Framing Contested Policies: Republican Governors and Medicaid Expansion Phillip M. Singer Michael D. Rozier University of Michigan
Motivation and Background • Medicaid has become one of the bulwarks of the United States’ health care system and social safety net. Highlighting the importance of the program is its role as a central component to improve insurance coverage in the ACA “As we mark the turning of spring, we also mark a new season in America...when I sign this bill, all of the overheated rhetoric over reform will finally confront the reality of reform” -President Barack Obama “ What Congress is not free to do is penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.” -Chief Justice John Roberts
Motivation and Background 1. How have Republican governors differed in their choice of frames to discuss their support or opposition to expanding Medicaid? 2. How have political events and the context of a state influenced the choice and frequency of frame selection?
Motivation and Background • Governors have unmatched access to the bully pulpit and shape what the ACA would look like in their state • Republican governors offer a case study of how contested policies are framed – Partisanship has colored debate over the ACA, yet a divide has emerged over Medicaid – Since 2012, 14 Republican governors have supported expansion and 9 successfully implemented the expansion – Framing is not static choice, but is shaped by broader events
Motivation and Background
Study Aims 1. Collect public instances of gubernatorial speech related to the Medicaid expansion reported in major newspapers from June 2012-January 2017 2. Describe framing categories for gubernatorial speech 3. Analyze variation in the frequency and type of political frame used by governors over time and across different political environments
Research Design • Created a unique database of gubernatorial statements by all sitting Republican governors in two major newspapers from each state • Newspaper selection followed a two-step process: – Identified the two most populous Metropolitan Statistical Areas (MSA) in each state – Selected the newspaper with the highest circulation within each separate MSA – The search was conducted using newspaper databases with a standardized search “ GovernorLastName ” & “Medicaid” between 28 June 2012 and 31 January 2017 • Coding followed a two-step process with multiple individuals coding gubernatorial statements
Results – Framing Medicaid • Search returned 1632 articles, from which 2982 statements were coded • All governor statements were assigned to nine distinct framing categories "My personal faith and the lessons I learned from the Good Book, they're important to me. I am unwilling to turn my back on those who live in the shadows of life, those with the least among us … Please examine your conscience. Put it in your family, put it on your doorstep .“ - John Kasich (OH) “Why would you want to put 1,000 more people on the Titanic when you know how it's going to turn out?" - Rick Perry (TX)
Results – Framing Medicaid Gubernatorial Medicaid Framing, June 2012-January 2017 Frame Used By Governor Percent All News Stories (n=2982) Gathering Information 5% (144) State Politics 20% (589) National Politics 20% (599) Oppositional Framing 34% (1017) Medicaid Needs Reform 10% (311) Financially/Economically Detrimental 21% (614) Morally Wrong 3% (92) Supportive Framing 21% (633) Medicaid Works 5% (156) Financially/Economically Beneficial 10% (296) Morally Right 6% (181)
• Results – Governor Volume expansion Wide variation in total frequency of governors talking about Medicaid 100 150 200 250 50 0 Dalrymple Daniels Christie Haley Sandoval Parnell Martinez Brownback Otter Bryant Branstad Corbett Heineman McDonnell Perry Fallin Brewer Walker Kasich Jindal Snyder Daugaard Bentley Scott LePage Mead Deal Herbert Haslam
Results – Volume of Frames • Spike in Summer 2012, with both “wait and see” and rejection as common responses, followed by a lag through the remainder of the year • 2013 had the highest volume of Medicaid frames, averaging 107 instances per month – Gubernatorial response to Obama re-election • Governor response to legislative sessions 250 200 150 Total Instances of Governor Framing 100 50 0
Results – Volume of Frames • Spike in Summer 2012, with both “wait and see” and rejection as common responses, followed by a lag through the remainder of the year • 2013 had the highest volume of Medicaid frames, averaging 107 instances per month – Gubernatorial response to Obama re-election • Governor response to legislative sessions 250 200 150 Total Instances of Governor Framing 100 50 0
Results – Supportive and Oppositional Framing • Oppositional framing initially far exceeded supportive, until a shift starting in January 2015 – Combination of supportive governors and oppositional legislatures and previously oppositional governors softening their approach – From “truly the worst piece of legislation” to “We lost… we have to take the resources we have available and try to improve the quality of life for the people of Alabama” – Negative framing in response to state elections in October 2014 90 – Response to Trump victory, repeal ACA and make further reforms to Medicaid 80 70 60 50 Any Supportive Framing 40 Any Opposing Framing 30 20 10 0 Aug-12 Dec-12 Apr-13 Aug-13 Oct-13 Dec-13 Apr-14 Aug-14 Dec-14 Apr-15 Aug-15 Dec-15 Apr-16 Aug-16 Oct-16 Dec-16 Jun-12 Oct-12 Feb-13 Jun-13 Feb-14 Jun-14 Oct-14 Feb-15 Jun-15 Oct-15 Feb-16 Jun-16 Feb-17
Results – Supportive and Oppositional Framing • Oppositional framing initially far exceeded supportive, until a shift starting in January 2015 – Combination of supportive governors and oppositional legislatures and previously oppositional governors softening their approach – From “truly the worst piece of legislation” to “We lost… we have to take the resources we have available and try to improve the quality of life for the people of Alabama” – Negative framing in response to state elections in October 2014 90 – Response to Trump victory, repeal ACA and make further reforms to Medicaid 80 70 60 50 Any Supportive Framing 40 Any Opposing Framing 30 20 10 0 Aug-12 Dec-12 Apr-13 Aug-13 Oct-13 Dec-13 Apr-14 Aug-14 Dec-14 Apr-15 Aug-15 Dec-15 Apr-16 Aug-16 Oct-16 Dec-16 Jun-12 Oct-12 Feb-13 Jun-13 Feb-14 Jun-14 Oct-14 Feb-15 Jun-15 Oct-15 Feb-16 Jun-16 Feb-17
Results – Financial Framing • Overall, financial framing was the most prevalent type of framing used by governors, both in support and opposition "We've got a mentality developing in this country of entitlement ... government every step of our life. I reject that notion. The road of good intentions is paved, not with gold, but with taxpayer money. Whether it takes you to hell or not, it's going to cost you a lot of money." - Gary Herbert (UT), 2012
Results – Financial Framing • Overall, financial framing was the most prevalent type of framing used by governors, both in support and opposition “The choice before us is stark: We can either watch our hard-earned tax dollars remain on the table in Washington, D.C., primarily benefitting other states, or we can bring back a significant amount of our own money to Utah to be spent on Utahns .” - Gary Herbert (UT), 2015
Results – State Context Republican Democratic/Split Non-partisan
Results – State Context Chi-Square Results Unified Republican Split or Democratic Total Any Oppositional Frames 771 180 951 Any Supportive Frames 564 69 633 Total 1335 249 1584 Chi-Square P-value >0.00001 Financially/Economically Detrimental 463 93 556 Financially/Economically Beneficial 265 31 296 Total 728 124 852 Chi-Square P-value 0.014 Morally Wrong 53 38 91 Morally Right 164 17 181 Total 728 124 852 Chi-Square P-value >0.00001 Medicaid Needs Reform 255 49 304 Medicaid Works 135 21 156 Total 390 70 460 Chi-Square P-value 0.45
Limitations • Communication landscape is rapidly expanding beyond the printed word • Limited to a single actor within the state • Difficulty in establishing causality in framing the legislative process
Policy Implications • No doubt that Republicans took an oppositional stance towards the ACA. However, the politics and framing of Medicaid expansion are not cut-and-dry • Governors advocating for expansion often partnered negative and positive frames together, admitting weaknesses in order to convince people of its strengths • As Republicans grapple with repeal and replace of the ACA, a better understanding of contested policies and the central role of governor is necessary
Acknowledgements • We wish to thank Martha and Ernest Hammel for their generous support of this project, as well as research assistants David McCredie, Jennifer Nguyen, and Jay Nautiyal
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