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Wesley's Dissertation (Final).docx.pdf (1.82 MB)

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To Expand or Not Expand Medicaid? That is the Republican Governor’s Question

Prater, Wesley
http://rave.ohiolink.edu/etdc/view?acc_num=osu152813205087059

Abstract Details

2018, Doctor of Philosophy, Ohio State University, Public Health.
The June 2012 Supreme Court decision concluded that all provisions of the Affordable Care Act were constitutional except for the mandatory Medicaid expansion for adults. Therefore, each state had the option to expand Medicaid. By 2015, thirty-one states had adopted Medicaid expansion. Medicaid expansion is generally supported by Democrats and resisted by Republicans. Given the power governors have in Medicaid policymaking, it would stand to reason that states with Democratic governors would expand while states with Republican governors would not. However, ten states adopted expansion with a Republican governor. In the context of widespread Republican opposition to the ACA, why did some Republican governors support Medicaid expansion? What factors influence Republican governors’ decisions regarding Medicaid expansion? The overall goal of this study is to understand the conditions under which Republican governors decided to support Medicaid expansion, given their party’s opposition. Using mixed methods, the specific aims of this study are: 1) Identify the factors associated with a Republican governor’s decision to support Medicaid expansion. 2) Determine in-depth how these factors and perhaps others, interacted with Republican governors in two states – one expansion state (Arizona) and one non-expansion state (Florida). The results from this study imply that in the case of Medicaid expansion, ideological, economic, political, and racial factors influence the decision-making of Republican governors, with ideological factors being the most dominant. The implications of this study are extensive for stakeholders including policymakers, public health advocates, interest groups, and researchers in states with Republican governors. It offers statistical and qualitative data that can be used to help them identify potential problems and solutions for coverage expansions in the future in seemingly challenging circumstances. Moreover, findings from this study can help stakeholders in favor of Medicaid expansion illuminate the conditions in which coverage expansion may be difficult or relatively easy as well as help them explain why. Learning more about what drives expansion of coverage in challenging circumstances is important as these expansions contribute to making health care more accessible, equitable, and affordable, particularly for low-income and vulnerable populations.
Sandra Tanenbaum (Committee Chair)
Tasleem Padamsee (Committee Member)
Deena Chisolm (Committee Member)
Thomas Nelson (Committee Member)
286 p.
Political Science; Public Health; Public Policy
Medicaid; Medicaid expansion; governors; Republican governors

Recommended Citations

Citations

  • Prater, W. (2018). To Expand or Not Expand Medicaid? That is the Republican Governor’s Question [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu152813205087059

    APA Style (7th edition)

  • Prater, Wesley. To Expand or Not Expand Medicaid? That is the Republican Governor’s Question . 2018. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu152813205087059.

    MLA Style (8th edition)

  • Prater, Wesley. "To Expand or Not Expand Medicaid? That is the Republican Governor’s Question ." Doctoral dissertation, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu152813205087059

    Chicago Manual of Style (17th edition)

osu152813205087059
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This open access ETD is published by The Ohio State University and OhioLINK.