The nationalization of health care policy: the Affordable Care Act and state-based Medicaid expansion programs
Files
Main article
Date
2024-05-03
DOI
Authors
Drinkward-Herrmann, Sadie
Version
Embargo Date
2024-05-04
OA Version
Citation
Abstract
Medicaid expansion programs vary drastically from state to state. Slow and uneven implementation, differing programs and eligibility requirements, and ideological conflict have all caused each state to have their own unique relationship and history with the welfare program. Such differentiation amongst states inherently causes vastly different health outcomes. Previous scholarship on the politics of Medicaid have largely emphasized partisan differences in state coverage. While this is useful in a broader more national sense, the study of Medicaid has been, therefore, limited and has yet to fully uncover the discrepancies in the program at the state by state basis, especially within states with similar partisan backgrounds. Uneven implementation policies and partisan politics can cause very different outcomes at the state level because of the political processes that constructed and, therefore, define the programs. Such variations can be lost in the complexities of the national narrative.
In an attempt to dissect these state Medicaid programs, I discuss how nationalization, which refers to the partisan political divide at the national level impacting local policies and politics which were previously non-partisan, impacts local level of health policy. More specifically, I analyzed the effects of the nationalization of the Affordable Care Act (ACA) implemented in 2010 and subsequent Medicaid expansion policies enacted by Republican state governments. I analyzed the differences in implementation and effectiveness of Medicaid expansion policy and found that there is significant variation between the effectiveness of expansion policies even within states with similar political partisanship. While many states of the same party utilize similar rhetoric and employ similar policy implementation approaches, each state enacts incredibly different and state-specific policy. Ultimately, the emphasis on nationalization and partisan polarization has missed important variation in policy within states with similar party politics. This makes local policies all the more important to discuss because the effects of the implementation politics and the implementation process itself plays a significant role in how individuals interact with their government and how such governments have effects on the health outcomes of their constituents.