Doctor of Philosophy, The Ohio State University, 2018, 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 s (open full item for complete abstract)
Committee: Sandra Tanenbaum (Committee Chair); Tasleem Padamsee (Committee Member); Deena Chisolm (Committee Member); Thomas Nelson (Committee Member)
Subjects: Political Science; Public Health; Public Policy