How inclusive welfare reforms shape political trust: understanding the feedback effects in China’s urban-rural health insurance integration

An emerging paradigm of inclusive welfare developmentalism is reshaping the social policy system in China and beyond. However, the specific causal mechanisms through which such reforms influence residents’ political trust in local governments remain underexplored. This study theorizes the connection between inclusive welfare reforms and political trust by employing a policy feedback framework. Empirical tests focus on China’s health insurance integration, a major policy initiative designed to reduce urban-rural disparities and promote social equity. Using a difference-in-differences design, this study demonstrates that the health insurance integration reform significantly enhanced political trust among rural residents, while yielding no significant effect among their urban counterparts during the study period. Further analysis reveals that the increase in rural political trust was driven simultaneously by the material benefits of expanded insurance coverage and by positive reassessments of government performance in social security provision. These results extend the attitudinal feedback framework to the context of developmental welfare states, and offer insights into how equity-oriented social policies cultivate political support.