As people across the country head to the polls, some voters in traditionally red states will be weighing in on Medicaid expansion. Ballot initiatives on expansion are on the ballot in Idaho, Nebraska, and Utah, and Montana is voting on a ballot initiative to continue its Medicaid expansion. While research suggests Medicaid expansion has had positive effects on various health and economic outcomes, a new paper suggests that expansion may have a surprising impact on another behavior: political participation.
Since 2008, economists Katherine Baicker and Amy Finkelstein have been studying the effects of Oregon's Medicaid expansion. That initiative, which preceded the Affordable Care Act, was uniquely structured as a randomized, controlled trial to allow for a careful, rigorous evaluation of its effects. In the trial, a group of previously ineligible, low-income adults were randomly granted (via lottery) Medicaid eligibility. The resulting data has allowed researchers to draw conclusions about the effects of the expansion on health outcomes, financial outcomes, utilization of the health-care system, and labor market outcomes. And now, thanks to Baicker and Finkelstein, political engagement.
Looking at how the Oregon expansion affected voter registration and turnout, Baicker and Finkelstein found that Medicaid expansion increased voter turnout by about 2.5 percentage points in the 2008 presidential election, with a larger effect for men (5.4 percentage points) and residents of Democratic counties (3.6 percentage points). Baicker and Finkelstein also found some evidence (albeit, not statistically significant) that Medicaid expansion increased voter registration, again especially among males and those living in Democratic counties. "We interpret this as suggestive evidence that the increase in voter turnout may reflect the behavior of newly registered voters," they write. (Interestingly, these effects did not persist in subsequent elections.)
Baicker and Finkelstein offer several caveats—it's not clear, for example, that these results in Oregon are generalizable—but their research adds to a small but growing body of evidence suggesting that the ACA's Medicaid expansions boosted short-term political participation in the years immediately after the law was passed. More broadly, this work serves as a reminder of the effect that policy decisions have on political engagement and participation.
Experts are projecting record levels of turnout for today's elections, but turnout is nonetheless expected to be less than 50 percent of eligible voters. Democrats, meanwhile, have invested millions of dollars in efforts to increase turnout among low-income, minority, and youth voters. Should those efforts prove successful, these Medicaid ballot initiatives may in turn drive voter turnout in 2020.