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

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 inNational 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.

Political Science and U.S. Health Policy in the Era of the Affordable Care Act

“…That is, voting also increases among conservatives in the form of a backlash against the expansion. These findings are in line with those of Clinton and Sances (), who focus on effects on registration and turnout. They find the largest effect for counties with the highest number of potential beneficiaries.…”

Policy Feedback Effects on Mass Publics: A Quantitative Review

“…In one of the exceptions, Kumlin and Rothstein () study how perceptions of health‐care treatment matter for interpersonal trust. Interestingly, recent studies are using health‐care reforms in the United States to study policy feedback effects on political engagement (Clinton & Sances, ) and policy attitudes (Hopkins & Parish, forthcoming).…”

“…In one of the exceptions, Kumlin and Rothstein (2005) study how perceptions of health-care treatment matter for interpersonal trust. Interestingly, recent studies are using health-care reforms in the United States to study policy feedback effects on political engagement (Clinton & Sances, 2018) and policy attitudes (Hopkins & Parish, forthcoming). Third, in the domain of social policies, quite unsurprisingly, a great number of policy feedback effects are interested in social policy attitudes (e.g., Im & Meng, 2016), but we also see studies interested in political engagement (Bruch, Ferree, & Soss, 2010) and general attitudes, such as satisfaction with democracy (Kumlin, 2011).…”

Government Privatization and Political Participation: The Case of Charter Schools

“…More generally, this study contributes to the "policy feedback" literature (seeCampbell, 2012), particularly as it relates to political participation (seeClinton and Sances, 2017).…”