Most Americans support minimizing administrative burdens for Medicaid recipients as the public health emergency ends
- PMID: 38756841
- PMCID: PMC10985919
- DOI: 10.1093/haschl/qxad001
Most Americans support minimizing administrative burdens for Medicaid recipients as the public health emergency ends
Abstract
During the coronavirus disease 2019 (COVID-19) public health emergency (PHE), states were barred from disenrolling anyone from Medicaid unless the beneficiary asked to be disenrolled, moved out of state, or died. Coverage increased, but as the PHE ends an estimated 7 million eligible Americans are expected to lose insurance due to difficulty navigating the renewal process. The end of the PHE therefore offers state policymakers a chance to reassess the value of such administrative burdens as a variety of policy tools are available to mitigate these losses. We inform this discussion via a national survey that captures public preferences around administrative burdens in public health insurance. We find strong public support for burden-reduction techniques that minimize coverage losses such as using administrative data to shift burdens onto the state and better outreach and communication, with an average of 74% of respondents supporting each policy tool. This support holds across the ideological spectrum and demographic groups, but it is stronger among liberals than conservatives, for those with more direct experience of burdens, those who struggle with such burdens, and for those with lower racial prejudice.
Keywords: COVID-19; Medicaid; access to care; public health emergency.
© The Author(s) 2023. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.
Conflict of interest statement
Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.
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References
-
- Halling A, Bækgaard M. Administrative burden in citizen-state interactions: a systematic literature review. OSF Preprints; 2022. https://osf.io/26xdj
-
- Doughty M, Baehler KJ. “Hostages to compliance”: towards a reasonableness test for administrative burdens. Perspecti Public Manage Govern. 2020;3(4):273–287.
-
- Herd P, Moynihan DP. Administrative Burden: Policymaking by Other Means. Russell Sage Foundation; 2018.
-
- Brown JT, Carey G, Malbon E. What is in a form? Examining the complexity of application forms and administrative burden. Aust J Public Adm. 2021;80(4):933–964.
-
- Chudnovsky M, Peeters R. A cascade of exclusion: administrative burdens and access to citizenship in the case of Argentina's national identity document. Int Rev Adm Sci. 2022;88(4):1068–1085.
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