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Shifting threats and rhetoric: how Republican governors framed Medicaid expansion

Published online by Cambridge University Press:  04 March 2020

Phillip M. Singer Open the ORCID record for Phillip M. Singer [Opens in a new window]  and
Michael Rozier
Phillip M. Singer*
Affiliation:
Political Science Department, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
Michael Rozier
Affiliation:
Department of Health Management and Policy, Saint Louis University, St. Louis, MO, USA
*
*Corresponding author. Email: phillip.singer@poli-sci.utah.edu
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Abstract

The 2012 Supreme Court decision in National Federation of Independent Business v Sebelius gave states the option to adopt the Medicaid expansion as part of the Affordable Care Act. Many states, especially those under Republican control, have since grappled with their decision to implement the expansion. We conduct a comparative analysis of how Republican governors framed their stance on the Medicaid expansion. We analyze public statements on the Medicaid expansion published in two major in-state newspapers from all Republican governors from June 2012 through June 2018. In total we collected, coded and analyzed 3277 statements from 66 newspapers. Several key themes emerge from our analysis. While every Republican governor used oppositional framing as part of their rhetorical response to the Medicaid expansion, the policy had a destabilizing effect on the previously unified opposition to health reform. We find that Republican framing split after the results of the 2012 election and that overall Republican governors shifted towards more supportive framing prior to the 2016 presidential election. Republican governors transformed how they framed their stance towards Medicaid expansion after Donald Trump was elected in 2016, with both supportive and oppositional moral-based framing of expansion increasing. These findings inform how policymakers use rhetoric to support their stance on controversial policies in a hyper-partisan and polarized political environment.

Keywords

Health reformhealth policymedia framingMedicaid expansion
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 4 , October 2020 , pp. 496 - 508
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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