Can middle-class support ease Medicaid’s stigma?

Medicaid is now seen as an important part of the middle-class social safety net, thanks to nearly 60 percent of Americans being connected to the program directly or through a family member or close friend, a new study indicates.

Earlier this year, a concerted effort by Republicans in Congress to repeal and replace the Affordable Care Act hit a surprising road block: strong pushback against cuts to Medicaid. How did a program once tied to a “welfare stigma” become so fiercely debated, transcending partisan divides?

More than 90 percent of Americans say they would sign up for Medicaid if they were eligible.

In their new study, researchers found that those with a connection to Medicaid were more likely to view the program as important and to support increases in spending than those with no connection. Medicaid provides health care coverage to nearly 68 million low income and elderly Americans.

While most means-tested programs in the United States, like food stamps and public housing, are stigmatizing, Medicaid has proven resilient to retrenchment and has actually expanded dramatically over the years, most recently through the Affordable Care Act.

The question is: Has it become something closer to a non-partisan, middle-class entitlement program?

“These findings suggest that, although partisanship is important, Medicaid constituents and their allies are primed to be mobilized to not only protect the program against retrenchment but also to proactively fight for expansion,” says Colleen M. Grogan, a professor in the School of Social Service Administration at the University of Chicago.

“If Medicaid constituents can be sufficiently mobilized, then Medicaid can begin to mimic the politics of a middle-class entitlement,” she adds.

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Researchers used the Kaiser Family Foundation Poll: Medicare and Medicaid at 50, a nationally representative survey of 1,849 participants. Using the data, Grogan and Park examined three questions: Are individuals with a connection to Medicaid more likely to view the program as important? Are they more likely to support an increase in Medicaid spending? Are they more likely to support adoption of the Medicaid expansion under the Affordable Care Act?

The researchers found that more than half of all Americans are connected to the Medicaid program either directly or indirectly, and are significantly more likely to view the program as important and support increases to it. Further, more than 90 percent of Americans say they would sign up for the program if eligible.

For future research, Grogan and Park recommend exploring whether people with different types of connections to Medicaid view the program differently and, if so, how and why—and whether state-level attempts to destigmatize the program by renaming it would also reduce knowledge of and support for the program.