The Good and Evil of Health Policy: Medicaid Expansion, Republican Governors, and Moral Intuitions

Abstract

Using moral foundations theory (MFT), this study analyzes how Republican governors employed moral concepts to either build support or opposition to Medicaid expansion. The study examined statements about Medicaid expansion made by all Republican governors as reported in two large newspapers in each governor’s state from 28 June 2012 to 31 December 2018. A slight majority of the statements (183 or 58.5%) used moral arguments in support of Medicaid expansion. Governors from both policy camps most frequently used the moral foundations shared by liberals and conservatives: care/harm and fairness/cheating. Those supporting expansion also used loyalty/betrayal, authority/subversion, and sanctity/degradation. Those opposing expansion used liberty/oppression. Policymakers recognize that activating the public’s moral intuitions can be an effective way to advance a policy of interest. Those interested in advancing health policies would do well to better understand the kind of moral arguments that are used with potential supporters and arguments that may be used by opponents.

Keywords:

• Medicaid
• moral foundations theory
• health policy
• health care reform

Acknowledgements

The authors would like to thank research assistants who aided with data collection: David McCredie, Jay Nautiyal, Jennifer Nguyen, Allyssa Stevens, and Jerry Stott.

Author contributions

Rozier conceived the study and drafted the manuscript. Rozier and Singer designed the study, supervised data collection, and analyzed the data. Singer edited the manuscript.

Ethical approval

This study did not involve human subject research.

Disclosure statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

Funding for this study was provided by the Martha and Ernst Hammel Graduate Student Research Award.