When Gallup asked Americans how much they worry about the availability and affordability of health care, over 80% of respondents said they were either fairly or greatly worried about it. Texas voters also recognize the urgent need for health care reform. A recent LBJ-Univision Texas poll of 1,400 registered voters found that the cost of health care was a top priority that many in the state want Congress to address.
Yet, while many worry about health care affordability, Congress seems much less eager to provide legislative solutions. In part, our research shows that the lack of motivation might stem from the fact that while older voters are most affected by health care cuts, this is not necessarily what they worry about the most; it is immigration. In particular, young voters, those ages 18-29, see health care cost as the second most important issue, with 27% of this group seeing it as a vital priority in their future. Unfortunately, they also show the lowest voting rates.
Some lawmakers have agreed that cuts to Social Security and Medicare are “off the table” in these discussions, which means that all cuts will have to come from other programs, including Medicaid, the Affordable Care Act, and the departments of the Veterans Affairs and Transportation.
In Texas, one-third of respondents say they have problems paying or cannot pay any medical bills. But while discussions and back-and-forth negotiation continue, cutting benefits of this sort of social program has serious consequences for all kinds of people at risk. Unlike legislative discussions, health care cost is felt across party lines, with Republicans (27%), Democrats (32%) and independents (37%) reporting health care debt.
The LBJ-Univision poll might also show a glimpse into the reasoning behind the lack of legislation on health care. Older Texans are the most likely to report being Medicare beneficiaries (75%), compared with young adults and middle-age people (13% and 32%, respectively). However, according to the poll, despite the clear benefit to older Texans, this group is less likely to see the cost of health care as a priority (12%). On the other hand, a combined 65% of respondents saw immigration and border security as the main issue, a stark contrast to young voters (33%). That is, while young voters are not the main beneficiaries of those reforms, at the moment, they are much more concerned. Unfortunately, young voters also report the lowest levels of registration and participation.
Regardless of who sees health care costs as a priority, the economic consequences of legislative inaction are particularly dire for the population participating in Medicare and Medicaid, commonly known as “duals.” Texas ranked 28th in spending at $14,865 per dual-eligible enrollee compared with the national average of $19,811. Relatively low levels of wealth combined with protracted periods of functional incapacity among Hispanics pose challenges in states with large Hispanic populations, like Texas, that need to rely on both Medicare and Medicaid. Losing Medicaid coverage significantly puts older adults at risk of financial insecurity. It leaves low-income older adults in a precarious situation because they may have to pay for Medicare premiums and 20% of all medical costs, including physician visits and laboratory tests.
Although it may seem difficult to reach bipartisan agreements, the truth is that numerous groups across the country depend on safety-net programs. While not all voters may view health care as a top priority, young voters appear to have recognized its importance. Consequently, any endeavors to reform health care should prioritize the delivery of more affordable and equitable benefits. After all, at some point in life, everyone will require protection.
Jacqueline Angel is the Wilbur J. Cohen Professor of Health and Social Policy at The University of Texas at Austin.
Sergio Garcia-Rios is an assistant professor and the associate director for research in the Center for the Study of Race and Democracy in the LBJ School of Public Affairs at The University of Texas at Austin.