Costs are top health care issue for midterm voters, but fraud tops GOP list

Health care costs top the list of voters’ health care priorities for the midterm elections, with half (51%) of all voters and more than half of Democratic (60%) and independent (55%) voters saying the issue is extremely important for candidates to discuss, according to a new KFF Health Tracking Poll.

At the same time, Trump administration statements about and actions targeting suspected health care fraud appear to be registering with Republican voters—more than half (55%) of whom say it is extremely important for candidates to discuss fraud in government health programs.

Most voters say there is at least “some” fraud in government health programs, but larger shares say there is fraud in other areas of government.

About half of all voters say there is “a lot” of fraud in the federal tax system (52%); federal military and defense contracts (46%); and foreign aid programs (46%).

Smaller shares of voters say there is a lot of fraud in Medicaid (40%); Medicare (36%); and the Affordable Care Act (ACA) Marketplaces (29%).

Compared with the other areas of government asked about in the survey, fewer voters (29%) say there is a lot of fraud in the ACA Marketplaces—though nearly half of Republican voters (47%) say a lot of fraud is occurring there.

Trump administration officials have attributed this year’s drop in ACA enrollment to their efforts to combat fraud, rather than the expiration of the enhanced tax credits that made coverage much more costly for some Marketplace enrollees.

Partisan divisions also emerge over fraud in other health care programs, including Medicaid and Medicare, with Republican voters more likely (62% and 54%, respectively) than Democratic (21% and 19%) or independent voters (39% and 38%) to say there is a lot of fraud.

Across party affiliations, however, voters are much more likely to attribute fraud in Medicaid and Medicare primarily to health care providers rather than individual patients, but about 3 in 10 are not sure who is primarily responsible.

About half of Democratic, Republican and independent voters say providers are mostly responsible for fraud in these programs, compared with between 1 in 10 and 3 in 10 who say patients are mostly responsible.

Voter perceptions of federal fraud actions in Medicaid

The Trump administration has launched sweeping fraud, waste and abuse initiatives across all 50 states and taken targeted actions—including deferring federal Medicaid payments and decertifying fraud control units—that have so far mostly focused on Democratic–led states.

Asked about the potential impact of deferred Medicaid payments, voters are much more likely to say these actions will harm beneficiaries and unfairly target states based on politics than reduce fraud or lower costs.

When asked to choose, most voters (71%) say ensuring Medicaid beneficiaries can access the care they need should be a higher priority than reducing fraud, even if it means some fraud may occur.

Republican voters are closely split on this trade-off, with about half (52%) saying access to care should be a priority and half (47%) saying preventing fraud should be a priority, even if it harms access for some eligible people.

Three-fourths of voters (77%) say delayed federal payments to state Medicaid programs would likely cause some eligible low-income people to lose access to health care services, including majorities of Democratic (89%), independent (81%) and Republican (61%) voters.

Nearly two-thirds of voters overall—including large majorities of Democratic (89%) and independent (70%) voters—say the Medicaid deferral approach is motivated by politics, while most Republicans (69%) say it is mostly motivated by protecting Medicaid.

Meanwhile, voters are evenly split (50% versus 50%) over whether delaying federal funding to states is likely to significantly reduce fraud, and fewer than half of voters across party affiliations say it is likely to lower health care costs for people like them, including 46% of Republican voters and smaller shares of independent (25%) and Democratic (26%) voters.

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Sadie Harley

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Andrew Zinin

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