O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN, United States of America.
Kelley School of Business, Indiana University, Bloomington, IN, United States of America.
PLoS One. 2019 Apr 4;14(4):e0214206. doi: 10.1371/journal.pone.0214206. eCollection 2019.
In the last decade, health care reform has dominated U.S. public policy and political discourse. Double-digit rate increases in premiums in the Health Insurance Marketplaces established by the Affordable Care Act (ACA) in 2018 make this an ongoing issue that could affect future elections. A seminal event that changed the course of policy and politics around health care reform is the 2016 presidential election. The results of the 2016 presidential election departed considerably from polling forecasts. Given the prominence of the Affordable Care Act in the election, we test whether changes in health insurance coverage at the county-level correlate with changes in party vote share in the presidential elections from 2008 through 2016. We find that a one-percentage-point increase in county health insurance coverage was associated with a 0.25-percentage-point increase in the vote share for the Democratic presidential candidate. We further find that these gains on the part of the Democratic candidate came almost fully at the expense of the Republican (as opposed to third-party) presidential candidates. We also estimate models separately for states that did and did not expand Medicaid and find no differential effect of insurance gains on Democratic vote share for states that expanded Medicaid compared to those that did not. Our results are consistent with the hypothesis that outcomes in health insurance markets played a role in the outcome of the 2016 presidential election. The decisions made by the current administration, and how those decisions affect health insurance coverage and costs, may be important factors in future elections as well.
在过去的十年中，医疗保健改革一直主导着美国的公共政策和政治话语。2018 年《平价医疗法案》（ACA）设立的医疗保险市场保费增长率达到两位数，这是一个持续存在的问题，可能会影响未来的选举。改变医疗保健改革政策和政治进程的一个重要事件是 2016 年总统选举。2016 年总统选举的结果与民意调查预测有很大出入。鉴于《平价医疗法案》在选举中的突出地位，我们检验了县级医疗保险覆盖范围的变化是否与 2008 年至 2016 年总统选举中政党选票份额的变化相关。我们发现，县级医疗保险覆盖率每增加一个百分点，与民主党总统候选人的选票份额就会增加 0.25 个百分点。我们进一步发现，民主党候选人的这些收益几乎完全来自共和党的（而非第三方）总统候选人。我们还分别为扩大医疗补助计划的州和没有扩大医疗补助计划的州建立模型，发现扩大医疗补助计划的州的医疗保险收益对民主党选票份额没有差异影响，而没有扩大医疗补助计划的州则没有。我们的结果与这样一种假设一致，即医疗保险市场的结果在 2016 年总统选举结果中发挥了作用。现任政府的决策，以及这些决策如何影响医疗保险覆盖范围和成本，也可能是未来选举的重要因素。
