Since decentralization in 2001, Indonesian local governments have acquired a key role in poverty alleviation and social service delivery. The extent to which they have been able to meet this challenge is subject to debate, however, and systematic analysis of policy outcomes remains scarce. This paper contributes to the literature with a study of the district-level implementation of Jamkesmas, Indonesia's free healthcare program for the poor. Using original data on policy implementation, I show that local government is to some extent responsive to the needs of the most vulnerable. In years when local elections (pilkada) are implemented, low-income households are targeted more accurately, suggesting that electoral incentives for local elites may increase access to social services among the poor. However, I also show that the positive effect of local direct elections is limited to districts with electorally competitive politics.

The 2019 Indonesian presidential elections indicate that ideology played an important role in voting behaviour, as aggregate subnational results seem to mirror the mid-1950s, when Indonesian politics was organised around ideological and partisan groups known as aliran. However, the extent to which these macro-level patterns are rooted in real ideological divisions among Indonesian voters is an open question. This article analyses an original survey specifically designed to measure aliran identities, ideological orientations and political preferences of ordinary Indonesians. Findings indicate that aliran identities are still present and associated with party choice but only loosely connected with political ideology. Most notably, however, political Islam is associated with important political attitudes and behaviours. Islamist Indonesians are less likely to support liberal understandings of democracy, more likely to see economic issues as policy priorities and more likely to support economic redistribution and regional autonomy. This suggests that ideology should receive greater attention in the study of Indonesian politics.

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While the debate on universal healthcare coverage (UHC) often focuses on policy prescription and technical issues, the expansion of access to healthcare in developing countries is an eminently political process. This article analyzes the historical background of the adoption of UHC in Indonesia to articulate two intertwined arguments. First, in decentralized young democracies such as Indonesia, local government can play an important role in health policy by experimenting with innovative health insurance schemes. Although such activism may widen subnational inequalities, it can also contribute to the adoption of UHC by increasing the salience of health reform and by allowing policy learning. Second, institutional developments such as decentralization and the introduction of local direct elections can have a substantial impact on incentives for political elites to provide broad-based social services. This article discusses the relevance of these findings for the comparative literature on UHC and social policy in low and middle-income countries.