The Agenda

John Hudak on Electoral Constituencies and Coverage Expansion

The Brookings Institution’s John Hudak offers a theory of why Republican governors of state with large numbers of uninsured individuals and households oppose coverage expansion why Democratic governors of states with small numbers of uninsured individuals and households favor it:

Does principle really motivate Democrats and Republicans in the health care debate? No. A more base, self-interested, and political motive drives behaviors over health care. The statistics that appear to suggest that governors are acting contrary to the health care needs of their constituents fail to account for the demographics of the uninsured. While support for or opposition to the president surely affects governors’ views on the health care law, responsiveness to their electoral constituencies plays a central role. University of Rochester professor Richard Fenno describes an elected official’s electoral constituency as a subset of their broader constituency. The electoral constituency is a voting bloc large enough to secure continued electoral success, and politicians primarily cater to this subgroup.

In fact, because the president’s and Democratic governors’ electoral constituencies share demographic characteristics, their pursuit of similar voters motivates support for the law. By contrast, Republicans are successful because of the support of different demographics than Democrats. These electoral forces (not principles such as liberty or empathy) drive elected officials’ positions on health care.

Republicans often depend on white and wealthier voters for electoral success. Democrats’ electoral constituencies have a larger percentage of non-white and/or lower income voters. White and wealthier individuals are insured at dramatically higher rates. The national average for non-elderly uninsured is 18%. The rate for white Americans is only 14%. However, black Americans and Latino Americans are uninsured at rates of 22% and 32%, respectively. As one would expect, there is an inverse relationship between income and the rate of uninsured. [Emphasis added]

I made a closely related argument in a post on how the demographics of partisanship shape unemployment policy.

In a basic way, Republican and Democratic governors are not putting principle before politics. Instead, they are capitalizing on the politics of health care and appealing to the voters most important to their electoral needs. While Republican governors have higher percentages of uninsured in their states, their key voters don’t face the same burden. Conversely, voters critical to Democrats’ electoral fates face dramatically higher uninsured rates. Such a basis for policy support—constituency needs—is certainly not a damning trait. Elected officials are seeking to represent a sufficient percentage of their electorate. However, both sides’ political rhetoric of principle and altruism is disingenuous. Concerns about general health and welfare or of government takeovers are window dressing for political pandering. [Emphasis added]

Note that the view that the core Republican constituency consists of “low-income religious voters,” a view that is widely held among the media-savvy, is a source of a great deal of confusion. Per Andrew Gelman et al., Republicans represent the relatively affluent in heavily Republican non-affluent states while income is weakly correlated with partisanship in affluent states. 

Hudak’s theory is compatible with Josh Barro’s argument that Republicans are fundamentally disinterested in coverage expansion. My view, which I realize sounds absurd to many of my interlocutors, is that Republicans favor coverage expansion that flows from rising productivity and affluence rather than from increased public social expenditures. This is also compatible with Hudak’s theory, as the kind of “organic” coverage expansion I describe does not involve shifting resources from affluent constituents in non-affluent states. 


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