The Politics of Policy: The Initial Mass Political Effects of Medicaid Expansion in the States
by Joshua D. Clinton, Vanderbilt University and Michael W. Sances, University of Memphis
Did the expansion of Medicaid provided for under the Patient Protection and Affordable Care Act (ACA) of 2010 also increase political participation? Many thought that the passage of the ACA would help cement Democratic majorities in the House and Senate by creating politically active constituencies invested in the continued success of the ACA due to the large number of individuals receiving health insurance from the expansion. However, it is unclear whether public policy can feedback into electoral politics for complicated and highly-politicized policies such as the ACA. Comparing the political participation of counties in states that did and did not expand Medicaid reveals that counties in expansion states experience higher political participation relative to similar counties in non-expansion states. Moreover, the increases we observe are concentrated in counties with the largest percentage of eligible beneficiaries. The expansion of Medicaid has produced a higher percentage of registered voters through the 2016 election, but turnout increased only in the 2014 midterm elections.