The Politics of Evidence in Medicaid

Session Submission Type: Roundtable

Session Description

Recent years have seen an abundance of research evidence on the Medicaid program—on the consequences of insurance coverage gains through the Medicaid expansion, associated health and financial benefits, and increasingly, the relationship between Medicaid participation and democratic citizenship. Alongside the availability of so much research evidence, however, comes important questions about the politics of evidence in the Medicaid program. This Roundtable convenes four experts from different disciplinary perspectives to engage in a discussion on the politics of evidence production and use related to the Medicaid program: a critical, but threatened, pillar of the safety net for low-income and marginalized Americans.

Sarah Gollust (University of Minnesota), will begin the discussion. She will set the stage with an introduction to the production of Medicaid research evidence in public health and health services research. She will discuss examples of research evidence that has entered Medicaid policy discourse and also present new data on the frequency with which research evidence about Medicaid gets translated to the public in news coverage.

Marian Jarlenski (University of Pittsburgh), will present an analysis of the evidentiary claims made in the State Health Official letters from the Centers for Medicare and Medicaid Services (CMS) in support of Medicaid work requirements. She will discuss examples of misrepresentation of research evidence, potential consequences for Medicaid enrollment, and implications for the required policy evaluations under Section 1115 Medicaid waivers.

Simon Haeder (Penn State) will continue the conversation by describing the democratic response to work requirements, sharing findings from a content analysis of public comments to 1115 waivers from more than a dozen states. He will discuss the role of expertise in public comments, and how medical providers and interest group coalitions leverage their expertise alongside scientific evidence.

Charley Willison (Harvard) evaluates the use of evidence for access to Medicaid in intergovernmental relations seeking to address homelessness. She considers how institutional constraints and policy coordination may influence what evidence is used between governing bodies, how it is used, and what policy goals are produced.

Michael Gusmano and Frank Thompson (Rutgers) will discuss the role of evidence in justifying and evaluating Medicaid 1115 waivers. In doing so they will assess the strengths and limitations of using states as ‘laboratories of democracy'.

Finally, Jamila Michener (Cornell) will serve as chair and moderate the panel, while also providing context from her own work about how Medicaid beneficiaries themselves affect and engage the politics of evidence in Medicaid. She will consider how and when beneficiaries play a role in producing evidence about Medicaid and how evidence based on Medicaid beneficiaries' experiences, stories and narratives is used and interpreted in the policy process.

During the moderated discussion, the participants will engage in a debate and deliberation over core questions related to the politics of evidence use in public policymaking, including: What are the normative implications of using science in bad faith in public policymaking? Are there ethical implications of producing or translating research that has the potential to be misused in policy? What are the roles and responsibilities of scholars and others to mediate or interpret the types of evidence that are translated and communicated in the public policy process? And what are the implications of these questions playing out within the context of a public policy that has a fundamental mission to protect the most vulnerable and address health and social inequity?

This Roundtable will draw audiences interested in the politics and policy of the Medicaid program, as well as those interested more broadly in questions about the role of science in democracies.

Sub Unit

• Division 48: Health Politics & Health Policy

Chair

• Jamila D. Michener Cornell University

Presenters

• Sarah E. Gollust University of Minnesota

• Marian Jarlenski university of Pittsburgh

• Simon F. Haeder The Pennsylvania State University

• Michael K. Gusmano Lehigh University

• Charley Ellen Willison Cornell University

• Frank J. Thompson Rutgers University