Policy and Politics: A Case Study on the Rhetoric of Republican Governors on the Affordable Care Act’s Medicaid Expansion

The passage of the Affordable Care Act (ACA) is arguably one of the most significant pieces of health care legislation passed in the United States in the past half-century, with the expansion of Medicaid eligibility dramatically altering the way Medicaid is delivered. Despite strong political, social, and economic opposition, four Republican governors chose to fully expand Medicaid eligibility under the ACA. Using the case study method and qualitative content analysis, the purpose of this research is to explore the rhetoric and language by these four Republican governors despite party-wide opposition to the expansion and to the ACA overall. The results of this study found that three major themes emerged: advocacy for the disadvantaged, an argument for fiscal responsibility, and an appeal to rationality. Though each governor faced unique social, political, and economic conditions that may have contributed to their decision to expand, all four governors framed their decision as a means of aiding those in their state who would benefit most from it. As neither politics nor policies exist in a vacuum, the results of this research further support the need for thick, contextual analysis of gubernatorial decision-making and the impact of language and rhetoric on the success of their policies.