Disenrolled: Retrenchment and Voting in Health Policy Jake Haselswerdt University of Missouri Jamila Michener Cornell University Abstract Context: Recent studies have shown that changes in public health insurance policy have the potential to affect political participation. In particular, aggregate-level analyses suggest that increases in Medicaid enrollment due to the Affordable Care Act’s Medicaid expansion are associated with increased voter turnout. Given the current uncertainty surrounding the future of Medicaid, these results lead to an important and related question: What happens to political participation when public health insurance coverage is reduced? Methods: Leveraging changes instituted by the state of Tennessee in the early 2000s to its Medicaid program, TennCare, the authors employed a first-differences approach to examine the effect of health policy retrenchment on county-level voter turnout and partisan vote share in gubernatorial elections. Findings: Counties with larger Medicaid enrollment declines saw larger decreases and smaller increases in voter turnout between 2002 and 2006 relative to those with smaller declines. Dis- enrollment was also associated with reduced Democratic vote share, though these results are not robust to controls. Conclusions: Rather than mobilizing voters angry about losing coverage, the TennCare disen- rollment seems to have had a demobilizing effect. The negative resource and interpretive effects of losing coverage likely outweigh any mobilizing backlash effect of retrenchment. Keywords policy feedback, Medicaid, retrenchment, voting, prospect theory Much of 2017 was marked by a succession of failed congressional bills aimed at repealing the Affordable Care Act (ACA). In March, the US House proposed the American Healthcare Act (H.R. 1628). In June and September, the US Senate attempted its own versions of repeal: the Better Journal of Health Politics, Policy and Law, Vol. 44, No. 3, June 2019 DOI 10.1215/03616878-7367012 Ó 2019 by Duke University Press Downloaded from https://read.dukeupress.edu/jhppl/article-pdf/561044/7367012.pdf by guest on 08 April 2019