“The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States” with Joshua Clinton, Vanderbilt

AMERICAN POLITICS & PUBLIC POLICY WORKSHOP

Abstract: Whether public policy affects electoral politics by altering the composition of the electorate or public opinion is an enduring question with an elusive answer. We use variation in the implementation of the highly contested Patient Protection and Affordable Care Act (ACA) of 2010 resulting from the 2012 Supreme Court decision in National Federation of Independent Business v. Sebelius to compare the political participation of otherwise similar counties and individuals in states that differ in terms of their decision to expand Medicaid. Using county-level data on voting and registration, we show that counties in expansion states experience higher political participation compared to otherwise similar counties in non-expansion states. Moreover, the impact is largest in counties with above average poverty levels and the impact is larger than the predicted wealth effects. Using 220,000 individual responses we collect from 175 polls, we also examine whether the expansion of Medicaid influenced public attitudes towards the ACA and we find small effects — between a fifth and a third of a percentage point – concentrated among low-education respondents who are more likely to benefit from the expansion. Despite the partisan politics surrounding the ACA – a political environment that differs markedly from social programs producing policy feedbacks in the past – the evidence is broadly consistent with claims that social policy programs can produce political impacts, but the impacts may be limited.

Joshua D. Clinton is Professor and Abby and Jon Winkelried Chair in the Department of Political Science, and the Co-Director of the Center for the Study of Democratic Institutions at Vanderbilt University.