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His dissertation explores how human service organizations employ diverse responsiveness mechanisms and how those efforts impact organizational outcomes, using a nationally representative sample of substance use disorder treatment centers in the United States.This study considers five important questions related to the role of race in state-level public support for the Medicaid expansion: (1) whether public support for the Medicaid expansion varies across the American states; (2) whether public support is positively related to state adoption; (3) whether this support is racialized; (4) whether, if racialized, there is evidence of more state responsiveness to white support than to nonwhite (black and/or Latino) support; and (5) does the size of the nonwhite population matter more when white support is relatively low?

Lax and Phillips (2012) estimate state-level support for thirty-nine policies across eight issue areas and find that state policy decisions are strongly associated with policy-specific opinion, much more so than a measure of state liberalism or another more general proxy for public opinion.

Perhaps not surprisingly, because public support for the ACA overall is uniformly low, they find that state-level public support for the ACA has an insignificant impact on governor support for the Medicaid expansion.

(not the ACA overall) when creating state-level estimates.

While state-specific public opinion is generally positively associated with state adoption of the specific policy, Lax and Phillips also show that, under highly salient, controversial issues, such as gay rights policies, states have been shown to be less responsive to public opinion where high levels of support (often requiring supermajorities) are needed before a state will adopt (Lax and Phillips 2009a; Lax and Phillips 2012).

Because the Medicaid expansion decision is also highly salient and ideologically charged, it is important to not only look at whether public support for the Medicaid expansion is positively associated with state adoption, but the level of state responsiveness as well.

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