Who votes for medicaid expansion? Lessons from Maine's 2017 referendum

David A. Matsa, Amalia R. Miller*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Context: In November 2017, Maine became the first state in the nation to vote on a key provision of the Affordable Care Act: the expansion of Medicaid. Methods: This study merged official election results from localities acrossMaine with Census Bureau and American Hospital Association data to identify characteristics of areas that support Medicaid expansion. Findings: Places with more bachelor's degree holders more often vote in favor, whereas those with more associate's degree graduates tend to vote against. Conditional on education rates, areas with more uninsured individuals who would qualify for expanded coverage tend to vote in favor, while those with more high-income individuals tend to vote against. Also conditional on education rates, greater hospital employment is associatedwith support for expansion, but the presence of other health professionals,whose incomes might decrease fromexpansion, is associatedwith less support. Conclusions:Voting patterns are mostly consistent with economic self-interest, except for the sizable association of bachelor's degree holders with support for Medicaid expansion. Direct democracy can shift Medicaid policy: extrapolating to other states, the model predicts that hypothetical referenda would pass in 5 of the 18 states that had not yet expanded Medicaid at the time of Maine's vote.

Original languageEnglish (US)
Pages (from-to)563-588
Number of pages26
JournalJournal of health politics, policy and law
Issue number4
StatePublished - 2019


  • Direct democracy
  • Higher education
  • Medicaid expansion
  • Political economy
  • Referendum

ASJC Scopus subject areas

  • Health Policy


Dive into the research topics of 'Who votes for medicaid expansion? Lessons from Maine's 2017 referendum'. Together they form a unique fingerprint.

Cite this