Americans Prioritize Strengthening Safety Net Programs—Medicare, Medicaid

By Sarah Loch and Elizabeth Mendes

As Congress works toward passing a budget reconciliation plan, lawmakers and experts are clashing over how to handle massive cuts to safety net programs that provide essential health care to millions of Americans, such as Medicaid.

A recent survey conducted by the Rollins School of Public Health and Gallup provides insights into how Americans view safety net programs such as Medicaid and Medicare and their views on health care overall as a top priority for the government.

Americans rank strengthening safety net programs, such as Medicare, Medicaid, and free health clinics as their number four priority for government leaders out of a list of 15 different public health issues. And, overall, 28% of Americans said safety net programs should be a top-three priority for government leaders.

The Rollins-Gallup Public Health Priorities Survey asked 2,121 adults in the United States, ages 18 and older to: “Please rank the public health issues that you think should be given the highest priority by government leaders at this time.” Rollins released the topline results from the survey February 4.

Older Americans, Those with Lower Incomes Most Concerned about Medicare, Medicaid

Strengthening safety net programs is among the top four issues Americans of all ages, races, and geographic regions would like government leaders to prioritize. 

More Americans aged 65 and older and those with an annual income of less than $48,000 prioritize strengthening safety net programs as a top public health priority. Strengthening safety net programs is statistically tied for the second highest priority for older Americans, with 36% ranking it in their top three. And safety net programs are also tied for the second highest priority for Americans earning less than $48,000 annually, with 35% ranking it in their top three.

Additionally, those living in the Northeast are concerned about strengthening safety net programs—with 36% ranking the issue among their top three priorities.

Net Percentage of Americans Who Chose Strengthening Safety Net Programs as First, Second, or Third Highest Priority

Medicaid, Medicare Critical to Addressing Americans’ Top Public Health Priority

Additionally, Americans across all subgroups ranked improving health care access and affordability as a top public health priority. One in four selected this issue as their highest priority, and more than half (52%) rated it in their top three priorities.

With improving health care access and affordability a key focus for Americans, it is important to understand the role safety net programs play in the health insurance coverage mix in the United States.

Medicaid provides health coverage to approximately 83 million low-income people in the U.S.—that represents about 24% of people in the country. In addition, Medicaid is the single largest insurer of children in the US, providing coverage for 39% of the nation’s children.

And Medicare offers health care to about 67 million people in the U.S., including adults age 65 and older and certain populations with long-term disabilities, including children.

Safety Net Programs Could Help What Americans See as Biggest Public Health Problems

In the same survey, Rollins and Gallup asked Americans which areas of public health the U.S. has made progress, lost ground, or has not changed in over the past 10 years. The two issues that Americans think we’ve lost the most ground on—the opioid epidemic and mental health—are areas that the government and public health practitioners could address further through strengthened safety net programs. And these public health problems could stand to get worse if those programs are cut as many Americans depend on them for access to medications and treatment for substance use disorder and mental health care. Forty percent of opioid treatment in the U.S., for instance, is funded by Medicaid.

“Medicaid is a backbone of health care for America’s children, as well as for the elderly, disabled, and pregnant individuals," says Stephen Patrick, MD, chair of the Department of Health Policy and Management at Rollins. "Established in the 1960s, the program was designed to provide coverage for those who might otherwise fall through the cracks. It operates as a federal-state partnership, with federal funding allocated based on a state’s average income. In wealthier states like Massachusetts, the federal government matches each state dollar spent on Medicaid, while lower-income states like Georgia receive $3 in federal funds for every $2 they contribute. As a result, cuts to Medicaid would hit poorer, Southern states the hardest, and disproportionately affect the nation’s children.”

Methodology

Results in this report are based on self-administered web interviews conducted Dec. 2-15, 2024, with U.S. adults aged 18 and older who are members of Gallup’s probability-based panel. For results based on the total sample of 2,121 adults, the margin of sampling error is ±3 percentage points at the 95% confidence level. Sampling error varies for different survey items based on the total number of respondents who saw and responded to each item. Survey sample weights were applied to all results to correct for unequal selection probability and nonresponse rates. Samples are weighted to match the national demographics along the following dimensions: gender, age, race/ethnicity, education, and region. All reported margins of sampling error include the computed design effects for weighting. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls. These sources of error were minimized through several iterations of survey design choices and by following Gallup’s best practices for survey administration.