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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? Our findings suggest that while public support for the Medicaid expansion is high at the state level, especially in comparison to public support for the ACA, there are important variations across the states. Although overall public support is positively related to state adoption, we find that public support for the Medicaid expansion is racialized in two ways. First, there are large differences in support levels by race; and second, state adoption decisions are positively related to white opinion and do not respond to nonwhite support levels. Most importantly, there is evidence that when the size of the black population increases and white support levels are relatively low, the state is significantly less likely to expand the Medicaid program. Our discussion highlights the democratic deficits and racial bias at the state level around this important coverage policy.

Background: Responding to the growing demand for scientific understanding of adoption and uptake of evidence-based interventions (EBIs), numerous dissemination and implementation (“D&I”) models have been proposed in the extant literature. This review aimed to identify community-specific constructs with the potential to help researchers engage community partners in D&I studies or deploy EBIs. Methods: We identified 74 D&I models targeting community-level changes. We built on Tabak et al.’s narrative review that identified 51 D&I models published up to 2012 and identified 23 D&I models published between 2012 and 2020 from the Health Research & Practice website (16 models) and PubMed database (7 models). Three coders independently examined all 74 models looking for community-specific engagement constructs. Results: We identified five community engagement constructs: (1) Communication, (2) Partnership Exchange, (3) Community Capacity Building, (4) Leadership, and (5) Collaboration. Of the 74 models, 20% reflected all five constructs; 32%, four; 22%, three; 20%, two; and 5%, only one. Few models with strong community content have been introduced since 2009. Conclusion: This article bridges the community-engaged and D&I research literature by identifying community engagement constructs reflected in existing D&I models, targeting community-level changes. Implications for future research and practice are discussed. Plain language summary Responding to the growing demand for scientific understanding of adoption and uptake of evidence-based interventions (EBIs), numerous dissemination and implementation (“D&I”) models have been proposed. This review aimed to identify community-specific constructs with the potential to help researchers engage community partners in D&I studies or deploy EBIs. We identified 74 D&I models targeting community-level changes, published between 2012 and 2020. Three coders independently examined all 74 models looking for community-specific engagement constructs. We identified five community engagement constructs: (1) Communication, (2) Partnership Exchange, (3) Community Capacity Building, (4) Leadership, and (5) Collaboration. Of the 74 models, 20% reflected all five constructs; 32%, four; 22%, three; 20%, two; and 5%, only one. This article identified community engagement constructs reflected in existing D&I models targeting community-level changes. Implications for future research and practice are discussed.

Low-income people of color in urban communities have been found to suffer from high levels of political inequality and poor political representation. To make policy more responsive and accountable, neighborhood organizations are often solicited to serve as informal community representatives in local decision-making processes. Given this reliance on nonelected representatives, we ask, Do community residents believe neighborhood organizations are legitimate representatives of their interests? Using survey data from residents of the South Side of Chicago, this article demonstrates that residents’ trust in organizations as representatives varies significantly by organizational type. Specifically, community organizations, religious congregations, and schools are rated as more trustworthy to speak on behalf of the community than local elected officials. These findings hold relatively constant across a variety of individual- and community-level differences, implying that this preference is widespread and may extend to other vulnerable urban communities in the United States.