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

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)