A majority of Americans put the creation of state-based health insurance exchanges at the top of the priority list for health policy in their state this year, according to a survey released January 24, 2013 by the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and Harvard School of Public Health.

Fifty-five percent of the public, including majorities of Republicans and Democrats, say that establishing the exchanges – a key element of the Affordable Care Act (ACA) and one whose implementation has divided states along partisan political lines – is a “top priority” for their governor and legislature. So far 18 states and the District of Columbia have declared that they will create their own state-based exchanges, seven other states have opted to establish exchanges in partnership with the federal government and 25 others – some driven by resistance to the ACA – appear set to default to a federally run exchange.

“Governors are largely splitting along partisan lines on the exchanges, but the public is not. People like the idea,” said Drew Altman, president and CEO of the Kaiser Family Foundation.

Similarly, while some Republican governors are balking at the optional expansion of Medicaid under the ACA, more Americans (52%) say their state should expand its Medicaid program than not (42%). But on Medicaid views differ sharply by party, with two-thirds of Republicans saying they prefer to keep their state Medicaid program as is (66%) and 3 in 4 Democrats (75%) seeking a state expansion. Independents are evenly divided.

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