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Paragon Health Policy Survey 2025

Paragon Health Institute

Paragon tested the key proposal contained in our report, Medicaid Financing Reform: Stopping Discrimination Against the Most Vulnerable and Reducing Bias Favoring Wealthy States, and American voters overwhelmingly support it.

Public Opinion Strategies surveyed a representative set of 1,000 registered voters from across the country. The results provide encouraging news for reformers committed to improving health programs serving the most vulnerable while making commonsense reforms.

February 25-March 2, 2025
N=1,000 Registered Voters
Credibility Interval: ±3.53%

* Denotes result under 0.5%.
^ Denotes rounding. Due to rounding, some figures may be higher or lower by less than one-half of one percent.

In which state do you live?

21%NORTHEAST
5%NEW ENGLAND
16%MID ATLANTIC
21%MIDWEST
16%GREAT LAKES
5%FARM BELT
35%SOUTH
16%DEEP SOUTH
19%OUTER SOUTH
24%WEST
7%MOUNTAIN
16%PACIFIC

All Participants indicated that they were registered to vote.

Please record your gender.

48%Male
52%Female

All Participants indicated that they, or someone in their household, were not employed by a newspaper, television or radio station, or by a political party or a candidate for office.

In what year were you born?

5%18 - 24
20%25 - 34
16%35 - 44
14%45 - 54
19%55 - 64
25%65 AND ABOVE

Generally speaking, would you say that things in the country are going in the right direction, or have they pretty seriously gotten off on the wrong track?

43%Right Direction
57%Wrong Track

Do you approve or disapprove of the job Donald Trump is doing as President?

31%Strongly Approve
20%Somewhat Approve
10%Somewhat Disapprove
39%Strongly Disapprove
51%TOTAL APPROVE
49%TOTAL DISAPPROVE

If the election for U.S. Congress in your district were being held today, for whom would you vote?

46%The Republican Candidate
44%The Democratic Candidate
10%Unsure

If you had to choose a side, would you lean towards...

4%The Republican Candidate
or
7%The Democratic Candidate?

Now, please read some statements and indicate if you agree or disagree with that statement.

We need to make reforms to federal government health care programs to ensure they can best meet the needs of Americans now and in the future.

Strongly agree50%
Somewhat agree42%
Somewhat disagree6%
Strongly agree2%
OVERALL AGREE93%^
OVERALL DISAGREE7%^

Congress should focus on eliminating waste, fraud and abuse in federal health care programs.

Strongly agree53%
Somewhat agree38%
Somewhat disagree7%
Strongly disagree2%
OVERALL AGREE91%
OVERALL DISAGREE9%

Generally speaking, should government policies encourage more private health insurance coverage or more enrollment into government programs?

55%Government policies should encourage more private health insurance coverage
45%Government policies should encourage more enrollment into government programs

How much have you seen, read or heard about the recent debate in Congress over whether to renew the federal tax cuts that were enacted in 2017?

13%A Lot
36%Some
33%Not Too Much
18%Nothing
49%TOTAL A LOT/SOME
51%TOTAL NOT MUCH/NOTHING

Now, thinking some more about financing the tax cuts... Which of the following comes closest to your own opinion?

47%Congress should look for areas to cut spending and save money in all federal health care programs to help fund the tax cut renewal - no program should be off limits.
...or...
53%Congress should leave federal health care programs alone and not use them to help
fund the tax cut renewal.

Now, as you may know, health care costs make up nearly one-quarter (24%) of all federal government spending, or $1.7 trillion a year and are rapidly rising. Which of the following comes closest to your own opinion?

66%Congress needs to take a hard look at all federal health care programs to ensure taxpayer dollars are spent wisely. Weeding out waste, fraud, and abuse would save billions and help safeguard these vital programs, so they are available for those who need them - now and in the future.
or
34%Congress must not make cuts to any federal health care program. These programs are very important to many vulnerable and needy people. We cannot risk them not getting the care they need. Instead, we should expand federal health care programs and spend more on them.

Now, as you may know, health care costs make up nearly one-quarter (24%) of all federal government spending, or $1.7 trillion a year and are rapidly rising. Which of the following comes closest to your own opinion?

64%Congress needs to take a hard look at all federal health care programs to ensure they are spending taxpayer dollars wisely. Let's make certain these programs are directing resources to those who truly need help, not enriching the special interests that exploit a flawed health care system.
or
36%Congress must not make cuts to any federal health care program. These programs are very too important to many vulnerable and needy people. We cannot risk them not getting the care they need. Instead, we should expand federal health care programs and spend more on them.

Changing topics now... To help Americans get through the COVID pandemic, Congress passed legislation to expand assistance to Americans who receive health care coverage through Obamacare. The legislation increased the amount of the subsidies people receive to help them pay their premiums, and it expanded the number of Americans who can receive the subsidies. The legislation made the insurance cost nothing to nearly half of the people in the program, with the subsidies going directly to insurance companies. These enhanced subsidies are scheduled to expire at the end of 2025 unless Congress votes to make them permanent. Which of the following statements do you agree with more, even if neither describes exactly how you feel?

47%Congress should vote to make these enhanced subsidies permanent.
or...
53%Congress should allow these enhanced subsidies to expire and return to the subsidy levels that existed before COVID.

Changing topics…now thinking about the Medicaid program, which is the program that has historically paid for health care coverage for pregnant women, the elderly, the disabled, and children.

As you may know, the Biden administration issued a series of rules specific to Medicaid that made major changes to the program at significant cost. How familiar are you with these rules?

6%Very Familiar
28%Somewhat Familiar
40%Not Too Familiar
26%Not Familiar At All
34%TOTAL FAMILIAR
66%TOTAL NOT FAMILIAR

Here are two arguments you might hear about those Biden Medicaid rules from supporters and opponents. Which one comes closest to how you think?

54%The Biden administration's rules were bad because they allowed people to remain on Medicaid who do not qualify and shouldn't be on it. Repealing these rules would save taxpayers as much as $200 billion and help Medicaid focus on the truly needy.
or
46%The Biden administration's rules were good because they made it easier for poor Americans to get Medicaid and stay on the program longer, including by avoiding paperwork errors that previously kicked recipients off. The more poor and vulnerable people Medicaid can cover, the better.

If you had to choose one of these options, which would it be?

36%Medicaid should cover as many people as possible, even if that makes accessing care harder for those Medicaid was meant to serve - pregnant women, children, the disabled, and the elderly.
or
64%The government has a responsibility to taxpayers as well as legitimate Medicaid recipients to ensure that only those who are eligible can enroll in Medicaid, even if that means some Americans are left without health insurance coverage.

Changing topics again…Medicaid has traditionally paid for health care coverage to pregnant women, the elderly, the disabled, and children. The federal government covers about 60% of the cost for these traditional Medicaid recipients on average, and states pay the rest of the cost.

The Affordable Care Act (also known as Obamacare) expanded people eligible for Medicaid to include every adult in the U.S. earning 138% of the poverty level and below (which is about $45,000 for a family of four) even if they are working-age and able-bodied. The federal government now covers at least 90% of the cost of these new Medicaid expansion recipients. Nearly 15 million people have joined Medicaid over the last decade under these expanded eligibility rules.

Do you support or oppose Congress lowering the percentage that the federal government pays states for Medicaid costs for able-bodied, working-age adults to the same level it pays for pregnant women, children, and those with disabilities?

21%Strongly Support
43%Somewhat Support
23%Somewhat Oppose
13%Strongly Oppose
64%TOTAL SUPPORT
36%TOTAL OPPOSE

Research on the effects of Medicaid expansion indicates it has made it harder for traditional Medicaid enrollees to receive needed medical care because millions of new enrollees are now competing for a limited number of doctors and other providers. Does this information make you more likely or less likely to support Medicaid expansion?

10%Much More Likely
34%Somewhat More Likely
41%Somewhat Less Likely
15%Much Less Likely
44%TOTAL MORE LIKELY
56%TOTAL LESS LIKELY

Thinking a little bit more about this issue…which of the following statements do you agree with more, even if neither describes exactly how you feel?

58%It is wrong for the federal government to pay so much more for able-bodied adults than traditional Medicaid recipients like pregnant women, children and the disabled. It has made it harder for the most vulnerable people to access care, has increased costs, and led to more fraud in the program. The federal reimbursement rate for able-bodied adults should be reduced to the same level as traditional recipients.
or
42%Medicaid expansion has been a huge success, insuring more than 15 million Americans who would otherwise not have health insurance. If we lower the federal share of the cost, states will have to make up the difference, which could lead to higher taxes or cutbacks on things like education, transportation, and public safety. We should keep the rate where it is.

Which one of the following is the main reason you picked the statement you selected?

26%It is wrong to pay so much more for, able-bodied working-age adults than traditional Medicaid recipients like pregnant women, children and the disabled.
11%It has increased costs and led to more fraud in the program.
11%Spending more on Medicaid expansion recipients increases inflation, the federal deficit, and will lead to higher taxes down the road.
10%It has made it harder for the most vulnerable people to access care.

Which one of the following is the main reason you picked the statement you selected?

29%Medicaid expansion has been a huge success, insuring 15 to 20 million Americans who would otherwise not have health insurance.
8%If we lower the federal share of the cost, states will have to make up the difference, which could lead to cutbacks on things like education, transportation, and public safety.
5%If we lower the federal share of the cost, states will have to make up the difference, which could lead to higher state taxes.

Thinking a little more about this… One proposal in Congress would move one-half of Medicaid expansion recipients into the Obamacare exchanges where they would have more choices for health insurance plans. The other half of Medicaid expansion recipients would remain in Medicaid, but states would receive the same funding for them as for all Medicaid recipients in their state. This policy would decrease federal spending, increase state spending, and move millions of people from Medicaid to private health insurance coverage with a generous subsidy to help pay their premium. It could increase the number of the uninsured if states decide not to keep the expansion. Do you support or oppose this proposal?

13%Strongly Support
55%Somewhat Support
24%Somewhat Oppose
8%Strongly Oppose
68%TOTAL SUPPORT
32%TOTAL OPPOSE

States use these provider taxes as well as other financing methods to bring in large payments from the federal government. Since states have little to no cost for these payments, they then set very high Medicaid payment rates - two to three times what Medicare, the government health insurance program for seniors, pays. These provider tax payments are increasingly sent through health insurers, who profit from the larger government payments. Now, having learned a little more, which of the following comes closest to how you would describe this arrangement?

57%It is just another way that states take advantage of federal taxpayers to cushion their budgets and cater to health care special interests.
or
43%It is a reasonable way to make sure that states and their health care systems have enough money to care for their people.

Thinking a little more about Medicaid and Medicare, the health insurance program for seniors and disabled Americans…please indicate whether you support or oppose the following policies…

The government paying hospitals and other health care providers two to three times more for treating Medicaid patients than they do for Medicare patients.

7%Strong Support
23%Somewhat Support
37%Somewhat Oppose
33%Strong Oppose
30%TOTAL SUPPORT
70%TOTAL OPPOSE

The federal government establishing policies that incentivize health care providers to prefer treating Medicaid patients over Medicare patients.

9%Strong Support
29%Somewhat Support
41%Somewhat Oppose
21%Strong Oppose
38%TOTAL SUPPORT
62%TOTAL OPPOSE

Congress requiring that Medicaid payments to health care providers cannot be higher than Medicare payments.

34%Strong Support
49%Somewhat Support
15%Somewhat Oppose
2%Strong Oppose
83%TOTAL SUPPORT
17%TOTAL OPPOSE

Which comes closest to your view?

58%Medicaid is a welfare program funded by our tax dollars, so states shouldn't work with hospitals and insurers to design payment schemes that result in large profits from serving Medicaid patients.
or
42%Larger Medicaid payments to hospitals and insurance companies mean that providers will be more likely to accept those on Medicaid as patients and are a cost worth paying in higher taxes.

States often make much larger Medicaid payments to government or public health care providers than to private health care providers. The government providers then transfer the excess money back to the states. Just based on what you know, would you support or oppose Congress mandating that states can't make larger Medicaid payments to government providers than they do to private ones?

22%Strongly Support
55%Somewhat Support
18%Somewhat Oppose
5%Strongly Oppose
77%TOTAL SUPPORT
23%TOTAL OPPOSE

Changing topics… As you may know, each state runs its own Medicaid program according to federal guidelines. Some states want to establish work requirements for able-bodied adults to receive Medicaid coverage, such as working at a job, volunteering, or engaging in educational activities for a minimum number of hours every week or month.

Do you support or oppose allowing states to implement a work requirement for able-bodied adult Medicaid recipients in their state?

42%Strongly Support
42%Somewhat Support
8%Somewhat Oppose
8%Strongly Oppose
84%TOTAL SUPPORT
16%TOTAL OPPOSE

Do you support or oppose requiring able-bodied adult Medicaid recipients to work in order for them to continue receiving Medicaid benefits?

44%Strongly Support
37%Somewhat Support
10%Somewhat Oppose
9%Strongly Oppose
81%TOTAL SUPPORT
19%TOTAL OPPOSE

Would you support federal legislation that requires all states to establish a Medicaid work requirement, or should each state be free to decide if it wants one?

54%Congress should require that all states have a Medicaid work requirement
or
46%States should be able to decide if they want a work requirement

Thinking a little bit more about Medicaid work requirements…which of the following statements do you agree with more, even if neither describes exactly how you feel?

67%Medicaid should be a temporary safety net, not a long-term entitlement for those who are able to work. Encouraging this population to work would improve their personal situation and help get them off Medicaid, saving money that could be directed toward those who need it most - children, seniors, and people with disabilities. Other public assistance programs like Food Stamps have work requirements and Medicaid should be no different.
or
33%Work requirements create barriers to health care and could lead to the most vulnerable populations losing this critical insurance coverage, jeopardizing the health and well-being of those who rely on Medicaid the most. And work requirements won't address the root causes of unemployment, as they do little to encourage people to work. Lastly, the costs of implementing work requirements often outweigh any savings.

Now, in this section, we are collecting general data for statistical purposes only. As a reminder, the data are anonymous and your responses will be kept completely confidential. Thinking some more about you…

And, what is the last grade you completed in school?

–Some grade school (Grades 1-8)
2%Some high school (Grades 9-11)
20%Graduated high school (Grade 12)
6%Technical/vocational school
31%Some college
28%Graduated college (e.g. Bachelor of Arts, Bachelor of Science)
13%Graduate/professional school (e.g. PhD, MD, JD, MA)
22%TOTAL HS OR LESS
36%^TOTAL SOME COLLEGE
41%TOTAL COLLEGE+

In politics today, do you consider yourself a...

23%Strong Republican
11%Not-so-strong Republican
11%Lean towards the Republicans
18%Something else/Independent
12%Lean towards the Democrats
6%Not-so-strong Democrat
20%Strong Democrat
45%TOTAL REPUBLICAN
38%TOTAL DEMOCRAT

In politics today, do you consider yourself to be...

14%Very conservative
23%Somewhat conservative
37%Moderate
15%Somewhat liberal
11%Very liberal
37%TOTAL CONSERVATIVE
26%TOTAL LIBERAL

What is your main racial or ethnic heritage? Is it...

71%Caucasian or White
12%African American or Black
11%Hispanic, Latino or some other Spanish speaking background
5%Asian or Pacific Islander
1%American Indian or Alaskan Native
N/AOther/Mixed Race

Regardless of how you feel now, for whom did you vote in the 2024 Presidential election...

47%Donald Trump
45%Kamala Harris
2%Someone else?
6%Did not vote

Which of the following is your main source of health insurance coverage?

38%A health plan through your current employer or your spouse's current employer
29%Medicare
14%Your state's Medicaid program
13%A health plan you purchase on own
3%The Veteran's Administration or VA or Tricare
2%Your parents' health plan
1%COBRA coverage through a former employer
N/ASome other way
7%Do you not currently have health insurance coverage?

These are questions from the survey related to key issues in the Medicaid program and key proposals for reform as well as information about the respondents who were surveyed.