Beyond the Toplines: Pennsylvania’s Health Care Fault Lines

As promised in the first installment, this piece turns to the cross-tabs from our joint survey with Emerson College Polling about the state of health care in Pennsylvania.

But first, the sharpest partisan divide in the poll doesn’t involve health care at all. We asked Pennsylvanians whether they support or oppose U.S. military action against Iran. Overall, 49% oppose this action and 30% support, with 22% unsure. Among Democrats, those numbers run 78% oppose and 11% support. Among Republicans, it’s essentially the reverse: 60% support and 22% oppose. Independents land closer to Democrats, with 51% opposing and 18% in favor. Note that Republicans are more deeply split than Democrats. That’s often a bad sign for a Republican president on a policy issue.

The question also produces a notable generational split. Almost 40% of Pennsylvanians 70 and older support the action, which is nearly double the 20% figure among those under 30. Even among this oldest cohort, though, we don’t see a majority in favor; opposition runs at 51% among seniors as well.

But the focus of this poll is the U.S. health care system itself. Democrats are more concerned about the state of the U.S. health care system than are Republicans. Thirty-two percent of Democrats say the system is “in a state of crisis,” compared to just 12% of Republicans. That gap narrows when you add in those who say the system has “major problems.” At that point, 81% of Democrats and 58% of Republicans are in the same category. Both parties are largely pessimistic about American health care; Democrats are simply more so.

The first article noted that Medicaid recipients have the hardest time affording care, at 54% reporting difficulty, while Medicare recipients fare considerably better at 39%. Worth adding to that picture: Those paying entirely out of pocket come in at 56% reporting difficulty, which is nearly identical to the Medicaid figure, and is actually worse than Medicaid when we examine the margins. Private insurance holders are more evenly split, with 47% saying that it is difficult.

The VA’s ratings produce another interesting partisan split. Fifty-one percent of Republicans give the agency “good” or “excellent” marks, compared to about 36% of Democrats. Democrats are also more likely to rate the VA “poor,” with 25% assigning that rating versus 15% of Republicans. This probably reflects something beyond a pure performance assessment. We’d expect VA ratings to track at least somewhat with how favorably a respondent views the administration currently in charge of it.

Perhaps the most counterintuitive finding in the cross-tabs involves transportation. We noted in the first article that 22% of Pennsylvanians say a lack of reliable transportation has kept them from medical appointments or other daily necessities in the past year. What the topline number obscures is that this problem is almost entirely concentrated among younger adults. About 35% of Pennsylvanians under 40 report transportation as a barrier, compared to 17% of those in their 50s, 11% of those in their 60s, and just 4% of those 70 and older. Policymakers tend to think of transportation access as primarily a senior issue. The data suggest it’s actually the reverse.

Finally, the nursing questions are worth examining by party. Eighty-five percent of Democrats and 71% of Republicans back student loan forgiveness for nurses who commit three years to a Pennsylvania hospital. Eighty-seven percent of Democrats and 80% of Republicans support expanding nursing apprenticeship programs. Both parties back a $1-$5 hourly pay increase for direct care workers, though the gap is wider: 84% of Democrats versus 63% of Republicans. On nursing workforce issues, the partisan divide nearly vanishes. That’s a rare thing these days.

Taken across the three surveys we’ve conducted this year, a few patterns hold. The biggest partisan gaps we find in this series don’t occur on policies, they’re found regarding institutions. The trust poll we ran earlier found Democrats placing high confidence in journalists (70%) and college professors (85%), while Republicans placed theirs in the military (94%) and immigration enforcement (79%). The 57-point partisan gap on trust in ICE from that poll essentially previewed everything that came after: the near-opposite readings on enforcement in February, the VA ratings this month, the divergent assessments of whether the health care system is in crisis.

Pennsylvania’s youngest adults, meanwhile, look consistently distinct across every wave – relying on social media for news at nearly 45%, voting locally at just 35%, expecting to move at rates roughly double their elders, and turning up as the most burdened cohort on both immigration exposure and health care access. It’s a consistent portrait: The cohort bearing the most direct exposure to the issues this series has examined is also the one least embedded in the communities where those issues play out. For a commonwealth invested in keeping its youngest residents around, this series gives good hints about where to start.

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