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The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States

Published online by Cambridge University Press:  02 November 2017

JOSHUA D. CLINTON*
Affiliation:
Vanderbilt University
MICHAEL W. SANCES*
Affiliation:
University of Memphis
*
Joshua D. Clinton is the Abby and Jon Winkelried Chair and Professor of Political Science, Vanderbilt University, PMB 505, 230 Appleton Place, Nashville, TN 37203-5721 ([email protected]).
Michael W. Sances is an Assistant Professor of Political Science, University of Memphis, 421 Clement Hall, Memphis, TN 38152 ([email protected]).

Abstract

Whether public policy affects electoral politics is an enduring question with an elusive answer. We identify the impact of the highly contested Patient Protection and Affordable Care Act (ACA) of 2010 by exploiting cross-state variation created by the 2012 Supreme Court decision in National Federation of Independent Business v. Sebelius. We compare changes in registration and turnout following the expansion of Medicaid in January of 2014 to show that counties in expansion states experience higher political participation compared to similar counties in nonexpansion states. Importantly, the increases we identify are concentrated in counties with the largest percentage of eligible beneficiaries. The effect on voter registration persists through the 2016 election, but an impact on voter turnout is only evident in 2014. Despite the partisan politics surrounding the ACA–a political environment that differs markedly from social programs producing policy feedbacks in the past—our evidence is broadly consistent with claims that social policy programs can produce some political impacts, at least in the short-term.

Type
Research Article
Copyright
Copyright © American Political Science Association 2017 

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Footnotes

Helpful reactions were provided by seminar participants at Vanderbilt, UCLA, Princeton University, Yale University, and the University of British Columbia. This article has been supported in part by Award No. 94-16-06 from the Russell Sage Foundation. All opinions and errors are our own.

References

REFERENCES

Angrist, Joshua D., and Pischke, Jrn-Steffen. 2009. Mostly Harmless Econometrics: An Empiricist’s Companion. Princeton, NJ: Princeton University Press.Google Scholar
Arnold, R. Douglas. 1990. The Logic of Congressional Action. New Haven, CT: Yale University Press.Google Scholar
Baicker, Katherine, Taubman, Sarah L., Allen, Heidi L., Bernstein, Mira, Gruber, Jonathan, Newhouse, Joseph, Schneider, Eric C., Wright, Bill J., Zaslavsky, Alan M., and Finkelstein, Amy N.. 2013. “The Oregon Experiment: Effects of Medicaid on Clinical Outcomes.” The New England Journal of Medicine 368 (18): 1713–22.Google Scholar
Balz, Dan. 2010. “Introduction.” In Landmark: The Inside Story of America’s New Health-Care Law-The Affordable Care Act-and What it Means for Us All. Philadelphia: PublicAffairs.Google Scholar
Bartels, Larry. 2008. Unequal Democracy: The Political Economy of the Gilded Age. Princeton, NJ: Princeton University Press.Google Scholar
Béland, Daniel, Rocco, Philip, and Waddan, Alex. 2016. Obamacare Wars: Federalism, State Politics, and the Affordable Care Act. Lawrence, KS: University of Kansas Press.Google Scholar
Bendor, Jonathan. 2010. Bounded Rationality and Politics. Berkeley, CA: University of California Press.Google Scholar
Bendz, Anna. 2015. “Paying Attention to Politics: Public Responsiveness and Welfare Policy Change.” Policy Studies Journal 43 (3): 309–32.Google Scholar
Blais, Andre. 2000. To Vote or Not to Vote? The Merits and Limits of Rational Choice Theory. University of Pittsburgh Press.Google Scholar
Brill, Steven. 2015. America’s Bitter Pill: Money, Political, Backroom Deals, and the Fight to Fix our Broken Healthcare System. New York, NY: Random House.Google Scholar
Brooks, Tricia, Touscher, Joe, Artiga, Samantha, Stephens, Jessica, and Gross, Alexandra. 2015. “Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015.” Kaiser Commission on Medicaid and the Insured. Accessed September 8, 2016. http://kff.org/health-reform/report/modern-era-medicaid-findings-from-a-50-state-survey-of-eligibility-enrollment-renewal-and-cost-sharing-policies-in-medicaid-and-chip-as-of-january-2015/.Google Scholar
Burden, Barry C., Fletcher, Jason M., Herd, Pamela, Moynihan, Donald P., and Jones, Bradley M.. 2017. “How Different Forms of Health Matter to Political Participation.” The Journal of Politics 79 (1): 166–78.Google Scholar
Cameron, Colin A., Gelbach, Jonah B., and Miller, Douglas L.. 2008. “Bootstrap-Based Improvements for Inference with Clustered Errors.” The Review of Economics and Statistics 90 (3): 414–27.CrossRefGoogle Scholar
Campbell, Andrea Louise. 2003. How Policies Make Citizens: Senior Political Activism and the American Welfare State. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
Campbell, Andrea Louise. 2012. “Policy Makes Mass Politics.Annual Review of Political Science 15: 333–51.Google Scholar
Card, David, and Krueger, Alan B.. 1994. “Minimum Wages and Employment: A Case Study of the New Jersey and Pennsylvania Fast Food Industries.” American Economic Review 84 (4): 772–93.Google Scholar
Dell, Melissa. 2010. “The Persistent Effects of Peru’s Mining Mita .” Econometrica 78 (6): 1863–903.Google Scholar
Derthick, Martha. 1979. Policymaking for Social Security. Washington, DC: The Brookings Institution.Google Scholar
Dube, Arindrajit, Lester, T. William, and Reich, Michael. 2010. “Minimum Wage Effects Across State Borders: Estimates Using Contiguous Counties.” Review of Economics and Statistics 92 (4): 945–64.Google Scholar
Eichelberger, Erika. 2014. “Obamacare Could Have Turned Millions of Uninsured Americans into Voters.” Mother Jones, November 4. Accessed August 5, 2015. http://www.motherjones.com/politics/2014/11/obamacare-national-voter-registration-act-minority.Google Scholar
Finkelstein, Amy, Taubman, Sarah, Wright, Bill, Bernstein, Mira, Gruber, Jonathan, Newhouse, Joseph P., Allen, Heidi, and Baicker, Katherine. 2012. “The Oregon Health Insurance Experiment: Evidence from the First Year.” Quarterly Journal of Economics 127 (3): 1057–106.Google Scholar
Gilens, Martin. 2012. Affluence and Influence: Economic Inequality and Political Power in America. Princeton, NJ: Princeton University Press.Google Scholar
Green, Donald P., Ha, Shang E., Bullock, John G.. 2010. “Enough already about ‘black box’ experiments: Studying mediation is more difficult than most scholars suppose.” The Annals of the American Academy of Political and Social Science 628 (1): 200–8.Google Scholar
Hacker, Jacob S., and Pierson, Paul. 2010. “Winner-Take-All Politics: Public Policy, Political Organization, and the Precipitous Rise of Top Incomes in the United States.” Political Sociology 38: 152204.Google Scholar
Hagan, Elizabeth. 2016. “ACA Assisters Can Help Consumers Register to Vote.” The Upshot, July 4. Accessed May 22, 2017. http://familiesusa.org/blog/2016/07/aca-assisters-can-help-consumers-register-vote.Google Scholar
Haselswerdt, Jake. 2017. “Expanding Medicaid, Expanding the Electorate: The Affordable Care Act’s Short-Term Impact on Political Participation.” The Journal of Health Politics, Policy and Law 42 (4): 667–95.Google Scholar
Henderson, Michael, and Hillygus, D. Sunshine. 2011. “The Dynamics of Health Care Opinion, 2008-2010: Partisanship, Self-Interest, and Racial Resentment.” Journal of Health Politics, Policy and Law 36 (6): 945–60.Google Scholar
Highton, Benjamin, and Wolfinger, Raymond E.. 2001. “The Political Implications of Higher Turnout.” British Journal of Political Science 31 (1): 179223.Google Scholar
Holmes, Thomas J. 1998. “The Effects of State Policies on the Location of Manufacturing: Evidence from State Borders.” Journal of Political Economy 106 (4): 667705.Google Scholar
Imai, Kosuke, Keele, Luke, Tingley, Dustin, and Yamamoto, Teppei. 2011. “Unpacking the Black Box of Causality: Learning About Causal Mechanisms from Experimental and Observational Studies.” American Political Science Review 105 (4): 765–89.Google Scholar
Keele, Luke, Lorch, Scott, Passarella, Molly, Small, Dylan, and Titiunik, Rocio. 2017. “An Overview of Geographically Discontinuous Treatment Assignments With An Application to Children’s Health Insurance.” In Regression Discontinuity Designs: Theory and Applications, Advances in Econometrics 38: 147–94.Google Scholar
Keele, Luke J., and Titiunik, Rocio. 2015. “Geographic Boundaries as Regression Discontinuities.” Political Analysis 23 (1): 127–55.Google Scholar
Kliff, Sarah. 2016. “Why Obamacare enrollees voted for Trump.” Vox. Accessed December 15, 2016. http://www.vox.com/science-and-health/2016/12/13/13848794/kentucky-obamacare-trump.Google Scholar
Kriner, Douglas L., and Reeves, Andrew. 2014. “Responsive Partisanship: Public Support for the Clinton and Obama Health Care Plans.” Journal of Health Politics, Policy and Law 39 (4): 717–49.Google Scholar
Lee, David S., and Lemieux, Thomas. 2010. “Regression Discontinuity Designs in Economics.Journal of Economic Literature 48: 281355.Google Scholar
Leighley, Jan E., and Nagler, Jonathan. 2014. Who Votes Now? Demographics, Issues, Inequality And Turnout In The United States. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
Leip, David. 2017. “Dave Leip’s Atlas of US Presidential Elections.” Accessed May 30, 2017. http://www.uselectionatlas.org.Google Scholar
Lerman, Amy E., and McCabe, Katherien T.. 2017. “Personal Experience and Public Opinion: A Theory and Test of Conditional Policy Feedback,” Journal of Politics, forthcoming.Google Scholar
Lerman, Amy E., Sadin, Meredith L., and Trachtman, Samuel. 2017. “Policy Uptake as Political Behavior: Evidence from the Affordable Care Act.American Political Science Review 111 (4): 755–70.Google Scholar
McCabe, Katherine T. 2016. “Attitude Responsiveness and Partisan Bias: Direct Experience with the Affordable Care Act.” Political Behavior, forthcoming.Google Scholar
McCrary, Justin. 2008. “Manipulation of the Running Variable in the Regression Discontinuity Design: A Density Test.” Journal of Econometrics 142 (2): 698714.CrossRefGoogle Scholar
Meredith, Marc, and Morse, Michael. 2015. “The Politics of the Restoration of Ex-Felon Voting Rights: The Case of Iowa.” Quarterly Journal of Political Science 10 (1): 41100.Google Scholar
Mettler, Suzanne. 2002. “Bringing the State Back in to Civic Engagement: Policy Feedback Effects of the G.I. Bill for World War II Veterans.” The American Political Science Review 96 (2): 351–65.Google Scholar
Mettler, Suzanne. 2005. Soldiers to Citizens: The G.I. Bill and the Making of the Greatest Generation. New York, NY: Oxford University Press.Google Scholar
Mettler, Suzanne, and Soss, Joe. 2004. “The Consequences of Public Policy for Democratic Citizenship: Bridging Policy Studies and Mass Politics.” Perspectives on Politics 2 (1): 5573.Google Scholar
Mettler, Suzanne, and Stonecash, Jeffrey M.. 2008. “Government Program Usage and Political Voice.” Social Science Quarterly 89 (2): 273–93.CrossRefGoogle Scholar
Michener, Jamila. 2015. “Medicaid, Federalism, and Political Participation.” Working paper, Department of Government, Cornell University.Google Scholar
Newkirk, Margaret. 2017. “Why Kentucky Couldn’t Kill Obamacare: A Lesson for Congress,” Bloomberg, January 23. Accessed May 24, 2017. https://www.bloomberg.com/news/articles/2017-01-23/why-kentucky-couldn-t-kill-obamacare-a-lesson-for-congress.Google Scholar
Novack, Sophie. 2013. “Obamacare May Be More Political Than You Think.” National Journal, October 14. Accessed June 16, 2015. http://www.nationaljournal.com/daily/obamacare-may-be-more-political-than-you-think-20131014.Google Scholar
Onek, Joe. 2015. “How Obamacare curtails voter registration.” The Hill, October 30. Accessed September 4, 2017. http://thehill.com/blogs/congress-blog/the-administration/258610-how-obamacare-curtails-voter-registration.Google Scholar
Pacheco, Julianna, and Fletcher, Jason. 2015. “Incorporating Health into Studies of Political Behavior: Evidence for Turnout and Partisanship.” Political Research Quarterly 68 (1): 104–16.CrossRefGoogle ScholarPubMed
Patashnik, Eric M. 2014. Reforms at Risk: What Happens After Major Policy Changes Are Enacted. Princeton, NJ: Princeton University Press.Google Scholar
Patashnik, Eric, and Zelizer, Julian E.. 2013. “The Struggle to Remake Politics: Liberal Reform and the Limits of Policy Feedback in the Contemporary American State.” Perspectives on Politics 11 (4): 1071–87.Google Scholar
Pierson, Paul. 1993. “When Effect Becomes Cause: Policy Feedback and Political Change.” World Politics 45 (4): 595628.Google Scholar
Pierson, Paul. 1992. “Policy Feedbacks and Political Change: Contrasting Reagan and Thatcher’s Pension Reform Initiatives.” Studies in American Political Development 6 (2): 359–90.CrossRefGoogle Scholar
Powell, G. Bingham. 1986. “American Voter Turnout in Comparative Perspective.” American Political Science Review 80 (1): 1743.CrossRefGoogle Scholar
Roth, Zachary. 2014. “Obamacare Helping Millions Register to Vote.” MSNBC, March 3. Accessed August 5, 2017. http://www.msnbc.com/msnbc/obamacare-helping-millions-register-vote.Google Scholar
Schattschneider, E. E. 1935. Politics, Pressures, and the Tariff. New York, NY: Prentice-Hall.Google Scholar
Schlozman, Kay Lehman, Verba, Sidney, and Brady, Henry E.. 2012. The Unheavenly Chorus: Unequal Political Voice and the Broken Promise of American Democracy. Princeton, NJ: Princeton University Press.Google Scholar
Schneider, Anne, and Ingram, Helen. 1993. “Social Construction of Target Populations: Implications for Politics and Policy.” American Political Science Review 87 (2): 334–47.Google Scholar
Schwartz, Aaron L., and Sommers, Benjamin D.. 2014. “Moving for Medicaid? Recent Eligibility Expansions Did Not Induce Migration From Other States.” Health Affairs 33 (1): 8894.Google Scholar
Sharp, Elaine B. 2012. Does Local Government Matter? How Urban Policies Shape Civic Engagement. Minneapolis, MN: University of Minnesota Press.CrossRefGoogle Scholar
Skocpol, Theda. 1991. “Targeting Within Universalism: Politically Viable Policies to Combat Poverty in the United States.” In The Urban Underclass, eds. Jencks, Christopher and Peterson, Paul E.. Washington, DC: Brookings Institution.Google Scholar
Sommers, Benjamin D., Baicker, Katherine, and Epstein, Arnold M.. 2012. “Mortality and Access to Care Among Adults After State Medicaid Expansions.” New England Journal of Medicine 367 (11): 1025–034.Google Scholar
Soroka, Stuart Neil, and Wlezien, Christopher. 2010. Degrees Of Democracy: Politics, Public Opinion, and Policy. New York: Cambridge University Press.Google Scholar
Soss, Joe. 1999. “Lessons of Welfare: Policy Design, Political Learning, and Political Action.” American Political Science Review 93 (2): 363–80.Google Scholar
Soss, Joe. 2002. Unwanted Claims: The Politics of Participation in the US Welfare System. Ann Arbor, MI: University of Michigan Press.Google Scholar
United States Census Bureau. 2017. “Model-based Small Area Health Insurance Estimates (SAHIE) for Counties and States.” Accessed May 30, 2017. https://www.census.gov/did/www/sahie/.Google Scholar
Weaver, Vesla M., and Lerman, Amy E.. 2010. “Political Consequences of the Carceral State.” American Political Science Review 104 (4): 817–33.Google Scholar
Wilson, William Julius. 1987. The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. Chicago: University of Chicago Press.Google Scholar
Wolfinger, Raymond E., and Rosenstone, Steven. 1980. Who Votes? New Haven, CT: Yale University Press.Google Scholar
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