The Role of Public Preferences and Racial Sentiments in the Policy Process: A Study of Medicaid Generosity from 1988-2012

• Other Authors: Lanford, Daniel (authoraut)
• Format: Others
• Language: English; English
• Published: Florida State University
• Subjects: Sociology; Political science
• Online Access: http://purl.flvc.org/fsu/fd/FSU_2017SP_Lanford_fsu_0071E_13821

This dissertation is composed of three distinct studies. Study 1 asks what type of 'public opinion' is most likely to influence policy. Studies arguing for a strong link between public opinion and policy outcomes have focused on purely political sentiments almost exclusively. These studies have neglected to account for research on racialized politics which suggests racial sentiments often play a key role in shaping policy outcomes. Yet as often as public opinion is implicated for policy outcomes, and as often as racial sentiments are implicated in public opinion, few studies have quantitatively assessed the link between racial factors and actual policy outcomes. The goal of the present study is to address this gap by analyzing the relative influence of liberal-conservative ideology, attitudes about the role of government, policy-specific preferences, and racial sentiments for Medicaid generosity in the U.S. states from 1988-2012. This study analyzes a unique dataset composed of MRP public opinion estimates, socio-structural measure, and Medicaid expenditure data. Results of the analysis show that racial sentiments play a uniquely powerful role in shaping Medicaid outcomes. This study suggests research on policy responsiveness would do well to consider the political influence of racial sentiments on policy outcomes more broadly. Study 2 examines the link between program structure, public opinion, and policy outcomes. Analysts of all types commonly to refer to Medicaid as either a popular entitlement or a restricted welfare program. These often contradictory perspectives rest on untested assumptions about the relationships between program design, public opinion, and policy outcomes. In this study, expectations flowing from each perspective are reformulated as hypotheses and tested in two analyses. The first analysis draws on ICPSR and ANES survey data to assess the influence of program design on attitudes toward Medicaid. The second analysis examines the influence of different types of public opinion and non-opinion factors on actual Medicaid expenditures in the state. Both analyses are based on data available in various years from 1970 through 2012. Results suggest that Medicaid is best understood as racially restricted. Theoretical propositions following from the results are presented. Program design does influence public preferences, but not in the ways suggested in prior studies. Program size and policy legacies do not have the expected effect on public opinion. Yet the design of Medicaid does attract racial and ethnic antipathy, and this has a uniquely powerful influence on policy outcomes across the study period. Study 3 addresses class-based representational inequality. This study formalizes and assesses an age-old proposition: that policy makers are able to produce policy outcomes biased toward the political preferences of their affluent constituents because their inaffluent constituents offer electoral support on the basis of racial sentiments. This study employs recently developed methods of estimating public opinion at the state level and detailed data on Medicaid expenditures in the states from 1988-2012 to determine whether the liberal-conservative ideology, health policy preferences, and racial sentiments of different income groups influence Medicaid policy outcomes. Results show that policy responds to the political preferences of the affluent but not the inaffluent. However, policy also responds to the racial sentiments of the inaffluent. Taken together, the results suggest that policy makers employ racialized segmented responsiveness in order to limit the electoral sanctions which would otherwise follow from their overrepresentation of affluent campaign donors. === A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. === Spring Semester 2017. === April 7, 2017. === Medicaid, race, racialized politics, segmented representation, social policy, states === Includes bibliographical references. === Dan Tope, Professor Directing Dissertation; Frances Berry, University Representative; Jill Quadagno, Committee Member; John Taylor, Committee Member.