Medicaid Stigma

This paper uses the National Survey of America's Families (NSAF) to examine whether the low take-up rate for publicly provided health insurance is caused by welfare stigma that people associate with those programs. The NSAF asks several questions related to welfare stigma, including whether respondents believe that welfare makes people work less, or whether welfare helps people get back "on their feet." If stigma plays a role in take-up, then among eligible patients, those who neglect to enroll in Medicaid will have more negative attitudes towards welfare, all else equal. As a second approach, we test the predictions of a Moffitt (1983) utility function, with fixed and variable stigma from public benefits. In the end, we believe we can demonstrate that stigma plays a large and statistically significant role in deterring Medicaid take-up, but we cannot distinguish responses to Medicaid benefits (which should have no variable stigma) from responses to Food Stamps (which should have large variable stigma). Finally, the results of this research, while of academic interest in their own right, also have substantial policy implications. If low Medicaid take-up is caused by welfare stigma, the policy prescription is much different than if low take-up is caused by paperwork hassles, lack of information, or perceived low quality of care.