Medicaid retrenchment politics: fragmented or unified?

ABSTRACT

Medicaid has grown substantially over time; indeed, more than half of all Americans have some connection to the program. Considering that Medicaid retrenchment is the centerpiece of recent proposals to repeal and replace the Patient Protection and Affordable Care Act, we ask: How will the American public react to massive reductions in Medicaid funding? Using a nationally representative survey, our study investigates whether adults with elderly parents who have used long-term care services and supports (LTSS), compared to other constituency groups, (1) perceive the Medicaid program as more important, (2) are more knowledgeable about program benefits, and (3) are more likely to oppose Medicaid funding cuts. Results show that people with any connection to the Medicaid program are more likely to view the program as important than those with no connection. However, when it comes to understanding specific Medicaid benefits and protecting Medicaid against retrenchment, adults with elderly parents who have used LTSS are significantly more knowledgeable and more likely to favor protection, compared both to other connected groups and the nonconnected. These findings suggest that Medicaid retrenchment politics could be characterized by fragmentation and infighting among constituency groups, unless significant mobilizing work is done to create a broad-based Medicaid coalition.

KEYWORDS:

• Medicaid
• retrenchment politics
• public opinion
• policy feedback effects

Acknowledgments

We would like to acknowledge helpful comments for revisions on an earlier draft from anonymous reviewers for the Journal of Aging & Social Policy, colleagues in the Health Politics Section of the American Political Science Association, and Seminars at the University of Chicago. We also gratefully acknowledge the use of survey data generated from the Kaiser Family Foundation.

Notes

¹ Individual states’ 95% confidence intervals vary from 3.3% in Pennsylvania to 10.1% in Utah, largely depending on the number of respondents we had in the May 2011 survey and the homogeneity of state population.

² Individual states’ 95% confidence intervals vary from 3.5% in Georgia to 9.9% in Nebraska.