Frictions between China’s institutional legacies of the planned economy and the new trends of marketization, urbanization, and migration have shaped institutional change in social protection. Focusing on health and pension insurance, this study identifies a gradual process of functional integration, which overcomes the frictions and facilitates a dualization of benefits.

We used individual level survey data to examine the distribution of health insurance and other welfare programs by the Dravida Munnetra Kazhagam (DMK) government in Tamil Nadu. Core DMK supporters were more likely to receive welfare benefits than swing voters and opposition loyalists. Political analysis is important to understand motivations for establishing these programs.