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Different Paths: The Politics of Medicaid Expansion in Montana, North Dakota, and Wyoming

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Overview

Year:
2023
Contributor:
Hahn, Adeline (creator)
Hackey, Robert (thesis advisor)
Levitas, Anthony (reader)
Brown University. International and Public Affairs (sponsor)
Genre:
theses
Subject:
Medicaid
Language:
English
DOI
https://doi.org/10.26300/91dg-hh53

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Description

Abstract:
Since NFIB v Sebelius made Medicaid expansion optional for states in 2013, 40 states have expanded their Medicaid programs. Republican-controlled states have lagged in expansion decisions, despite strong popular support for expansion and benefits for rural hospitals, state economies, and uninsured populations. Montana, North Dakota, and Wyoming, three demographically comparable, conservative upper-Midwestern states each undertook a different expansion path; Montana (2015) and North Dakota (2013) expanded their Medicaid programs while Wyoming did not. These divergent paths were driven by the presence of moderate Republicans in Montana and North Dakota and lack of in Wyoming. These old-school Republicans focus on fiscal responsibility and working across the aisle. They’re older, more rooted in the GOP establishment, and have fewer future political aspirations than their newer, more conservative counterparts. Tea Party and conservative populist sentiment driven by the election of President Trump in 2016 displaced these legislators. Expansion in Wyoming was blocked by a shortage of moderate Republicans and strong conservative interest groups pressuring legislators. Overall, necessary conditions for Medicaid expansion in conservative states include a supportive governor, public opinion in favor of expansion, hospital and interest group backing, and moderate Republicans willing to build a coalition with Democrats to pass expansion.
Notes:
Senior thesis (AB)--Brown University, 2023
Concentration: International and Public Affairs

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Citation

Hahn, Adeline, "Different Paths: The Politics of Medicaid Expansion in Montana, North Dakota, and Wyoming" (2023). International and Public Affairs Theses and Dissertations, The Watson School of International and Public Affairs Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.26300/91dg-hh53

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