Assessing burden tolerance amid the Medicaid Great Unwinding

Abstract

The pandemic era ushered in a period of policy adaptation in how states deliver programs. One aspect of this experimentation is how burdensome safety net administrative processes should be. Using national surveys taken before and after the end of the public health emergency, we offer evidence of how tolerant the public is about burdens when allowed to choose between discrete policy implementation options. First, we show that burden tolerance beliefs are durable and largely unmovable, staying relatively consistent over time, and unaffected by experimental frames. Second, while there is varying support for specific strategies, the public is broadly supportive of tools that reduce burdens in Medicaid. Third, we find consistent predictors of burden tolerance: conservative beliefs and racial resentment are associated with support for burdens, while empathy toward others, belief in burdens as a form of systemic racism, and low administrative capital make people less tolerant of burdens.