Expansion of Medicaid under the Affordable Care Act (ACA) to millions of low-income adults has been controversial. However, little is known what these Americans themselves think about Medicaid. A new study, being released by Health Affairs as a Web First, surveyed nearly 3,000 low-income adults in Arkansas, Kentucky, and Texas (states that have adopted different approaches for Medicaid expansion). This telephone survey, conducted in late 2013, found that 83 percent of respondents in Arkansas and Kentucky and 79 percent of those in Texas were in favor of their state expanding Medicaid under the ACA. Roughly two-thirds of uninsured respondents planned to apply for coverage in 2014. The majority of adults surveyed viewed Medicaid as comparable to or better than private insurance in overall health care quality.

The authors developed a thirty-eight-item survey and targeted citizens ages 19-64 with household incomes of less than 138 percent of the federal poverty level. Forty percent of Texas respondents were Latino. A significant number of respondents (40 percent in Arkansas and Kentucky and 32 percent in Texas) said they were in "fair" or "poor" health, with a substantial number of respondents reporting living with chronic health conditions. "While state policy makers continue to debate the relative merits of whether and how to expand Medicaid under the ACA, our data indicate that there is little debate among most low-income adults that they would benefit from expanded coverage," concluded the authors. "Most respondents in our survey thought that Medicaid coverage was better than being uninsured, and at least as good as or better than private insurance in overall quality."