What Texans Really Think About Health Care, According To The 2018 Lyceum Poll
This year’s Texas Lyceum Poll from the Texas Politics Project asked — as always — about how Texas adults feel about their elected officials and how they plan to vote in the upcoming elections.
The 2018 poll also looked into Texans’ assessment of how well the health care system is working today, from government-run programs, like Medicare and Medicaid, to the access they have — or lack — through private insurance companies.
All this comes as we look ahead to November’s midterm elections.
Joshua Blank, manager of polling and research at the Texas Politics Project, told host Krys Boyd on KERA’s Think that health care was the focus of this year’s poll because it’s an unwavering concern among Texans. Last year, the poll’s focus was on border security and immigration. Education is the other main issue consistently cited by Texans, Blank says.
The health care survey results corresponds with the Texas Lyceum’s annual public conference scheduled next week in San Antonio.
On Think, Blank discussed several statistics from the poll, which you can explore in its entirety on the Texas Lyceum’s website or at the bottom of this page.
48 percent of Texans surveyed say American adults are “less healthy today” than they were 20 years ago; 61 percent of Texans surveyed say the same thing for American children.
When people are responding to that, they’re thinking about the trend line. Some of this is also the fact that everything always looks better when you look back in time, in some ways — obviously, not in all dimensions. But times were simpler, people were healthier. Texans in particular but people in general are really onto the fact that we’re living less healthy lifestyles than we used to.
It’s really easy to generate a hypothesis for what’s driving this. Everybody knows about the crisis of childhood obesity to begin with. The life expectancy of children has been declining slightly over time and that’s a shocking thing. But also, people look around and see the effects of technology. Children, who would have nothing else to do but go outside and play, now have a million other distractions and things to fill their time that almost require a sedentary lifestyle. That’s what adults are reacting to when they're answering that question.
88 percent of Texans surveyed say affordability is “very important” in health care, a higher percentage than respondents who say quality (86 percent) and access (84 percent) are “very important.”
That’s where it’s really important to highlight what makes this poll unique. Most public polls you’re going to see, especially as we get closer to the elections, are going to focus on registered voters and then further, they’ll focus on likely voters. But here, we’re talking about all Texas adults and we’re talking about a very young, very diverse population that also, on average, is going to be a little lower in socioeconomic status. It’s not surprising, but even for people who have access to health care, affordability is an issue. Asked individually, affordability, quality and access are all important. Everybody wants everything; that’s not surprising. We asked what’s most important, and that’s where affordability emerged. People believe that we have a high-quality system — the question is really about whether ordinary people can afford it.
"Even for people who have access to health care, affordability is an issue."
While affordability remains the No. 1 choice among both self-identified Democrats and self-identified Republicans, we find the second choices mirror each other. For Democrats, the second choice is, by far, access. For Republicans, the second choice is, by far, quality. This is sort of a classic tradeoff in some ways: You can either make a system that everybody can access, but it’ll probably be a little more bare bones, or we can have an extremely high-quality system that’s going to be harder to provide to everybody. I think that’s a pretty good reflection of at least part of the health care debate that we see repeatedly in Congress, and where the friction comes between Democrats and Republicans when you’re trying to talk about what the health care system should look like.
64 percent of Texans surveyed view Medicare (a government program for people over 65) favorably; 57 percent view Medicaid (health insurance offered to low-income people) favorably.
That’s surprising in Texas because Medicaid is often seen as a third rail; it’s a dirty word almost when people bring up Medicaid. There are a lot of reasons for that — ideas about the “welfare state” and underlying questions of who benefits from the policy. And then if you follow the Legislature closely, every session it’s the first issue that comes up: paying off the debt owed to Medicaid from the last session. It’s a huge part of the budget. This is where you see a disconnect between political rhetoric and people’s felt experience. The reality is that most people who have Medicare seem to like Medicare. As far as Medicaid goes, it’s access to health care for people who probably would not have access otherwise. There’s just a broad-base acceptance that the government is going to be offering some kind of health care to some groups of people.
75 percent of Texans surveyed have a primary care doctor or go-to health care provider.
This was sort of a “glass half full, glass have empty” result. On the bright side, 75 percent of Texas adults say they see someone that they think of as their primary care physician and that they’ve seen a doctor in the last year. I think that number’s probably a little bit inflated because people tend to fall prey to the “social desirability bias,” which is you want to look like a good person and good people get checkups. Given all the other numbers, it’s probably in the ballpark. This is a pretty big state, so 25 percent of Texans not seeing a doctor regularly or not having someone they think they can go to for regular checkups or maybe more serious conditions is actually both very troubling butalso in line with this issue of people not having health insurance.
Interview responses have been lightly edited for clarity and length.