Who Votes for Medicaid Expansion? Lessons from Maine's 2017 Referendum

Area of Science:

• Health Policy and Economics
• Public Health
• Political Science

Background:

• Maine's 2017 vote on Medicaid expansion under the Affordable Care Act was a landmark event.
• Understanding voter characteristics is crucial for analyzing the success of health policy initiatives.

Purpose of the Study:

• To identify demographic and economic factors associated with local support for Medicaid expansion.
• To analyze the influence of education, insurance status, income, and healthcare employment on voting patterns.

Main Methods:

• Merged official election results with data from the Census Bureau and American Hospital Association.
• Analyzed correlations between local characteristics and support for Medicaid expansion.

Main Results:

• Areas with higher rates of bachelor's degree holders and uninsured individuals favored expansion.
• Higher associate's degree attainment and higher incomes were associated with opposition to expansion.
• Greater hospital employment correlated with support, while the presence of other health professionals correlated with opposition.

Conclusions:

• Voting patterns largely align with economic self-interest, with a notable exception for bachelor's degree holders.
• Direct democracy can influence Medicaid policy, with potential for expansion in other states.