More Than Words: How Framing Affects Perceptions of the Medicaid Program

• In Event: How Framing Shapes Abortion, COVID-19, and Medicaid Politics

Abstract

The Medicaid program has long served as one of the backbones of the American safety net and the US health care system. The COVID-19 pandemic has only cemented its crucial role in providing health access for vulnerable individuals in the American welfare state. Yet, the Medicaid program is incredibly complex and its reach into the American population is ever-evolving. Unsurprisingly, Americans are often unaware of how the program works or the demographics of who benefits from the program. Given this complexity, scholars of public opinion have long struggled about how to appropriately introduce the program to potential survey respondents without overly and unduly priming them. To this point, it remains empirically unexplored how descriptions of the program – by pollsters and policymakers - affect perceptions of the Medicaid program, its beneficiaries, and program enrollment.

To investigate this issue, we first collected information on how states describe their own programs on their state Medicaid websites. We then utilized these findings to develop and field a nationally representative survey of 2,700 Americans. The survey included a survey experiment that primed respondents to certain aspects of the Medicaid population as described on various state Medicaid websites. Specifically, we rely on experimental manipulations derived from state websites to alternatively expose respondents to one of 8 different framings of Medicaid beneficiaries. These framings include combinations of describing Medicaid beneficiaries as “low-income individuals and families,” “children, pregnant women, and to eligible aged, blind or disabled people,” and “U.S. citizens or legal, long-term permanent residents (Green Card holders) after a 5-year waiting period.” We also included a frame that focused on the shared-governance nature of the Medicaid program (a program “jointly by states and the federal government”). In order to test the causal effects of the descriptions, we then asked respondents a number of questions about their perceptions of the Medicaid program as well as Medicaid beneficiaries. Importantly, we also asked respondents whether they would enroll in Medicaid if they were uninsured.

Our analysis finds that how states (and pollsters) describe Medicaid has considerable implications for public opinion and health behavior. Depictions of Medicaid as a program for groups often seen as deserving including children and pregnant women result in high levels of support for the program and intention to enroll while those emphasizing its intergovernmental nature or that it provides coverage for low-income individuals results in lower levels of support. We conclude by discussing the significance of these findings for policymakers as well as scholars of health policy and public opinion.

Authors

• Steven M. Sylvester, Utah Valley University

• Simon F. Haeder, The Pennsylvania State University

• Timothy Herbert Callaghan, Texas A&M University