Who Votes for Medicaid Expansion? Lessons from Maine's 2017 Referendum.

CONTEXT: In November 2017, Maine became the first state in the nation to vote on a key provision of the Affordable Care Act: the expansion of Medicaid. METHODS: This study merged official election results from localities across Maine with Census Bureau and American Hospital Association data to identify characteristics of areas that support Medicaid expansion. FINDINGS: Places with more bachelor's degree holders more often vote in favor, whereas those with more associate's degree graduates tend to vote against. Conditional on education rates, areas with more uninsured individuals who would qualify for expanded coverage tend to vote in favor, while those with more high-income individuals tend to vote against. Also conditional on education rates, greater hospital employment is associated with support for expansion, but the presence of other health professionals, whose incomes might decrease from expansion, is associated with less support. CONCLUSIONS: Voting patterns are mostly consistent with economic self-interest, except for the sizable association of bachelor's degree holders with support for Medicaid expansion. Direct democracy can shift Medicaid policy: extrapolating to other states, the model predicts that hypothetical referenda would pass in 5 of the 18 states that had not yet expanded Medicaid at the time of Maine's vote.

Competition and product quality in the supermarket industry.

This article analyzes the effect of competition on a supermarket firm's incentive to provide product quality. In the supermarket industry, product availability is an important measure of quality. Using U.S. Consumer Price Index microdata to track inventory shortfalls, I find that stores facing more intense competition have fewer shortfalls. Competition from Walmart­the most significant shock to industry market structure in half a century­decreased shortfalls among large chains by about a third. The risk that customers will switch stores appears to provide competitors with a strong incentive to invest in product quality.