Losing Out: How the Public Assesses Coverage Loss due to Administrative Burden

Objective Undersubscription to social benefits is common and varies across programs. Administrative burdens have been identified as a major contributor to incomplete take‐up. However, whom does the public blame when beneficiaries lose coverage as a result of these burdens? Methods To explore this question, a national study was fielded (N = 6178) that presented respondents with vignettes about different Medicaid beneficiaries. Scenarios also varied in the use of racially/ethnically identifiable names. Respondents were asked whether they thought it was appropriate for the individual to lose coverage, whether the Medicaid office was primarily to blame, whether the Medicaid office could have done more, and whether it should implement burden reductions. Results Americans strongly differentiated between beneficiaries, generally establishing a rank ordering from disabled individuals to individuals who are working, those who recently moved, and lastly those who simply ignored renewal notices. No differences based on the race or ethnicity of the beneficiary were identified. Subgroup analyses confirmed these findings for various demographics of interest. Moreover, expectations from the literature related to differences between subgroups were mostly confirmed. Conclusion The findings here highlight the role that beneficiary behavior has on blame attribution as well as the powerful role of blame attribution on public attitudes.