The Politics of Community Health Centers’ Expansion, 2012 – 2019

• In Event: The Local Politics of Community Health Care

Abstract

About one in three Americans living in poverty receives primary health care from community health centers, but few studies examine why and how community health centers expanded as they did since the passage of the ACA. Community health centers are local entities with governing boards consisting of community representatives that receive a substantial amount of federal funds. This paper examines how the local political environment influences local entities’ decision to participate in the federal-funded program of health centers. Using a county-level dataset covering community health centers from 2012 to 2019, we find that the logic of community health centers’ expansion varies across Democratic and Republican communities. While the federal government aims to allocate community health centers in communities with limited medical resources, we find that only Republican counties confirm this logic. Within Democratic counties, community health centers were more likely to locate in counties with richer medical resources. We also find that, inconsistent with the common view that Medicaid spurred community health centers, the percentage enrolled in Medicaid is negatively correlated with the number of community health centers, both in Democratic counties within a Democratic state, and Republican counties within a Republican state. Only when the county and state partisanship differ does the correlation between Medicaid and health centers become positive. Finally, we show that the relationship between Medicaid and health center expansion changed during the Trump presidency— Republican counties within a Republican state benefited more from Medicaid, while all other counties benefited less.

Authors

• Nuannuan Xiang, Columbia University

• Amanda Isabel Mauri, University of Michigan

• Robert Mickey, University of Michigan