The Racial Divide in State Medicaid Expansions
The Racial Divide in State Medicaid Expansions
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DOI：
10.1215/03616878-3802977
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发表时间：
2017-06-01
影响因子：
4.2
通讯作者：
Park, Sunggeun (Ethan)
中科院分区：
文献类型：
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作者：
Grogan, Colleen M.;Park, Sunggeun (Ethan)
本研究考虑了五个与州一级公众对医疗补助扩张支持的作用有关的重要问题：（1）公众对医疗补助扩张的支持是否在美国各州有所不同;（2）公众支持是否与州采用正相关;（3）这种支持是否种族化;（4）公众支持是否与州采用正相关。（4）如果种族化，是否有证据表明，州政府对白色支持的反应比对非白色（黑人和/或拉丁裔）支持的反应更大;（5）当白色支持相对较低时，非白色人口的规模是否更重要？我们的研究结果表明，虽然公众对医疗补助扩张的支持在州一级很高，特别是与公众对ACA的支持相比，但各州之间存在重要差异。尽管公众的总体支持与州的采用呈正相关，但我们发现公众对医疗补助扩张的支持在两方面表现出种族化。首先，有很大的差异，在支持水平的种族;第二，国家采用的决定是正相关的白色的意见，不响应非白色的支持水平。最重要的是，有证据表明，当黑人人口规模增加，而白色支持水平相对较低时，该州扩大医疗补助计划的可能性明显较低。我们的讨论突出了围绕这一重要覆盖政策的州一级的民主赤字和种族偏见。
This study considers five important questions related to the role of race in state-level public support for the Medicaid expansion: (1) whether public support for the Medicaid expansion varies across the American states; (2) whether public support is positively related to state adoption; (3) whether this support is racialized; (4) whether, if racialized, there is evidence of more state responsiveness to white support than to nonwhite (black and/or Latino) support; and (5) does the size of the nonwhite population matter more when white support is relatively low? Our findings suggest that while public support for the Medicaid expansion is high at the state level, especially in comparison to public support for the ACA, there are important variations across the states. Although overall public support is positively related to state adoption, we find that public support for the Medicaid expansion is racialized in two ways. First, there are large differences in support levels by race; and second, state adoption decisions are positively related to white opinion and do not respond to nonwhite support levels. Most importantly, there is evidence that when the size of the black population increases and white support levels are relatively low, the state is significantly less likely to expand the Medicaid program. Our discussion highlights the democratic deficits and racial bias at the state level around this important coverage policy.