Counterproductive Consequences of a Conservative Ideology: Medicaid Expansion and Personal Responsibility Requirements.

POVERTY & psychology; POLICY sciences; HEALTH care reform; HEALTH services accessibility; MEDICAID; PUBLIC health; RESPONSIBILITY; SOCIOECONOMIC factors; PATIENT Protection & Affordable Care Act; HEALTH & social status; PSYCHOLOGY

MICHIGAN; UNITED States

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'sMedicaid 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. [ABSTRACT FROM AUTHOR]

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