Explaining States' Medicaid Expansion Decisions: Does Money Matter?
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American health policy has been subjected to a recent spike in politically polarizing legislative debates, while outside interests attempt to gain access and influence to policymakers in their decision-making process. The current implementation of the Affordable Care Act (ACA) has been politically divisive at the national level -- with Democrats typically in support of the entire bill and Republicans typically opposed to the entire bill, but many policymakers at the state level have made their own decisions on what to do when implementing certain ACA portions. For example, Republican governors Christie (NJ) and Brewer (AZ) both successfully pushed their state policymakers to accept Medicaid expansion, a major portion of the massive health reform bill, which almost all Republican Congressmen are opposed to. At the same time, health interest groups have spent more money than any other sector of interest at the state level in the last couple years advocating in support of the ACA. It is apparent that lobbyists and political influences have focused many of their resources on this complex area of policy. Therefore, what explains the variance in state decisions on the Medicaid expansion program?
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