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Partisan politics or public-health need?

An empirical analysis of state choice during initial implementation of the Affordable Care Act

Published online by Cambridge University Press:  22 December 2015

Martin Mayer ,
Robert Kenter  and
John C. Morris
Martin Mayer*
Affiliation:
Old Dominion University
Robert Kenter
Affiliation:
Old Dominion University
John C. Morris
Affiliation:
Old Dominion University
*
Correspondence: Martin Mayer, School of Public Service, 2084Constant Hall, Old Dominion University, Norfolk, VA 23529. Email: [email protected]
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Abstract

States’ policy decisions regarding the Affordable Care Act (ACA) of 2010 have often been explained as predominantly, if not solely, partisan. Might rival explanations also apply? Using a cross-sectional 50-state regression model, we studied standard political variables coupled with public-health indicators. This work differs from existing research by employing a dependent variable of five additive measures of ACA support, examining the impact of both political and socioeconomic indicators on state policy decisions. Expanding on recent empirical studies with our more nuanced additive index of support measures, we found that same-party control of a state’s executive and legislative branches was indeed by far the single best predictor of policy decisions. Public-health indicators, overwhelmed by partisan effect, did not sufficiently explain state policy choice. This result does not allay the concerns that health policy has become synonymous with health politics and that health politics now has little to do with health itself.

Keywords

Affordable Care Act (ACA)health care reformMedicaidpartisan politicspolitical conflictstate implementationstate policy choices
Type
Articles
Information
Politics and the Life Sciences , Volume 34 , Issue 2 , Fall 2015 , pp. 44 - 51
Copyright
© Association for Politics and the Life Sciences 2015 

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