John Griffith and Chris Karpowitz, Political Science

Introduction

With the passage of the Affordable Care Act, health care policy became one of the most talked about issues in the United States. As a result, many states have been grappling with the question of whether to expand Medicaid. Utah is a particularly good place to study this salient issue because it is in the midst of deciding whether and how much to expand the Medicaid program. In this study I used a novel method of analysis to identify which attributes of Medicaid recipients or potential recipients were most influential in the minds of Utah voters as they determined who deserved the state’s help.

Methodology

To understand how the attributes of potential recipients affect voters, I included a series of questions on the Utah Voter Poll (UVP), a survey sent to over 1,500 randomly selected voters. To determine voters’ preferences, I used a statistical method called conjoint analysis. In conjoint analysis, participants are asked to make a series of pairwise decisions. This allowed me to analyze many attributes of potential Medicaid recipients simultaneously. In my study I showed participants several pairs of potential Medicaid recipients and asked them to choose which of the two they thought most deserved to receive coverage. I chose five key attributes to study: gender, marital status, number of children, employment status, and race. With every presentation the attributes of each candidate were randomly assigned from a predetermined pool. I then used linear regression and confidence intervals to determine the statistical significance of and movement caused by each attribute.

Results

I analyzed the results in two ways: general findings and partisan differences. I found that by far the strongest influence on a voter’s decision to extend Medicaid coverage is the size of the potential recipient’s family. Utah voters are much more likely to favor expanding Medicaid to parents of large families. Another family-related variable, marital status, also yielded significant results. Single people are more likely than married people to be seen as deserving aid, while living with a partner sharply decreases the probability of voters favoring an individual’s receipt of Medicaid. Interestingly, voters are generally less likely to want people who are employed to receive Medicaid, even if their circumstances are such that they qualify to for it.

The comparison between Republicans and Democrats also yielded interesting results. Unsurprisingly, Democrats and Republicans differed most in their perspective of attributes connected to current social issues. For example, Republicans were much less likely to provide Medicaid to an individual living with a partner than were Democrats.

What’s more, Democrats were more inclined than Republicans to extend Medicaid to minorities. However, this finding does not reveal whether Democrats are more sympathetic towards minorities or if Republicans are simply more egalitarian in their beliefs, not viewing race as a factor important in determining merit of assistance. Where attributes not linked to larger issues were concerned, partisans looked quite similar. For instance, Democrats and Republicans were equally likely to value large family size.

Discussion

My analysis revealed that the strongest determinant of whether an individual would be regarded as deserving Medicaid is family dynamic. Across all iterations, family size and marital status of the recipient proved to have the greatest effect on voters’ opinions. While there was some movement from other factors such as race, it was surprisingly small and relatively unsubstantial. One possible explanation may be that such considerations were deemed far less important when factors relating to home life (i.e., number of children and marital status) were also considered. All this appears to confirm approval of the primary purpose of Medicaid: to support low income families. It also suggests that rather than valuing the characteristics of the individual being awarded Medicaid, voters seem to approach the issue in terms of who else would benefit from the coverage. In my study this meant favoring coverage for children (seen in the preference for larger family size) and disfavoring coverage for other adults (seen in the preference for single and widowed recipients).

But for a few noteworthy exceptions, Republicans and Democrats were largely the same in their ranking of the most important attributes. The fact that the biggest differences between the two were on attributes tied to larger social issues suggests that, for the most part, voters do not see the granting of Medicaid coverage as an inherently political thing. Yet, when such considerations do overlap with areas where the respective political parties have taken positions, voters act consistent with their parties.

Conclusion

Knowing which attributes affect voters most could have important implications in Utah and other states around the country considering Medicaid expansion. Similar ramifications exist on the national level as the government seeks ways to foster support among states for expanding Medicaid. On a deeper level this analysis also allows us to see how people think social benefits ought to be distributed. The results thus have important political, cultural, and sociological ramifications at the state, national, and human level.

Furthermore, the results of my analysis could be an important first step in a line of research that might help government make more informed decisions about how it wishes to structure and “sell” its social benefit programs so as to do the most good and attract the widest range of support. Understanding how voters value the attributes studied here begins the development a literature base that examines how people decide who should receive social benefits and how an individual’s attributes affect another’s decision to be generous or not. There is much that can still be studied in these areas and ideally this work will serve as a motivation for further exploration thereof.