New Georgia Chartbook: Facts v. Presentation in Medicaid Expansion Debate

The Georgia Budget and Policy Institute and Georgians for a Healthy Future released a great “back to basics” chart book last week explaining Medicaid in Georgia and how to use federal Medicaid dollars to close Georgia’s health insurance coverage gap.

It includes easily understandable charts like this:

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and this:

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Most of all, the chart book gathers in one place all critical information needed for the public and policymakers to really understand the Medicaid health program in Georgia and what the effects and cost of closing the coverage gap would be in the state.

Simply looking at all this well-presented, easily readable data leads – at least for me – to the conclusion that Georgia would gain enormous benefits from using Medicaid to close the health coverage gap in the state. However, as anyone in health policy knows, the facts and data aren’t the entire story when people are forming opinions and making decisions.

Political scientist Deborah Stone put it best in her well-known book Policy Paradox in a passage I always like to highlight for students:

Because it is an ideal, the rational ideal naturally exaggerates human rationality in processing information. A voluminous social psychology literature tells us we rely on habit, stereotypes, and cultural norms for the vast majority of decisions. We are as much influenced by the source of information — the person’s race, looks, social manners, reputation, and credentials, or whether the source is a person or some other medium – as by the content. We are subject to extremely strong influence by peers, co-workers, family and other groups of which we are a part.   The drive to conformity with important reference groups would seem to be at least as strong as the drive to select the best means to an end. (Stone, 2012)

From a very different perspective than Stone’s, Roger Ailes, Fox News CEO, distilled this concept down into his 1989 book “You are the Message” where he emphasized the persuasive importance of how a person speaks regardless of the words they choose or ideas they share.

However, can the facts really not matter? Does a debate on an issue like Medicaid expansion come down to simply who is presenting the information and how it is being communicated regardless of its accuracy? Of course not. The lesson here is that while presenting accurate information is incredibly important, both the messenger and the setting in which the information is shared are critical as well.

This information around Medicaid and the coverage gap in Georgia is a first, critical step around Medicaid expansion and serves not as an end in itself but a base from which discussion can start. And for the groups that published this report, the public forums and public discussions have already started. They heeded the trusted “you are the message” advice and selected a reputable messenger to deliver the message at their most recent forum. A health care economist from Georgia State University was a good choice indeed.

In the months to come, debate around Medicaid expansion in Georgia will continue. But this new collection of data around Medicaid and the coverage gap will provide those interested in making sure everyone in the state has access to the facts they need to make the strongest possible case.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.

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