title: Counterproductive Consequences of a Conservative Ideology: Medicaid Expansion and Personal Responsibility Requirements.
abstract: Medicaid expansion, a key part of the Affordable Care Act, has been opposed by conservative politicians despite its fiscal and public health benefits. In response, some Republican-led states have expanded Medicaid with new reforms, including requirements for cost sharing and behavioral incentives, that promote conservative political values tied to an ideology of personal responsibility. We examine this trend using Michigan's Medicaid expansion as a case example. We explore the origins, evidence base, and possible consequences of these reforms. We argue that these reforms prioritize ideology over sound public health knowledge, deflecting attention away from the social, economic, and structural factors that influence the health of the poor, and may ultimately contribute to counterproductive public health and fiscal outcomes.
authors.affiliation: Allison M. Baker and Linda M. Hunt are with the Department of Anthropology, Michigan State University, East Lansing.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Baker
authors.affiliation: Allison M. Baker and Linda M. Hunt are with the Department of Anthropology, Michigan State University, East Lansing.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Hunt
mesh_terms: D017047:Cost Sharing; D015438:Health Behavior; D006801:Humans; D008484:Medicaid / Q000458:organization & administration*; D008824:Michigan; D009042:Motivation; D011057:Politics; D011640:Public Policy; D013219:State Government; D014481:United States