The Public’s Views on Potential Changes to Medicaid | KFF

Key Takeaways

• As Congress considers changes to the Medicaid program as part of budget conversations, the latest KFF Health Tracking Poll finds that fewer than one in five adults (17%) want to see Medicaid funding decreased, and most think funding should either increase (42%) or be kept about the same (40%). Majorities of Democrats, Republicans, independents, Trump voters, and adults living in rural areas say Medicaid funding should either increase or be kept about the same, though about one-third of Republicans want spending to decrease. The public’s staunch opposition to Medicaid cuts likely reflects the fact that most people have a connection to the program. About half (53%) of adults, including a similar share of those living in rural areas, say they or a family member has received help from Medicaid at some point. This includes about four ten Republicans (44%) and those who voted for President Trump in 2024 (45%). Regardless of whether they have a connection to the program, nearly all (97%) adults say Medicaid is at least somewhat important for people in their local community, including three-quarters who say it is “very important.” Large majorities across partisans, those who voted for President Trump in 2024, and adults living in rural areas say the program is “very important” for their local community. Most of the public also says Medicaid is important to them and their families, including four in ten Republicans and those who voted for President Trump in the 2024 election. Recent KFF focus groups of Medicaid enrollees further emphasize the program’s importance to people and their families.
• Cuts to federal Medicaid funding could have significant impacts on rural hospitals and providers, where many residents already face limited access to care. One third (34%) of rural residents say there are not enough hospitals in their community to serve local residents, while about half say there are not enough primary care providers (49%) and about seven in ten say there are not enough mental health providers (67%) or specialists (71%) in their community.
• While Republicans in Congress have yet to put forth a bill specifying the changes they would make to Medicaid, some of the options that have been discussed include implementing work requirements and scaling back the Affordable Care Act (ACA)’s expansion of Medicaid. Overall, about six in ten (62%) adults support work requirements, which would require nearly all adults to be working or looking for work in order to have health insurance through Medicaid, while a majority (59%) oppose eliminating the 90% federal match rate for adults covered under the ACA Medicaid expansion. However, public opinion on both proposals is malleable when people hear arguments or are given more information.
• For example, a majority (62%) of the public incorrectly believe that most working-age adults on Medicaid are unemployed, and some people change their views on imposing work requirements when they hear about the potential implications. Overall support for work requirements drops from 62% to 32% when those who initially support the proposal hear that most people on Medicaid are already working and many would risk losing coverage because of the burden of proving eligibility through paperwork. Overall support also drops to 40% after supporters hear that there would be an increase in state administrative costs to oversee the work requirement. On the other hand, when opponents of work requirements hear the argument made by supporters that imposing such requirements could allow Medicaid to be reserved for groups like the elderly, people with disabilities, and low-income children, support for work requirements increases from 62% to 77%.
• Views on eliminating the 90% federal match rate for the ACA Medicaid expansion are also somewhat malleable when more information is presented. When supporters of the proposal hear that most states wouldn’t be able to make up the funding and that 20 million people would likely become uninsured as a result, overall support drops from 40% to 24%. On the other hand, when opponents of the proposal hear that it would reduce federal spending by $600 billion over ten years, support increases somewhat from 40% to 49%, with 50% overall continuing to oppose the proposal.
• As Republicans and President Trump continue to claim that Medicaid won’t change beyond addressing “waste, fraud, and abuse” and falsely assert that undocumented immigrants are on the program, public confusion about who is covered by Medicaid and what services it covers persists. Slightly less than half (47%) of adults are either unsure or incorrectly believe undocumented immigrants are eligible for health insurance programs paid for the federal government, although they are not. Additionally, most of the public does not know that Medicaid pays for nursing home care and other extended long-term care services for low-income, elderly, and disabled people.

Views on Medicaid Spending and Importance

As the debate over potential changes to Medicaid continues in Congress, the latest KFF Health Tracking Poll finds that fewer than one in five (17%) say they want to see Medicaid funding decreased. In fact, most people say funding for Medicaid should either increase (42%) or stay about the same (40%). A majority of Democrats (64%) want Congress to increase spending on Medicaid, as do about four in ten independents (39%). Support for decreasing Medicaid spending is somewhat higher among key groups of President Trump’s supporters, but still about two-thirds (65%) of Trump 2024 voters, and two-thirds (67%) of Republicans want spending to increase or be kept about the same. About three in four total rural residents (77%) say funding should increase or stay the same, as do two-thirds (66%) of rural Republicans.

While many Republicans legislators, President Trump, and Elon Musk have said changes to Medicaid will help root out “waste, fraud, and abuse” and make the program “more effective and better,” about three times as many people think the changes under consideration are more about “reducing federal government spending” than “about improving how the program works for people” (75% vs. 23%). Notably, this view is held by a majority of those who say they voted for President Trump in the 2024 election (57%) as well as majorities across partisans, though Democrats and independents are much more likely to say the changes are about reducing federal spending (88% and 78%, respectively) than Republicans (59%).

Opposition to a reduction in federal spending on Medicaid may reflect the fact that most people view Medicaid as important for their families and communities and most have a personal connection to the program. Nearly all (97%) adults say Medicaid is at least somewhat important for people in their local community, including about three in four (73%) who say it is “very important.” This includes majorities across partisans, Trump voters, as well as those with and without a personal connection to the program. Among those living in rural areas, three in four (75%) say Medicaid is “very important” for people in their local community– including about two in three Republicans (64%) and those who voted for President Trump in 2024 (66%).

A majority (56%) of adults also say Medicaid is important for them and their family, including about a third (35%) who say it is “very important.” Among those who are currently enrolled in Medicaid or have a family member who is, about nine in ten (89%) say it is “very important” or “somewhat important” or them and their families. Overall, about four in ten (42%) adults who voted for President Trump in the 2024 election say Medicaid is important for them and their family, as do a similar share (44%) of Republicans. Among Trump voters and Republicans living in rural areas, similar shares say the same.

Most adults report some level of connection to the Medicaid program. More than half (53%) of adults say they (18%) or a family member (35%) have received help from Medicaid at some point. An additional 13% say a close friend has been covered by the program. Substantial shares of Democrats (52%), independents (57%), and Republicans (44%) say they or a family member has ever been covered by Medicaid, as do substantial shares of those who voted for President Trump (45%) and former Vice President Harris (51%), and those who live in rural areas (54%).

KFF analysis finds that a reduction in federal spending on the Medicaid program will likely have widespread implications, such as losses in coverage and problems for state budgets. Cuts to Medicaid could also lead to hospitals closing, fewer providers taking Medicaid insurance due to reductions in their payment rates, and other implications for how people access care in their communities, particularly for those living in rural areas. These implications come at a time when substantial shares of adults overall, as well as those with a current connection to Medicaid and those living in rural areas say there are not enough hospitals and providers to serve their communities.

Three in ten (29%) adults overall, including 34% of those living in rural areas, say there are not enough hospitals to serve local residents in their communities. Even larger shares say there are not enough mental health providers (59%), specialist doctors (48%) and primary care doctors (39%) to serve their community’s needs. In rural areas, about half say there are not enough primary care providers (49%) and about seven in ten say there are not enough mental health providers (67%) or specialists (71%) in their community.

Work Requirements

Beyond a general reduction in federal spending on Medicaid, Republicans in Congress have discussed other changes to the program, including work requirements, which would require nearly all adults to be either working or looking for work in order to have health insurance through Medicaid. Although analysis has shown that most working-age adults on Medicaid are already working, about six in ten (62%) adults think most people in the program are unemployed. Fewer, about four in ten (37%), are aware most people in the program are working. Large shares across partisans are unaware that most working-age adults on Medicaid are already working including half of Democrats (50%), six in ten independents (60%), and three-quarters of Republicans (77%) and Trump voters (76%).

The latest KFF Health Tracking Poll finds substantial initial support for Medicaid work requirements but also finds that attitudes towards imposing work requirements are malleable when people are presented with more information. Overall, about six in ten (62%) adults say they support Medicaid work requirements, while about four in ten (38%) oppose. Majorities of Republicans (82%) and independents (60%) support such a requirement, while Democrats are more split (47% support, 53% oppose).

As Republicans in Congress consider instituting work requirements for Medicaid, polls can help illustrate how public opinion may change as the public debate unfolds and they begin to hear arguments both in favor and against such requirements. For example, when those who support work requirements hear that most people on Medicaid are already working and that many would be at risk of losing coverage because of paperwork challenges, about half change their view and now say they oppose Medicaid work requirements, dropping overall support for work requirements roughly in half, from 62% to 32%.

Hearing that work requirements would not have a significant impact on employment but would increase state administrative costs also changes views, but to a lesser extent. After supporters hear this argument, support drops to 40%, while 60% overall are now opposed.

On the other side, when those who initially oppose work requirements hear the argument made by supporters that this policy could allow Medicaid to be reserved for groups like seniors, people with disabilities, and low-income children, most say they still oppose the policy, but some change their opinion, increasing total support for work requirements from 62% to 77%.

Elimination of Federal Match Rate Under ACA Expansion

In addition to the implementation of work requirements, another prominent proposal to reduce federal spending on Medicaid is to eliminate the enhanced 90% federal match rate for adults covered under the Affordable Care Act (ACA) Medicaid expansion. KFF analysis estimates that the elimination of the enhanced federal match rate would likely lead to losses in coverage for 20 million Medicaid enrollees or would result in a substantial increase in state Medicaid spending to make up for a reduction of more than $600 billion in federal government spending.

About six in ten (59%) adults say they oppose reducing the share that the federal government pays for Medicaid expansion coverage, while four in ten (40%) support this. Majorities of Democrats (81%) and independents (65%) oppose this proposal, whereas a majority of Republicans (64%) support it. These views may be, in part, a reflection of partisan views on the ACA itself. KFF Health Tracking Polls have consistently found that most Republicans have an unfavorable view of the ACA, while most independents and Democrats view it favorably.

Hearing arguments for and against eliminating the enhanced federal match rate under ACA expansion causes some people to change their views. When those who support the reduction in the federal government’s contribution hear that most states wouldn’t make up the rest of the funding and that 20 million people would lose coverage, about four in ten change their view, dropping overall support for the change from 40% to 24%. When opponents of the proposal hear that it would reduce federal spending by $600 billion over ten years, about one in six change their view, increasing overall support to about half (49%) of the public, while 50% remain opposed to the change.

Medicaid Knowledge

Despite Medicaid’s reach, there is still some confusion about what the Medicaid program covers and who is on it. Most (71%) adults know that Medicaid is the primary source of health insurance for low-income people, including similar shares of Democrats and Republicans. However, about one in six (15%) confuse Medicare (the government program for adults 65 and older, and some younger adults with long-term disabilities) for Medicaid. And a majority (62%) of the public are either not sure or incorrectly believe Medicare or some other program pays for nursing home care and other extended long-term care services for low-income, elderly, and disabled people, when in fact, Medicaid covers these services and is the primary payer for over six in ten residents in nursing facilities.

In addition, some misinformation about who is covered by Medicaid persists. While the belief that undocumented immigrants are receiving free health care from the federal government circulated prior to the new administration coming into office, it has gained new prominence amid Republican talking points about rooting out fraud and abuse in government programs, including Medicaid. In recent KFF focus groups among Medicaid recipients, some participants who voted for Trump suggested that proposals to reduce Medicaid were part of the crackdown on illegal immigration and aimed at removing undocumented immigrants from the program.

The latest KFF Health Tracking Poll finds that slightly less than half of adults are either unsure (28%) or incorrectly believe (18%) that undocumented immigrants are eligible for health insurance programs paid for the federal government, although they are not. Republicans are more likely than Democrats to incorrectly believe undocumented immigrants are eligible for federal health insurance programs (21% vs. 14%), though similar shares across partisans correctly answer that they are not eligible.