Moderate Approach to Opposing Medicaid Reforms May Increase Success

If groups call for specific changes, they can potentially change the discourse and achieve success.

Researchers found that a majority of consumer advocacy groups tend to point to reasons why they oppose privatizing Medicaid rather than taking a stance completely against the reform, which lead to modest successes.

Kansas was the first state to completely privatize their Medicaid program, KanCare, and faced significant criticism from healthcare consumer advocates for doing so.

“There is evidence to suggest that advocates helped secure modest wins for consumers,” said researcher Kevin McCannon, a University of Kansas doctoral student in sociology. “But they faced limits.”

In the study, which will be presented at the 111th Annual Meeting of the American Sociological Association, researchers analyzed how healthcare consumer advocacy groups were able to shape the debate surrounding Medicaid reform.

“Given that other states are watching Kansas, it could influence the direction Medicaid takes nationally,” McCannon said. “The privatized model presupposes that a one-size-fits-all approach to health care that emphasizes consumer choice and personal responsibility in the private market will best meet people's needs. However, research finds that such models achieve mixed outcomes for consumers.”

Researchers analyzed news documents and legislative testimonies regarding the debate between critics and supporters of the reform. They discovered that oppositional consumer advocacy groups framed their problems with the reform in terms of symptoms, and discussed accountability, transparency, and problems that would arise rather than a wholesale opposition, according to the study.

“The unintended consequence is that this strategy legitimizes market-based solutions that do little to help low-income and poor people. By questioning the underlying premise of privatization, advocates can offer an alternative vision of care to the privatized model, if that is what they want to do,” McCannon said. “In the case of Kansas, I am not certain that was their goal. The tradition of political moderation in Kansas is strong, which means groups tend to shy away from extremes and work to maintain relationships with political friends and foes alike. This means compromise.”

These advocacy groups and their concerns reshaped the discourse on the reform, and even was able to achieve some successes, the researchers reported. After supporters of the reform called for consumers to take additional responsibilities, the opposition called for the same from the state.

This created mechanisms of public accountability, such as legislative oversight committees and an ombudsman for consumers, according to the study.

“Although the state gave opportunities for public input into the reform early on, these entities provide new opportunities for future claims for consumers and further democratizes the policymaking process,” McCannon concluded. “In light of the KanCare expansion debate and looming budget cuts, resistance to health care devolution is now enshrined in policy, and advocates could build on these successes to give voice to marginalized groups and shape policies that affect those groups.”