Medicaid Expansion and the Political Fate of the Governors Who Support It

Abstract

We provide evidence regarding potential policy feedback effects of healthcare reform by estimating the effect of Medicaid expansion on public support for the state actor most closely associated with responsibility for the expansion decision—the governor. The discretion granted to state governments concerning Medicaid expansion has created the potential for significant variation in mass feedback effects across the states. We are particularly interested in how these effects are influenced by the emerging racial polarization over healthcare policy, and how this may lead to different types of feedback effects that align with partisan, ideological, and racial cleavages. We estimate the impact of Medicaid expansion on gubernatorial approval, utilizing five waves of the Cooperative Congressional Election Study (2008–16). We find that on average, expansion led to a modest, yet statistically significant increase in gubernatorial approval. However, there is important variation both within and across states in the effect of expansion. Specifically, we find that governors were more likely to be rewarded for expansion by those who supported President Obama, and those who resided in states where the Medicaid recipient population is more likely to be white.