Populist Influence on Healthcare Policies: Tlaxcala’s Public Health System under Andrés Manuel López Obrador

With populism on the rise throughout the world, understanding its social impacts on human well-being is crucial. In Mexico, populism has gained traction with Andrés Manuel López Obrador's (AMLO) victory in the 2018 presidential election and the emergence of the Fourth Transformation political movement. During his presidency, AMLO implemented healthcare reforms characterized by anti-technocratic approaches, rapid timelines, and rhetoric positioning them as responses to neoliberal failures. These reforms provide an ideal case to test whether populist policies meet the basic needs of the people they claim to serve. I empirically tested if AMLO's populist healthcare promises delivered benefits to populations in the State of Tlaxcala, which represents the type of state AMLO claimed to prioritize with his reforms. I used data from the Encuesta Nacional de Salud y Nutrición (ENSANUT) conducted in 2018, 2021, 2022, and 2023 to create a Tlaxcala database that tracks healthcare access and utilization in the study period. With a sample of 9,001 residents, I employed a regression analysis to investigate whether AMLO's healthcare reforms delivered on their promises to improve access and utilization for uninsured individuals, rural residents, women, and lower-wealth groups. The findings indicate that the reforms did not deliver the promised results to the uninsured, who experienced reduced access to healthcare and decreased utilization of open-access public facilities. Wealth remained a predictor of healthcare access, and rural populations showed no differential access compared to urban areas. Ultimately, this study contributes to understanding, beyond the rhetoric of populism, how populist leaders pursue policy with material consequences for vulnerable populations.