Medicaid and the Policy Feedback Foundations for Universal Healthcare

Public policies are products of politics, but they also feed back into the political system by shaping the actions and attitudes of members of the polity. To date, scholarly examinations of feedback processes have been mostly concerned with understanding the relationship between public policy and democracy; relatively little attention has been paid to connecting policy feedback to the practical questions that animate politics. This article examines policy feedback as it applies to efforts aimed at achieving universal health coverage in the United States—a widely held policy goal shared by a majority of American voters across partisan lines. I argue that in the contemporary political context, Medicaid—a pillar of the American healthcare system and the primary mechanism for insuring low-income and disabled citizens—can produce negative feedbacks that demobilize political action, destabilize advocacy groups, and deter coalition building. Together, these feedbacks undermine future possibilities for universal healthcare. After detailing these democratic dilemmas, I outline strategies for proactively addressing them.