment money, emergency fund money, college fund money, vacation money, 401k money, and you are borrowing money each month to supplement your paycheck to pay the bills, is there really money in the college fund, or retirement fund etc. to pay for those commitments? 

Money comes out of the general fund each month to pay medicare. There is no medicare account full of money. There are medicare deductions from payroll paid in each month that have to be supplemented by the general fund.

Wascatlady
Wascatlady

@Starik @SGTGrit @JohnnyReb Which the rest of us pay for by our own bills being jacked up to cover it.


I had a 4 minute MRI (no contrast) the other day.  It cost $8000.