Do Opinions of Policy Target Population Deservingness Correlate to Public Service Motivation? Insights from Medicaid
| Author | Jacqueline Chattopadhyay,Jaclyn Piatak |
| DOI | http://doi.org/10.1177/02750740221137071 |
| Published date | 01 January 2023 |
| Date | 01 January 2023 |
| Subject Matter | Articles |
Do Opinions of Policy Target Population
Deservingness Correlate to Public Service
Motivation? Insights from Medicaid
Jacqueline Chattopadhyay and Jaclyn Piatak
Abstract
Perceptions of the deservingness of policy target populations play a vital role in the policy process. Yet, little research has
modeled assessments of deservingness as a function of core concepts from public administration. Arguably, one of
the most robust insights into deservingness assessments is that they correlate to beliefs about who receives a policy’s
benefits—likely because of how different groups have been socially constructed over time. Using Medicaid as a lens of
study, we test whether deservingness assessments also correlate to public service motivation (PSM). We find that deserving-
ness assessments relate to PSM in many models. However, PSM is often insignificant in models that control for racial senti-
ments. We also fail to find evidence that PSM moderates the relationship between deservingness assessments and beliefs about
who benefits from a policy.
Keywords
public service motivation, social construction, medicaid, target populations, deservingness
Individual-level perceptions of whether a policy’stargetpop-
ulation is deserving or undeserving of public benefits play a
vital role in the policy process. Deservingness assessments
held by political elites may influence policy design (Grogan,
1997; Schneider & Ingram, 1993), setting the beneficiaries
of different policies on divergent and sometimes inequitable
paths during policy implementation (Blessett, 2020; Mettler,
2018; Michener, 2019; Piatak, 2017; Soss et al., 2011).
Deservingness assessments held by the mass public and by a
policy’s own beneficiaries can influence support for the
policy’s endurance or conversely the policy’s contraction
(Béland et al., 2022; Bell, 2021; Campbell, 2003; Haeder
et al., 2021; Katz, 2013; Oberlander, 2003; Piven &
Cloward, 1993; Schneider & Ingram, 2005; Skocpol, 1992;
Wetherell et al., 2013). Deservingness assessments held by
public administrators can influence their treatment of policy
beneficiaries (Soss et al., 2011). Despite these myriad implica-
tions, however,the determinants of deservingnessassessments
may be incompletely understood. In particular, models of
deservingness assessments have rarely included core concepts
from public administration.
To take a step back, one of the most robust findings in the
social science literature is that deservingness assessments are
strongly tied to the group(s) that individuals associate with a
policy (Katz 2013; Schneider & Ingram, 2005). Research sug-
gests that one key reason for a link between assessments of
whether a policy’sbeneficiaries are (un)deserving and beliefs
about who benefits from the policy is that political elites,
the media, and other actors have, over time, socially constructed
some groups as deserving of public resources and others
as undeserving (Gilens, 1999; Ingram & Schneider, 2005;
Ingram et al., 2007; Kim, 1999; Schneider & Ingram, 1993,
1997, 2005; Schneider & Sidney, 2009; Soss et al., 2011;
Stone, 1997).
We ask whether a core concept from public administration
—public service motivation (PSM)—is also a determinant of
deservingness assessments. PSM—the drive to help others
grounded in public institutions—corresponds to public
opinion on a variety of policy issues (Piatak & Holt, 2021).
Considering PSM has been found to be a stable trait (Van
Witteloostuijn et al., 2017) and calls for testing the boundar-
ies of PSM (Bozeman & Su, 2015), we examine how PSM
relates to perceptions of deservingness among the general
U.S. population. To our knowledge, no research to date has
examined whether PSM correlates to assessments of policy
target population deservingness. Yet, there are reasons to
think that deservingness assessments may correlate to PSM
UNC Charlotte, Charlotte, NC, USA
Corresponding Author:
Jaclyn Piatak, Department of Political Science & Public Administration, UNC
Charlotte, 9201 University City Blvd., Charlotte, NC 28223, USA.
Email: jpiatak@uncc.edu
Article
American Review of Public Administration
2023, Vol. 53(1) 3–22
© The Author(s) 2022
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DOI: 10.1177/02750740221137071
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directly, and also to think that PSM might moderate the rela-
tionship between deservingness assessments and beliefs
about the identity of a policy’s target population(s).
In particular, a hypothesis that PSM may correlate directly
to deservingness assessments emerges from recent evidence
that PSM correlates to policy opinion, in the general popula-
tion, in a variety of ways (Piatak & Holt, 2021). The second
hypothesis—that PSM may moderate the relationship
between deservingness assessments and beliefs about whom
a policy benefits—follows from two other recent research
findings. The first is recent evidence that—as long hypothe-
sized—not everyone holds the same social constructions of
a given group in mind (Bell, 2021; Kreitzer & Smith, 2018).
The second is recent evidence that people with high versus
low levels of PSM may hold different perceptions about a
host of policy matters (Petersen, 2021). Applied to the
domain of social constructions, these findings suggest that
people with high and low levels of PSM could hold different
social constructions of given social groups in mind, or that
people with high levels of PSM could be less inclined than
those with low PSM to base deservingness assessments on
beliefs about whom a policy benefits. This article examines
these hypotheses. That is, we study two questions: (1) Do
assessments about policy target population deservingness
relate to PSM, even when controlling for perceptions of
who benefits from the policy? (2) Does PSM moderate the
relationship between assessments of policy target population
deservingness and beliefs about who benefits from the policy?
We address these questions in the context of Medicaid. Since
it is currently in flux and has been subject to political contesta-
tion over time, Medicaid provides an ideal policy setting to
examine whether PSM should join perceptions of who is
among a policy’sbeneficiaries in models of public opinion
about target population deservingness. Using original nationally
representative survey data from 2016, we find that deserving-
ness assessments do relate to PSM in numerous models, includ-
ing models that control for respondents’beliefs about what
groups use Medicaid or for historically prevalent constructions
of those groups. However, we find that PSM is often statistically
insignificant in models of deservingness assessments that
control for racial sentiments. We also do not find convincing
evidence that PSM moderatesthe relationship between deserv-
ingness assessments and beliefs about who uses Medicaid. In
the next sections, we describe policy events affecting
Medicaid circa 2016 and today, discuss our aforesaid hypothe-
ses in greater detail, describe our data, methods, and results, and
close with a discussion of the findings and implications.
Medicaid Context
Medicaid is a good lens through which to study whether PSM
belongs alongsideperceptions of who benefits from a policyin
models of public opinion of policy beneficiary deservingness,
since Medicaidrecipient deservingnessis politically contested.
In some respects, Medicaid recipients have been framed and
perceived as deserving (Cook & Barrett, 1992; Grogan &
Park, 2017a; Grogan & Patashnik, 2003; Stuber &
Kronebusch, 2004). In other respects, they have been framed
as undeserving and have reported feeling stigmatized
(Grogan et al., 2017; Michener, 2018; Oberlander, 2003;
Piatak, 2017; Stuber & Kronebusch, 2004). Medicaid also
has multipletargetpopulations—facilitating different framing
of the program at different times (Grogan & Patashnik,
2003). Thus, Medicaid recipient deservingness will likely con-
tinue to be contestedand important to understand in the future.
From a policy standpoint, Medicaid is also in flux, and so
understanding public opinion on Medicaid is of contemporary
relevance. While the Affordable Care Act (ACA) gave states
incentives to expand Medicaid eligibility to all residents
below 139% of the Federal Poverty Level (FPL), National
Federation of Independent Business v. Sebelius made expan-
sion optional, despite the Medicaid expansion being described
as “the most salient inequality-reducing feature of the ACA”
(Michener, 2020, p. 549). As of June 2022, 12 states were
declining to implement the expansion (KFF, 2022). Some
states have used ballot measures to determine whether to
proceed with Medicaid expansion (Luhby, 2018), highlight-
ing the fact that public opinion can determine the distribution
of policy benefits or burdens for years to come.
As noted above, deservingness assessmentsare particularly
worth studyingas a policy opinion because theymay influence
policy design (Grogan, 1997; Schneider & Ingram, 1993),
public and beneficiary support for policy endurance or con-
versely policy contraction (Campbell, 2003; Schneider &
Ingram, 2005; Wetherell et al., 2013; Haeder et al., 2021),
and administrative treatment of policy beneficiaries (Soss
et al., 2011). Therefore, we ask: What factors correlate to—
and potentially influence—public perceptions of the deserv-
ingness of Medicaid recipients? In particular, does PSM play
a role in explaining deservingness perceptions, either along-
side or as a moderator to the roleof beliefs about who benefits
from the policy?
Theory and Hypotheses
Recent research suggests that PSM should be studied not just
among public sector employees, but across society, and
makes the case for exporting PSM to other disciplines
(Piatak & Holt, 2020a, 2020b, 2021). To advance this
work, public administration scholars can examine PSM
alongside major constructs from those other disciplines. A
recent example is Piatak and Holt’s (2020b) study of the rel-
ative influence of PSM and altruism—a measure from social
psychology—on volunteering. The present article works in a
similar fashion, testing the boundaries of PSM as an influence
on policy opinion by testing whether PSM correlates to
public opinion of policy target population deservingness
after accounting for beliefs about what group(s) benefit
from the policy, in light of evidence from political science
of the power that social constructions of population groups
4American Review of Public Administration 53(1)
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