Poll by hospital, pharmacy groups finds voters opposed to managed care

A survey of voters by the Arkansas Hospital Association and the Arkansas Pharmacists Association found most Arkansans opposed to moving the state’s Medicaid population to a managed care system, both before and after they are given information about the model.

Managed care is a model where a private company assumes responsibility for Medicaid services under contract with the state. It makes money if it does so efficiently and can lose money if it doesn’t. Legislators are considering using such a model for certain aspects of Medicaid, the government program that funds health services to lower-income residents, the disabled and the aged. A task force is meeting March 7 to vote on legislation that will be included in a health care special session slated to begin in April.

The two associations surveyed 453 respondents Feb. 25-26 using an automated system, all by landline. Forty-four percent of respondents said they and/or someone with whom they are close are enrolled in Medicaid.

Asked at first if they “support moving the state’s Medicaid system to managed care,” 15% said yes and 37% said no, while 12% were neutral and 37% did not have enough information. Democrats were more likely to say they were opposed, while Republicans were more likely to say they lacked information.

When respondents were given what the associations said was a neutral explanation about managed care, 10% said they supported the concept and 42% were opposed. Only 221 respondents answered that question. Respondents also were presented arguments that would support the idea of managed care, and then arguments that would oppose it.

Support increased when respondents were told, “Managed care companies are very efficient at finding cost savings, and are the state’s best chance at reducing climbing Medicaid expenses. Some estimates say that managed care could save Arkansas tens of millions of dollars per year.”

After hearing that argument, 40% were much more or somewhat more likely to support, while 40% were somewhat or much less likely and the rest were neutral or unsure.

Less effective was the argument that, “Putting an insurance company in charge of healthcare creates profit incentives to make our healthcare system more efficient. Meanwhile, the government’s role in Medicaid would be smaller than ever, limited to managing contracts and ensuring a high quality of care.”

After hearing that argument, 32% were much more or somewhat more likely to support, while 50% were somewhat or much less likely.

Support for managed care dropped when respondents were given arguments against the concept. Respondents were told, “A managed care program would severely limit doctors’ ability to decide what’s best for their patients. The insurance company’s profit would be more important than giving a patient the best possible care.”

After hearing that argument, 15% were much more or somewhat more likely to support, while 69% were somewhat or much less likely.

Respondents then were told, “Shifting public dollars to private managed care companies would make the big business of health care even bigger and create huge payouts for private companies and CEOs that aren’t even based in Arkansas.”

After hearing that argument, 14% were much more or somewhat more likely to support, while 70% were somewhat or much less likely and the rest were neutral or unsure.

Afterward, respondents were asked, “Given what you’ve heard today, would you support moving the Arkansas’ Medicaid population to managed care?” The results were:
• Strongly support, 12%
• Somewhat support, 17%
• Somewhat oppose, 17%
• Strongly oppose, 37%
• Neutral, 9%
• Unsure, 9%

Strong majorities of Democrats and independents opposed managed care at the end of the survey. Among those who said they lean Republican, 38% strongly or somewhat support the concept, while 47% strongly or somewhat oppose. Among more committed Republicans, 29% said they strongly or somewhat support managed care, while 43% somewhat or strongly oppose it.