West vs. South: Regional Differences in Views of the Health Reform Law

In the wake of the November midterm election that resulted in a landslide victory for Republicans and a shift in party control of the House of Representatives, the debate about health reform continues to play out in Washington and in many states across the country. Republican lawmakers from many states have made public calls for repeal of or drastic changes to the law, and governors from several states have signed on to a lawsuit filed in Florida that challenges the law on constitutional grounds. The November Kaiser Health Tracking poll finds the public is still largely divided in their opinions of the law and what should happen next. In this Data Note, we examine how those opinions differ by region of the country.

A recent analysis by the Kaiser Commission on Medicaid and the Uninsured finds that many states in the American South and West stand to see the biggest shares of their residents newly covered by health insurance under the health reform law, as many of these states have larger numbers of residents who are currently uninsured. Many of these newly insured will get their coverage through the Medicaid program, meaning that these states could see large overall increases in Medicaid spending under the new law, with the vast majority of dollars coming from the federal government. But despite the fact that many states in these two regions stand to be disproportionately eligible for federal funds, opinions of the law play out quite differently in the West than in the South.

Looking at the four broad regions of the country overall, those living in the Western and Northeastern United States are more likely to view the law favorably, while those living in the South and Midwest tilt negatively in their views of the law. Given the fact that party affiliation has been so closely tied to views of health reform over the past two years, it is perhaps not surprising that these views to a large extent reflect the political profiles of these regions. The South and Midwest, where views of the law are most negative, have higher shares of self-identified Republicans and political conservatives compared with the Northeast and West. In the 2010 mid-term election, as reported by the national exit polls conducted by a consortium of media organizations, the South and Midwest backed Republican candidates by large margins, while the Northeast voted for Democrats by a 10 point margin and the West was almost evenly divided.

Taking a closer look at the two regions (West and South) with higher numbers of uninsured and states that stand to be disproportionately eligible for federal funds, we find broad differences in how residents are reacting to the law. Overall, while a majority (52 percent) of those living in the West view the law favorably, the South has the highest share expressing an unfavorable view of the law (45 percent unfavorable, 37 percent favorable). Compared with those living in the South, Westerners are 10 percentage points more likely to say both their own family (33 percent vs. 23 percent) and the country as a whole (43 percent vs. 33 percent) will be better off under the new law. And while about half (51 percent) of Westerners want lawmakers to leave the law as is or expand it, an equally large share of Southerners (54 percent) want to repeal the law, either entirely or in part. Health care also played a slightly more prominent role as a voting issue in the South than it did in the West, with 17 percent of Southern voters naming it as one of the top issues in their vote, compared to 11 percent in the West.

Looking at demographics, both regions also stand out from the rest of the country in having a particularly high proportion of racial and ethnic minorities: the South, with 18 percent of its adult residents self-identifying as African American and another 13 percent as Hispanic, and the West with 24 percent identifying as Hispanic according to Census estimates. Given that public opinion data has found both African Americans and Latinos to be more uniformly supportive of health reform overall, this suggests that the contrast between the West and the South in terms of opinion on health reform may be even more concentrated among white residents. And in fact the November tracking survey finds this is the case. While whites in the South oppose health reform by nearly three to one, whites in the West are roughly divided on the law. (Whites in the Northeast are also evenly divided, while Midwestern whites tilt negative in their overall opinion of the law.)

These regional differences suggest that, despite the fact that their states may stand to benefit from federal spending under the health reform law, recent actions by some Southern lawmakers, such as speaking out about changes to and/or repeal of the law, may be consistent with views of the majority of residents in those states.


This analysis is based on the November Kaiser Health Tracking Poll, designed and analyzed by public opinion researchers at the Kaiser Family Foundation and conducted November 3 through November 6, 2010, among a nationally representative random sample of 1,502 adults ages 18 and older, including 1,017 adults who say they voted in the mid-term elections. Telephone interviews conducted by landline (1000) and cell phone (502, including 252 who had no landline telephone) were carried out in English and Spanish by Princeton Survey Research Associates. The margin of sampling error for the total sample is plus or minus 3 percentage points; for results based on the South it is plus or minus 5 percentage points, and for the West, Midwest and Northeast it is plus or minus 6 percentage points. For results based on other subgroups, the margin of sampling error may be higher. A complete report, chartpack and the full question wording and methodology of the poll can be viewed online at http://www.kff.org/kaiserpolls/8120.cfm.

To view the complete Data Note with graphics:



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