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Poll Results: Implement a State-Run Insurance Exchange, Expand Medicaid

By Dr. David C. Pate, News and Community
August 21, 2012

Earlier this month, I invited blog readers to take part in a two-question poll. I asked whether Idaho should implement a state-operated health insurance exchange, as opposed to deferring to the federal government’s plan for an exchange, and whether the state should expand its Medicaid program, at least for the next three years.

I’m sharing the results here, along with a caveat: Our sample is not large enough for statistically significant conclusions. About 140 people took part. I appreciate the participation and the very thoughtful comments participants included, and I look forward to your help with future surveys.

Insurance Exchange

In all, 142 people answered the question, “Should Idaho implement a state-operated exchange or allow the federal government to implement the exchange in our state?” 

Of those, 77.5 percent voted for a state-run exchange and 22.5 percent voted for a federally-operated exchange. 

This is remarkably close to an AARP voter poll taken before the Supreme Court decision of Idahoans aged 30-64 in which 73 percent supported a state-created insurance exchange over a federal exchange.

Small numbers of retirees, students, and unemployed people took part in our poll, but in each case they were 100 percent in favor of the state-run exchange. 

In all, 87 percent of those identifying themselves as patients favored the state-run option and 86 percent of physicians favored the state-run option, 78 percent of St. Luke’s employees or employees of another health care employer favored the state-run option, and 60 percent of employees of non-health care employers favored the state-run option. 

No group taking the poll favored the federally-run exchange by as much as a simple majority. 

The only group to favor a state-run exchange by less than 78 percent was the employees of non-health care employers. I looked to the comments for reasons why. They seemed to come down to these:

  • The federal exchange might increase the number of insurance options, which respondents thought might help bring down health insurance costs and give people more choices of insurance carriers.
  • The state is probably too late in starting up its own exchange.
There were comments about distrusting the Idaho Legislature, and the fact that insurance companies would have a role in the oversight of a state-run exchange. There also were several comments supporting a state-federal partnership, or hybrid model.

Most of the comments in favor of a state exchange centered on insurance exchanges not being a “one size fits all,” and Idaho knowing best how to operate an exchange for Idahoans.  

Medicaid Expansion

A total of 143 people answered this question: “Should the state of Idaho expand its Medicaid program, at least for the next three years?” 

Of that number, 72 percent answered yes and 28 percent voted no. For this poll question, every category of voter was split, except for the small number of retirees, all of whom voted yes. Also answering in small numbers were students, 75 percent of whom voted yes, and unemployed people, half of whom answered yes. 

In the patient category, 73 percent voted yes, while 71 percent of physicians voted yes, as did 71 percent of employees of St. Luke’s or another health care employer. Among employees of non-health care employers, 87 percent voted yes.

Most of those who commented seemed to think this was simply a cost-benefit decision, and that it made sense to get into the expansion for at least the next three years, yet concern existed as to what the costs might be after the initial three years and what would happen if the state then dropped out. 

There were many compassionate comments about the importance of helping those in need and an equal number of comments about the dangers of creating a dependency among those being served by Medicaid and concerns about overuse and abuse of the system.

One of the things that we of St. Luke’s know is that the health care delivery system is broken, it does not meet the needs of all Idahoans, and it is too costly. Comments in response to both of the questions indicate that survey participants share that opinion. 

This is why it is so important that St. Luke’s Health System succeed in its vision and strategy to improve health, improve care, and lower health care costs. We have taken steps to make this a reality, and we are writing about our journey on this blog.

Thank you for taking our poll and contributing to the discussion. It is helpful for us to receive input from our stakeholders, and we appreciate the opportunity to transform health care together with you. We will have much more to communicate over the next six months as we put many of our plans into action. It will be exciting – please follow the blog!

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.