In a recent report published by the American Political Science Review, RSF grantees Joshua Clinton (Vanderbilt University) and Michael Sances (University of Memphis) explore the extent to which Medicaid expansions under the Affordable Care Act affected voter participation and public opinion regarding the ACA. 

Their study, supported by the foundation’s special initiative on the social, economic, and political effects of the Affordable Care Act, compares changes in voter registration and turnout between counties in states that expanded Medicaid and those that did not. They find that between 2010 and 2014, the percentage of registered voters increased by about 3 percent in counties that were located in states that expanded Medicaid and had a higher than average share of residents eligible for Medicaid. During this time, voter turnout also increased modestly in these areas. 

The authors also analyze a dataset of 230,000 respondents’ opinions on the ACA to determine how the Medicaid expansions affected public opinion toward the ACA. They find that after the expansions, there was an increase in support for the ACA in the states that adopted them. However, supplementary analysis at the individual level suggests these effects were small and driven by partisanship: only political independents adjusted their opinion of the ACA in response to the expansion. The authors also note that the impacts were dampened in states where the expansions were implemented under Republican governors, which may reflect those governors actively obscuring any connections to the ACA.

Overall, Clinton and Sances’ study reveals “a qualified political impact of Medicaid expansion, one that is concentrated among potential beneficiaries.” While the effects are limited, they nevertheless suggest that expanding access to health care tends to increase political participation, especially among disadvantaged groups.

View other findings from RSF’s special initiative on the ACA.