Open AccessCounterproductive Consequences of a Conservative Ideology: Medicaid Expansion and Personal Responsibility Requirements
Author(s) -
Allison M. Baker,
Linda M. Hunt
Publication year - 2016
Publication title -
american journal of public health (1971)
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.284
H-Index - 264
eISSN - 1541-0048
pISSN - 0090-0036
DOI - 10.2105/ajph.2016.303192
Subject(s) - medicaid , ideology , moral responsibility , incentive , politics , public economics , health care reform , public health , health care , public administration , political science , economics , health policy , economic growth , medicine , law , nursing , market economy
Medicaid expansion, a key part of the Affordable Care Act, has been opposed by conservative politicians despite its fiscal and public health benefits. In response, some Republican-led states have expanded Medicaid with new reforms, including requirements for cost sharing and behavioral incentives, that promote conservative political values tied to an ideology of personal responsibility. We examine this trend using Michigan's Medicaid expansion as a case example. We explore the origins, evidence base, and possible consequences of these reforms. We argue that these reforms prioritize ideology over sound public health knowledge, deflecting attention away from the social, economic, and structural factors that influence the health of the poor, and may ultimately contribute to counterproductive public health and fiscal outcomes.