The Contagion of Liberty: The Politics of Smallpox in the American Revolution
Why Some Nonelderly Adult Medicaid Enrollees Appear Ineligible Based on Their Annual Income
Recent studies have highlighted Medicaid enrollment among middle- and higher-income populations and questioned whether the program is reaching those for whom it is intended.
Policy Feedback and the Politics of Childhood Vaccine Mandates: Conflict and Change in California, 2012-2019
In 2012, California instituted a new requirement for parents to consult with a clinician before receiving a personal belief exemption (PBE) to its school entry vaccine mandate. In 2015, the state removed this exemption altogether. In 2019, legislators cracked down on medical exemptions to address their misuse by vaccine refusers and supportive clinicians. This article uses "policy feedback theory" to explore these political conflicts, arguing that PBEs informed the emergence and approaches of two coalitions whose conflict reshaped California's vaccination policies.
Regime Type and Data Manipulation: Evidence from the COVID-19 Pandemic
This study examines whether autocratic governments are more likely than democratic governments to manipulate health data. The COVID-19 pandemic presents a unique opportunity for examining this question because of its global impact.
Medicaid Waivers to Address Homelessness: Political Development and Policy Trajectories
This article reviews the role of Medicaid Waivers in homeless policy, and their emerging role as a mechanism to address homelessness. We evaluate the political development of Waivers in housing and homeless policy over the past thirty years, and investigate the status of current and approved Waivers targeting homelessness. We then consider how Waivers may shape homeless policy governance going forward, including the success of existing systems, and ethical questions related to the role of healthcare payers in solutions to homelessness. We find that the scope of Medicaid Waivers to address homelessness has always been present, but significantly expanded post Affordable Care Act (ACA) and more notably following the COVID-19 pandemic. These expansions brought new opportunities for states to fund responses to homelessness through Medicaid social determinants of health (SDoH) provisions providing wrap-around medical services for populations at-risk of or experiencing homelessness, and now through time-limited direct housing costs paired with essential medical services. Over one third of states have an 1115 Waiver specifically targeting homelessness, with nearly one in five states including provisions that cover direct housing costs (e.g., rent). Going forward, Medicaid's involvement in homeless policy has the potential to reshape state and local responses to homelessness.
Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19
Addressing criticism that the agency's Covid-19 response was lacking, the US Centers for Disease Control and Prevention (CDC) has proposed internal agency reforms intended to improve its performance during the next pandemic. They are aimed at improving surveillance and analytic capacity and agency communications. This essay, via a counterfactual analysis of the CDC's proposed reforms, asks how, if completed in advance of Covid-19, they might have changed outcomes in four cases of guidance controversy during the pandemic. CDC planned reforms, though they have merit, are predicated on the ability to come to "scientific closure" in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise threaten the agency's reform goals.
Does Experience of Vaccination Improve Vaccine Confidence and Trust? Policy Feedback Effects of Mass COVID-19 Vaccination in the United States
Policy feedback research has demonstrated that a highly tangible policy that shapes public attitudes through direct and day-to-day experiences often reshapes public opinion, with the effect of generating supportive or skeptical constituencies that determine the sustainability of future programs. This paper examines the impact of mass vaccination efforts on attitudes towards vaccines in a context of high vaccine hesitancy in the U.S.
Does Policy Uncertainty Boost Vaccine Hesitancy? Political Controversy, the FDA and COVID-19 Vaccine Hesitancy in Fall 2020
Vaccine hesitancy is associated with political and institutional distrust, but there is little research on how people's trust responds to political events. We revisit the fall of 2020 when evaluation of new COVID-19 vaccines collided with an impending national election. Drawing on a political Bayesian perspective, we assess abrupt changes in attention to political events and test hypotheses on subpopulation response: (1) partisan, (2) educational, and (3) ethnic and racial.
Despair and Voter Turnout in the United States
Deaths of despair, a term used to capture rising mortality rates among Americans who appear to be suffering from growing mental and physical distress, have received added attention from those seeking to understand this disturbing trend. Yet it is unclear how, if at all, despair influences the political behavior of the people and communities where it is most prominent. The authors contribute to the health and politics literature by examining whether personal and community-level despair shapes political participation.
Rationing Rights: Administrative Burden in Medicaid Long-term Care Programs
States use Medicaid waivers to provide supports for disabled people in communities, rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this 'conditional' right?
Building Power for Health: The Grassroots Politics of Sustaining and Strengthening Medicaid
Notwithstanding an impressive corpus charting the politics of Medicaid, we have much to learn about the contemporary politics of sustaining, expanding, and protecting the program. There is especially scant scholarly evidence on the significance and function of grassroots political actors (i.e.,the communities and groups most directly affected by health policy). This paper explores the role such groups play in the politics of Medicaid.
Policy Feedbacks and Medicaid on its 60th Anniversary
Despite early skepticism about Medicaid's ability to withstand retrenchment as a program of "welfare medicine," it has proved remarkably durable. Existing analyses explain durability with a policy feedbacks perspective - how program provisions affect the subsequent political environment and policymaking options. This article updates earlier feedback accounts to the ACA era.
Medicaid's Political Development Since 1965: How a Fragmented and Unequal Program Has Expanded
The Medicaid program has changed enormously over the past 60 years from a very restrictive program primarily attached to recipients on public assistance in 1965 to a much more expansive program allowing coverage for persons regardless of marital, parental or employment status. Incorporating the 'medically needy'-an ambiguous concept from the start-allowed states to include many different groups in Medicaid who are not traditionally thought of as poor. In addition, three structural features illuminate why the program has expanded and changed dramatically over time: federalism and intergovernmental financing, the dominance of the private sector, and fragmentation. Unequal treatment among Medicaid covered groups alongside partisan politics create a political discourse that often reveals Medicaid as a public subsidy for stigmatized groups, while hiding Medicaid's reach into the middle-class. This central political ideological tension collides with programmatic realities such that Medicaid strangely often suffers from a residual, retrenchment politics while at the same time benefiting from embeddedness making it extremely difficult to truly turn back the clock on Medicaid's expansion.
Closing Gaps or Holding Steady? The Affordable Care Act, Medicaid Expansion, & Racial Disparities in Coverage, 2010-2021
The Affordable Care Act's (ACA) Medicaid expansion produced major gains in coverage. However, findings on racial and ethnic disparities are mixed and may depend on how disparities are measured. This study examines both absolute and relative changes in uninsurance from 2010-2021 by race and ethnicity, stratified by Medicaid expansion status.
Medicaid/CHIP Coverage for Immigrants During Pregnancy, Childhood, and Adulthood: A Discussion of Relevant Policies and Evidence
Despite major expansions in public health insurance under Medicaid and CHIP over the last 60 years, many immigrants remain ineligible for coverage.
Entrenched Opportunity: Medicaid, Health Systems, and Solutions to Homelessness
As inequality grows, politically powerful healthcare institutions - namely Medicaid and health systems - are increasingly assuming social policy roles, particularly solutions to housing and homelessness. Medicaid and health systems regularly interact with persons experiencing homelessness who are high utilizers of emergency health-services, and experience frequent loss of/inability to access Medicaid services, resulting from homelessness. This research examines Medicaid and health system responses to homelessness, why they may work to address homelessness, and the mechanisms by which this occurs.
Pandemic Times and Health Care Exclusion: Attitudes Toward Health Care Exclusion of Undocumented Immigrants
Most of the 11 million undocumented immigrants living in the United States are excluded from government healthcare programs. Yet, healthcare inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government healthcare programs.
The Limits to Food and Beverage Industry Influence over Fiscal and Regulatory Policy in Latin America
Little is known about the political, institutional, and social contexts contributing to a decline in food and beverage industry power and influence over fiscal (soda taxes) and regulatory (sales/advertising restrictions and food labels) policy. This article addresses this issue by exploring why Mexico and Chile eventually saw such a decline in the food and beverage industry's influence whereas Brazil was not as successful. I argue that in Mexico and Chile, these outcomes are explained by shifts in presidential, congressional, and bureaucratic interests in pursuing policies that went against industry preferences.
Political Partisanship, Confucian Collectivism, and Public Attitudes toward the Vaccination Policy in Taiwan
Conventional wisdom suggests that people with a collectivist tradition tend to comply more with the government's regulatory and even coercive disease-prevention policies. Besides this socio-cultural element, political partisanship is also an important aspect relating to people's willingness to cooperate with the government. This study aims to examine the relationships between these two factors and three dimensions of vaccination policy attitudes: common responsibility to take the vaccine, the government's vaccine mandate, and indignation over anti-vaxxers.
Regulating Abortion Later in Pregnancy: Fetal-Centric Laws and the Erasure of Women's Subjectivity
In the United States, fetal development markers, including "viability" and the point when a fetus can "feel pain", have permeated the social imaginary of abortion, affecting public support and the legality and availability of care, but the extent to which they describe and orient the experience of abortion at later gestations is unclear.