How Deservingness & Racial Attitudes Shape Tolerance for Administrative Burdens

• In Event: Determinants and Consequences of Social Policies

Abstract

The American welfare state has grown from a small runt among developed nations to massive proportions today. Health-related programs have grown disproportionately. Today, more than 72.5 million people are on Medicaid or the Children’s Health Insurance Program (CHIP). However, many of these programs require potential beneficiaries to follow a certain process to first become enrolled and then maintain their enrollment over time. While these processes provide accountability and limit fraud, as the growing literature on administrative burdens indicates, these hurdles to enrollment are likely to be consequential and have substantial effects. There is growing evidence that these burdens are likely to fall disproportionately onto individuals of lower socio-economic status and here particularly minorities. Indeed, administrative burdens may often be purposefully included in policy designs as part of a “hidden politics” that deliberately seeks to suppress enrollment.

So far, most scholarship on administrative burdens has focused on identifying various burdens as well as highlighting their effects on potential beneficiaries. Much less work has focused on how the broader public feels about them and under what circumstances Americans are particularly tolerant of them. Given what we know about the development of public assistance in the United States, it seems likely that perceptions of deservingness for program’s target populations likely play an important role in how Americans perceive administrative burdens. At the same time, perceptions of public assistance programs have also been shown to have a strong, and growing, racial components. The role of racial attitudes has only gained in importance since the election of the nation’s first Black president and his successful efforts to expand health insurance coverage via the Affordable Care Act.

However, our understanding of how perceptions of deservingness and racial attitudes interact when it comes to tolerance for administrative burdens is limited.

To do answer this question, we fielded a survey experiment on a sample of 4,000 Americans to examine how American’s perceptions of deservingness as well as their racial attitudes shape their tolerance for administrative burden. Specifically, we created four hypothetical life scenarios that would apply to Medicaid applicants that were not employed and did not have employee sponsored health insurance. The scenarios involved women who were legally disabled, dealing with substance addiction, single with two children, and healthy without children. Respondents were randomized into the four scenarios. In addition, we also randomly assigned specific first and last names to each scenario that have been previously shown to be associated with different races and ethnicities (non-Hispanic White, Black, Hispanic, Asian). We then asked respondents whether they thought the individual in the scenario should be (1) allowed to enroll into Medicaid, (2) be required to sign up in a face-to-face interview or be allowed to enroll online, (3) be required to recertify in a face-to-face interview or be allowed to enroll online, or (4) pay premiums to stay on Medicaid.

Authors

• Wendy Xu, The Ohio State University

• Simon F. Haeder, Texas A&M University