By Jenny Deam, New York Times

More than 60 percent of Texans support an expansion of Medicaid here and plan to take those views into the voting booth in November, a new survey commissioned by the Texas Medical Center Health Policy Institute finds.

The survey results, unveiled Wednesday at the annual Medical World Americas convention in Houston, show the public at odds with the state's Republican leadership, which has steadfastly refused to consider such an expansion, calling it wasteful and a bad solution.

"I understand people in Austin have been reluctant, but I believe what this survey demonstrates is that people want something done to improve access," said Dr. Arthur "Tim" Garson, director of the Health Policy Institute. "People are looking for help and their choice seems to be Medicaid expansion. A uniquely Texas solution would be best, but we have to do something."

The findings further resonate in a state that continues to lead the nation in the number of uninsured. Texas remains one of 19 states that has chosen not to expand Medicaid under the Affordable Care Act.

The second Medical Center study gauging public opinion on health care issues covered topics ranging from access to health care to the wisdom of raising the price of foods that contribute to obesity.

Of the 1,000 people polled by Nielsen in five states, close to 100 percent said they feel it is deeply important to have insurance for themselves and their family. In Texas, 96 percent value health insurance.

The study's margin of error is 3 percentage points overall and close to 5 percentage points in Texas.

Beyond self-interest, 91 percent of respondents in Texas, California, New York, Ohio and Florida said it was important to them that everyone in the nation have health insurance.

The sticking point has always been how to get there.

In Texas, 63 percent of those polled said they support an expanded Medicaid program. Similarly, 68 percent in Florida also favored a Medicaid expansion. These numbers are significant because of the states surveyed, only Florida and Texas did not expand the safety-net program, which is jointly paid for with federal and state dollars.

Not a bipartisan issue

On Wednesday, about 100 audience members, primarily in the health care industry, were given a chance to weigh in as well, using interactive clickers to express their views on topics including the question of Medicaid expansion. Seventy-six percent of the audience favored it.

But their enthusiasm is not shared among Texas Republican leaders. Gov. Greg Abbott, like his predecessor, Rick Perry, has held firm against even considering the program. Democrats and advocates for expanded coverage argue that Texas is foolishly refusing billions of dollars in federal funding that could be used to cover more people here.

On Wednesday night, the head of the conservative Texas Public Policy Foundation said she remains unmoved.

"Though we haven't yet seen the study, no study will change the fact that Medicaid is a program that provides a very low quality of care at a very high cost to taxpayers," executive director Arlene Wohlgemuth said in a statement.

"The federal requirements that come with Medicaid expansion make it the wrong way to address the unique health care needs of Texans. Instead, states must be given the flexibility to create a program that better serves Texans in need, and one that works with communities to design programs that work for them and for taxpayers."

Health care costs and access also are part of the national political debate. On the Republican side, presumptive nominee Donald Trump is echoing calls to dismantle the Affordable Care Act altogether, although he previously said he favored the mandate that required everyone to carry health coverage.

Among Democrats, front-runner Hillary Clinton has said she would continue the federal health care law and expand it. Her rival Sen. Bernie Sanders has proposed universal health care, saying coverage is a right not a privilege.

In the five states surveyed for the Health Policy Institute, respondents were emphatic that a political candidate's stance on health issues will influence how they vote, a sentiment shared by 82 percent of Texans.

Still, 65 percent of Texans said they are paying more out of pocket that two years ago. That was the highest rate of any of the five states. In addition, 56 percent in the state admitted they had cut down in other expenses to pay for their health care.

Rising out-of-pocket expense has lately been in the national spotlight beyond the political arena as well. A recent Kaiser Family Foundation report showed that patient cost-sharing rose "substantially faster than payments for care by health plans as insurance coverage became a little less generous."

The meaning of 'affordable'

According to data culled from millions of health benefit claims nationwide, patient contributions rose 77 percent between 2004 and 2014, while the average payment by health plans rose 58 percent.

At the same time, the average cost of deductibles for an individual in an employer-sponsored coverage more than tripled nationwide to $1,077 last year from $303 in 2006, according to a separate Kaiser Family Foundation analysis.

Despite the implementation of the federally mandated insurance exchange programs, an overwhelming 87 percent of the uninsured across all five states who visited the exchanges said they could not afford coverage. It is unknown whether those people were aware of the subsidies in place that lower premium cost for lower income customers.

"The problem is beyond the premium," Garson said in a recent interview, "We all thought the word 'affordable" included out of pocket expenses."

Another finding shed light on a continuing problem that drives up health care costs. Forty-six percent of those surveyed in the five states said they had used a hospital emergency room even though their medical problem was not an emergency.

Texas led the five states surveyed with more than a third saying medical quality had worsened in the past two years.

Also, more than one in two across all states supported making food and drinks linked to obesity more expensive.

Despite widely differing demographics, both red and blue politically, and with and without Medicaid expansion, opinions in the surveyed states remained mostly consistent.

"What I found interesting was not how different people were but how much they were the same," Garson said.

To Learn More:

Consumer Health Report (TMC Health Policy Institute)

Oklahoma Republicans, Big Foes of Obamacare, Do About-Face and Push for Medicaid Expansion (by Sean Murphy, Associated Press)

10 States with Highest Uninsured Rates are all Run by Republicans (by Steve Straehley, AllGov)

Republicans Opposed to Obama’s Health Care Law are Willing to Take its Funding (by Noel Brinkerhoff, AllGov)

Rejecting Expansion of Medicaid, Republican Governors Prevent Insurance for “Poorest of the Poor” (by Matt Bewig, AllGov)