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. 

Reihan Salam — Reihan Salam is executive editor of National Review and a National Review Institute policy fellow.

Most Popular


If Amy Wax Is Wrong, Let’s See the Data

Regarding the kerfuffle Jason Richwine addressed here earlier, the economist Glenn Loury has posted an impassioned plea to his Facebook page. Loury, you may recall, hosts the video blog where Wax made her controversial claim that black students at Penn Law School rarely graduate in the top half of the ... Read More
Politics & Policy

San Francisco Bans Fur Sales

San Francisco has banned the sale of fur. From the CBS-SF story: San Francisco has become the first major U.S. city to ban the sale of fur clothing and products. Tuesday, the Board of Supervisors unanimously approved a measure that prohibits the sale of fur clothes, accessories, even souvenirs in stores and ... Read More

For the First Time in Weeks, Relief Sweeps over Austin

Making the click-through worthwhile: The Austin bomber is done in by one of his own devices; some new numbers suggest that a small but significant portion of Trump voters are tiring of the chaos and aren’t showing up to support other Republicans in 2018; and the mixed news for conservatives coming out of the ... Read More

The Baleful Effect of #MeToo on Campus

Remember the series of hurricanes that pounded the Caribbean last summer? Something like that has been occurring on college campuses, as they're hit by one destructive mania after another: diversity, Title IX, anti-speech protests. Now it's the #MeToo Movement. In this Martin Center article, British academic ... Read More
Politics & Policy

A Time for Choosing

This year’s Conservative Political Action Conference was controversial. Invitations to European nationalist populists such as Nigel Farage and Marion Maréchal-Le Pen (the niece of Marine Le Pen) caused many longtime conservatives to question whether they still belong to the conservative movement. Vocal critics ... Read More