Policy Making Politics? The Mass Political Impact of Medicaid Expansions

Awarded Scholars:
Michael W. Sances, University of Memphis
Joshua D. Clinton, Vanderbilt University
Project Date:
Mar 2016
Award Amount:
Project Programs:
Co-funded Research
The Social, Economic and Political Effects of the Affordable Care Act

Findings: Policy Making Politics? The Mass Political Impact of Medicaid Expansions; Joshua D. Clinton, Vanderbilt University, and Michael W. Sances, University of Memphis

Co-funded with the Robert Wood Johnson Foundation

Public policies often create constituencies that are invested in a particular program and that may alter the electoral and policy dynamics for future policymaking. However, it remains unknown whether policies can have a causal effect on the political behavior of beneficiaries, or whether there is simply something different about these beneficiaries that would have affected their behavior even in the absence of the enacted policy.

Political scientists Michael Sances and Joshua Clinton will examine the extent to which the passage of the Affordable Care Act (ACA) and the related expansion of Medicaid affected political behavior and opinions. They will focus on two main questions: 1) To what extent did the Medicaid expansion change voter participation? 2) To what extent did it affect social policy attitudes?

Sances and Clinton will compare the political behavior and attitudes of otherwise similar individuals (or counties or states depending on the level of analysis) who differ primarily in terms of whether or not their state expanded Medicaid. This “natural experiment” will allow them to identify how the differential expansion of Medicaid relates to variation in voting behavior and public opinion over time across states, holding as many features fixed as possible. To explore the expansion’s impact on turnout, they will take advantage of the geographic discontinuity in implementation—that is, voters living along state borders just barely do or do not receive the treatment of Medicaid expansions. They will measure voter turnout first at the county level, and then at the individual level.


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