Disenrolled: Retrenchment and Voting in Health Policy

Abstract

Abstract Context: Recent studies have shown that changes in public health insurance policy have the potential to affect political participation. In particular, aggregate-level analyses suggest that increases in Medicaid enrollment due to the Affordable Care Act's Medicaid expansion are associated with increased voter turnout. Given the current uncertainty surrounding the future of Medicaid, these results lead to an important and related question: What happens to political participation when public health insurance coverage is reduced? Methods: Leveraging changes instituted by the state of Tennessee in the early 2000s to its Medicaid program, TennCare, the authors employed a first-differences approach to examine the effect of health policy retrenchment on county-level voter turnout and partisan vote share in gubernatorial elections. Findings: Counties with larger Medicaid enrollment declines saw larger decreases and smaller increases in voter turnout between 2002 and 2006 relative to those with smaller declines. Disenrollment was also associated with reduced Democratic vote share, though these results are not robust to controls. Conclusions: Rather than mobilizing voters angry about losing coverage, the TennCare disenrollment seems to have had a demobilizing effect. The negative resource and interpretive effects of losing coverage likely outweigh any mobilizing backlash effect of retrenchment.