Americans Prioritize Strengthening Medicaid and Medicare

As Congress works toward passing a budget reconciliation plan, lawmakers are considering massive cuts in federal financing for programs that provide health care to millions of Americans, such as Medicaid. Any cut in federal funding for Medicaid will force states to make tough decisions about whether to disenroll people, curtail enrollee benefits, reduce provider payments, increase state dollars to the programs, or some combination of those options.

A recent survey conducted by the Rollins School of Public Health and Gallup finds Americans across all subgroups rank improving health care access and affordability as a top public health priority. And Americans rank strengthening safety net health programs, such as Medicaid, Medicare, and community health centers as one of the leading priorities for government leaders out of a list of 15 different public health issues. Overall, 28% of Americans said these safety net programs should be a top-three priority for government leaders. Rollins released the topline results from the survey February 4.

Medicaid, Medicare Critical to Addressing Americans’ Top Public Health Priority

With one in four selecting health care access and affordability as their highest priority, and more than half (52%) rating access and affordability in their top three priorities, it is important to understand the role safety net programs play in the health insurance coverage mix in the United States.

Medicaid provides health coverage to low-income adults (most of whom are working), older adults, people with disabilities, and pregnant individuals. In addition, Medicaid is the single largest insurer of children in the US, providing coverage for 39% of the nation’s children. Medicare offers health care to about 67 million people in the US.

“Established in the 1960s, the program was designed to provide coverage for those who might otherwise fall through the cracks,” says Stephen Patrick, MD, chair of the Department of Health Policy and Management at Rollins “It operates as a federal-state partnership, with federal funding allocated based on a state’s average income.”

Patrick points out that poorer states stand to lose the most from federal cuts to Medicaid. “In wealthier states like Massachusetts, the federal government matches each state dollar spent on Medicaid, while lower-income states like Georgia receive $3 in federal funds for every $2 they contribute. As a result, cuts to Medicaid would hit poorer, Southern states the hardest, and disproportionately affect the nation’s children.”

Safety Net Programs Could Help What Americans See as Biggest Public Health Problems

In the survey, Rollins and Gallup asked Americans which areas of public health the US has made progress, lost ground, or has not changed in over the past 10 years. The two issues that Americans think we’ve lost the most ground on — the opioid epidemic and mental health — are areas that the government and public health practitioners could address further through strengthened safety net programs. And these public health problems could stand to get worse if those programs are cut as many Americans depend on them for access to medications and treatment for substance use disorder and mental health care. Forty percent of opioid treatment in the U.S., for instance, is funded by Medicaid.

Older Americans, Those with Lower Incomes Most Concerned about Medicare, Medicaid

More Americans aged 65 and older and those with an annual income of less than $48,000 prioritize strengthening safety net programs as a top public health priority. Strengthening safety net programs is statistically tied for the second highest priority for older Americans, with 36% ranking it in their top three. And safety net programs are also tied for the second highest priority for Americans earning less than $48,000 annually, with 35% ranking it in their top three.

Additionally, those living in the Northeast are concerned about strengthening safety net programs — with 36% ranking the issue among their top three priorities.

Percentage of Americans Who Chose Strengthening Safety-Net Programs as First, Second, or Third Highest Public Health Priority

Strengthening safety net programs is among the top issues that Americans of all ages, races, and geographic regions want government leaders to prioritize. It is critical that Congress understand the views of the American public about key programs, including Medicaid and Medicare, that its budget legislation is looking to change.

Methodology

Results in this report are based on self-administered web interviews conducted Dec. 2-15, 2024, with U.S. adults aged 18 and older who are members of Gallup’s probability-based panel. For results based on the total sample of 2,121 adults, the margin of sampling error is ±3 percentage points at the 95% confidence level. Sampling error varies for different survey items based on the total number of respondents who saw and responded to each item. Survey sample weights were applied to all results to correct for unequal selection probability and nonresponse rates. Samples are weighted to match the national demographics along the following dimensions: gender, age, race/ethnicity, education, and region. All reported margins of sampling error include the computed design effects for weighting. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls. These sources of error were minimized through several iterations of survey design choices and by following Gallup’s best practices for survey administration.