Simon F. Haeder (
Donald Moynihan, Georgetown University, Washington, D.C.
Health Aff (Millwood). 2023 Oct;42(10):1334-1343. doi: 10.1377/hlthaff.2023.00472.
Safety-net programs do not reach all eligible Americans, partly because of administrative burden, or experiencing bureaucratic obstacles in obtaining and maintaining program benefits. This burden often disproportionately affects historically marginalized groups, adding concerns about equity. We used a national survey to examine public thinking about the acceptability of administrative burdens imposed by states when implementing Medicaid and the Supplemental Nutrition Assistance Program and the role of race in these considerations. We found that support for state actions associated with six types of burden was unchanged when respondents were informed about disparate effects by race. Neither racial identity nor prejudice toward other racial groups was associated with support for policies imposing higher burdens. However, non-Hispanic White respondents with higher levels of racial resentment were more supportive of policies that would create burden, whereas respondents who believed that burdens had disparate effects on historically disadvantaged groups favored less burdensome alternatives. Also associated with lower support for more burdensome policies were responses indicative of respondents' empathy, concerns about ability to manage burdens, Democratic party identification, and program experience.
安全网计划无法覆盖所有符合条件的美国人，部分原因是行政负担过重，或者在获得和维持计划福利方面遇到官僚障碍。这种负担往往不成比例地影响到历史上处于边缘地位的群体，增加了对公平性的担忧。我们使用一项全国性调查来研究公众对各州在实施医疗补助和补充营养援助计划时所施加的行政负担的可接受性的看法，以及种族在这些考虑中的作用。我们发现，当告知受访者种族差异对这些负担的影响时，受访者对与六种类型的负担相关的州政府行动的支持率并没有改变。种族认同或对其他种族群体的偏见与支持施加更高负担的政策无关。然而，对历史上处于不利地位的群体的负担有不同影响的信念，与支持创造负担的政策的非西班牙裔白种人受访者有关。对更具负担性政策的支持率较低的原因还包括表明受访者富有同情心、对管理负担能力的担忧、民主党的认同以及项目经验。
