Coverage Denied: How Health Insurers Drive Inequality in the United States
Who is the most vulnerable to the health insurance practice of coverage denials, and how does this insurance practice deepen health and economic inequities across race and class lines? I argue that this insurance practice -- including but extending beyond the growing reliance on prior authorization -- harms marginalized populations because of the health literacy demands that health insurance-related administrative burdens place on patients. Coverage denials are all the more prevalent in recent years as the United States has continued to witness the growth of managed care, even in health care realms typically managed by the government (Medicare Advantage, managed Medicaid), and relatedly a shift in concerns from cost containment to profit maximization. To examine this health policy problem, I conduct an original nationwide survey of 1,340 U.S. adults and supplement the nationwide survey with 110 semi-structured interviews with patients, physicians, health care advocates, health care lawyers, and health insurance executives. Combining quantitative analysis with patient and physician storytelling, I highlight not only patient vulnerabilities to this practice but both patients' and physicians' administrative burdens of appeal, and the longer-term destabilizing nature of this insurance practice as patients are left to postpone medical care and other purchasing. The findings shed light on the value of policy reforms that can help to mitigate these adverse impacts on marginalized populations.
"Rationing by Inconvenience: How Insurance Coverage Denials Induce Administrative Burdens." Journal of Health Politics, Policy, and Law
How does the practice of health coverage denials keep care out of reach for American patients through the imposition of unevenly distributed administrative burdens? While there has been increased conversation about the extent of wrongful coverage denials and prior authorization administration in the context of Medicare Advantage, little work has examined the impact of these denials across patients enrolled in public and private insurance. I argue that the process of appealing insurers’ denials has the effect of imposing administrative burdens on patients in ways that are not equitable, and which have the effect of deepening the divide between those with meaningful access to health coverage and those for whom benefits are kept out of reach. Drawing on an original nationwide survey of 1,340 United States adults, I find support for the myriad ways in which denials can drive patients to experience administrative burden that more affluent and healthier patients are better equipped to navigate. The paper highlights the informational barriers to appeal, and the ways in which this bureaucracy deepens health divides along class lines.
"Damages Denied: The Impact of ERISA's Statutory Design on Patients' Access to Care" (working paper under review)
Despite being written primarily as a pension law, the Employment Retirement Income Security Act (ERISA) of 1974 has come to apply to the majority of employer-sponsored health plans in the United States. However, despite its health care salience in self-insured plans, it has a key statutory design feature that limits patients’ ability to access their prescribed care: it precludes damages recovery for those who have been denied health coverage, an insurance practice that is pervasive and increasing. What’s more, the law does not even necessarily guarantee the awarding of attorney’s fees if successful. A consequence is that patients from marginalized groups will be less willing to incur the costs of litigating to secure coverage for their prescribed care. The absence of litigation incentives creates perverse incentives for insurers because it makes it all the more unlikely that patients will be able to obtain legal representation, such that insurers may deny with impunity. Drawing on extant literature on path dependence and on ERISA’s history and implementation, legislative history of Congress's health care reform efforts, original data on ERISA-related litigation and bill introductions, and interviews with key legislative and executive staffers, this paper evaluates this statutory design’s persistence across moments of health care reform including the 1993-1994 health care reform efforts, the Patients’ Bill of Rights, and the Affordable Care Act, and the ways in which this can not only limit patients’ rights upon a coverage denial but reduces health insurer accountability in a manner that can perpetuate the denials themselves.
"Congressional Assertions of the Spending Power: Institutional Conflict and Regulatory Authority." 2016. Journal of Law, Economics, and Organization 32(2): 272-305.
This study seeks to answer a crucial and unexplored question about American regulatory law and policy: How do majority coalitions in Congress use the spending power to circumvent intra-branch conflict and judicial constraints against regulating by finding alternate avenues to regulate states and private actors? This study provides the first large-scale empirical evidence of congressional use of the spending power to assert implementation authority in the face of constraints against more direct legislating. It is through this process of conditioning funds upon regulatory compliance that Congress works toward ideal policy outcomes without inciting institutional conflict with the other branches or from the opposing party. I base my conditional spending analysis on data on statutory specificity and congressional delegation from the 80th to the 110th Congresses provided by Sean Farhang, and include additional measures of institutional conflict. The above argument is supported by the empirical analysis.
Here is the paper. Data are available upon request.
"Divided Government and the Fragmentation of American Law" (with Sean Farhang). 2016. American Journal of Political Science 60(2): 401-17.
We investigate institutional explanations for Congress’s choice to fragment statutory frameworks for policy implementation. We argue that divided party government, which fuels legislative-executive conflict over control of the bureaucracy, motivates Congress to fragment implementation power as a strategy to enhance its control over implementation. We develop a novel measure of fragmentation in policy implementation, collect data on it over the period 1947 to 2008, and test hypotheses linking separation of powers structures to legislative design of fragmented implementation power. We find that divided party government is powerfully associated with fragmentation in policy implementation, and that this association contributed to the long-run growth of fragmentation in the post-war U.S. We further find that legislative coalitions are more likely to fragment implementation power in the face of greater uncertainty about remaining in the majority.
The paper can be found here. The replication files can be found here.
"Systematic Review and Meta-Analysis of Depression, Anxiety, and Suicidal Ideation Among Ph.D. Students." 2021. Scientific Reports.
University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I2 = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I2 = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.
The paper can be found here.
"Re-Setting the Agenda: Estimating Congressional Responses to Fire Alarms in the DC Circuit Court of Appeals" (Invited to revise and resubmit to Political Science Quarterly.)
Evaluating the effects of bureaucratic policymaking requires a systematic way to evaluate the policies that emerge over time. Such a measure would allow us to understand the substantive policy effects of agencies' implementation choices over time. This paper raises the following core question: To what extent, and under what conditions, do congressional coalitions respond to interest group fire alarms raised through the DC Circuit by statutorily amending administrative capacity? I argue that agency losses through DC Circuit litigation should raise signals to Congress that the agency has drifted in its implementation behavior, and spur it to amend legislation to better constrain the agency's latitude. I evaluate this in the context of the Environmental Protection Agency from 1973 to 2010 using a rich new dataset comprising the 2,000 statutory amendments to the legislation under the jurisdiction of the EPA, each of which is hand-coded to determine the magnitude of the congressional revision, as well as the DC Circuit cases in which the agency was the defendant. I find robust support for the claim that agency losses are associated with subsequent statutory constraints on the agency, but do not find strong support for the claim that executive branch vulnerability is predictive of congressional interventions.
Here is a current version of the paper.
"When Do Agencies Have Agency? The Limits of Compliance in the EPA" (Invited to revise and resumbit to Political Science Quarterly)
This paper raises a question that is little-discussed yet central to lawmaking and policy implementation in the American separation-of-powers system: Under what institutional conditions is Congress unable to induce compliance with legislative dictates in contemporary statutory implementation? Unlike a number of existing delegation models, the paper holds that variation in institutional conflict and oversight of agencies fundamentally reshape agencies' latitude as active policymakers. I answer this question in the context of the Environmental Protection Agency from 1973-2010 using an extensive original dataset on noncompliance using the hand-coding of several thousand congressional bill introductions and several hundred DC Circuit court cases. I use these data to test the separation-of-powers theories concerning the effects of legislative-executive conflict and legislative division on agencies' regulatory compliance, as well as the effect of third-party oversight through litigation. The study provides the first systematic empirical analysis of the extent to which Congress is unable to successfully induce compliance when delegating, providing support for the core inter-branch conflict hypotheses.
Here is a current version of the paper. Data are available upon request.
"Inter-Agency Learning in United States Regulatory Policymaking" (preliminary paper draft, do not cite)
While a number of scholars have evaluated the strategies driving congressional decisions to delegate regulatory authority to administrative agencies, the literature has been largely restricted to evaluating the relationship between Congress and its administrative agent. I argue that this presents an incomplete picture of implementation given that it is typically carried out by multiple administrative actors that interact in multiple contexts and that share political principals. Such arrangements for overlapping jurisdiction and interagency organizations provide opportunities for agencies to learn from one another about the constraints of the political environment within which they are operating. This paper provides a preliminary examination of the extent to which administrative agencies can learn from other agencies the preferences of shared political principals and use that information to reshape their regulatory strategies. Using original data on Court of Appeals litigation directed at administrative agencies from the 93rd to the 113th Congress, as well as congressional delegation to administrative agencies within the text of the Statutes at Large, I provide preliminary evidence that when an agency observes a closely-linked agency facing legal constraints, it reshapes its own regulatory strategy so as to provoke less costly litigation. The results pave the way toward further, more in-depth examination of the spillover effects of bureaucratic punishment and the ways in which this inter-agency learning takes place over time.
Here is a current version of the paper, which is very much a work in progress. Comments and complaints welcome.
"Selection Bias and Ideal Point Estimation on the United States Supreme Court" (under review)
This paper addresses a long-standing limitation of analyses of Supreme Court ideology, which is the fact that the Court's docket is discretionary and thus renders the pool of votes a highly non-random sample. While many scholars rely on ideology measures that rely on information drawn from justices' votes, I argue that the political conditions in which the Court operates has the capacity to fundamentally reshape the Court's incentives to take on certain types of cases (e.g., those of higher or lower salience), the votes on which we observe. I evaluate the effects of inter-branch partisan conflict and public mood in shaping the Court's propensity to devote attention to particular policies and find that while some policies appear to be insulated from these influences, a non-trivial number of policies do appear to be strongly affected by the political environment in which the Court is operating. Evaluating the wide variation in justices' voting behavior across different issue areas, I go on to simulate dockets of cases and demonstrate that with different compositions of cases, we can recover a wide range of ideal points for the justices. The political influences at the cert stage thus induce bias in our inferences about Supreme Court justices' ideology and their relation to the other branches in the American separation-of-powers system.
Here is a current version of the paper.
"Party and Authorship on the U.S. Court of Appeals" (with Sean Farhang and Greg Wawro)
The paper builds upon recent work evaluating opinion assignment and authorship on the U.S.Court of Appeals. Using a large dataset Court of Appeals cases pooling all areas of law, as well as models focused on criminal and labor policy, we find that, in some areas, Democratic judges are more likely to author opinions when cases are decided in a liberal direction, and Republicans are more likely to author opinions decided in a conservative direction. We further find that this partisan authorship pattern is not driven by assigning judges disproportionately self-assigning, or assigning to co-partisans. Instead, it appears to result from a consensual assignment norm under which judges seek out opinions they wish to write. We also find that assigning judges disproportionately self-assign.
"Democratic Responsiveness in State Policy Implementation" (with Doug Spencer)
While a burgeoning literature has evaluated responsiveness to state and district-level opinion in estimating members' votes -- that is, choices pertaining to policy adoption -- we know precious little about how these policies ultimately are carried into effect. We utilize multi-level regression with post-stratification (MRP) to estimate state-level opinion on abortion policy, and evaluate the extent to which shifts in opinion translate into changes in the strength of enforcement in the states, thus providing new insights into responsiveness not simply at the voting, but also at the implementation stage of policymaking. We examine the areas of criminal justice, hate crimes, abortion policy, and healthcare spending. Focusing first on abortion policy, we find that shifts in pro-life sentiment are significantly associated with reductions in access to abortion providers.
"When Duel Incentives Become Dueling: Public Health Consequences of Responsiveness to Pro-Life Sentiment" (under review)
Those elected into office are tasked with the dual responsibilities of representing public preferences as well as taking a leadership role in defense of the public health and safety of their electorate. What are the consequences when public opinion is in tension with public health interests? Looking within the context of women's health, over which there has been extensive federal and state-level activism resulting in numerous state-level constraints on access, I address the public health consequences of Planned Parenthood clinic access in the states between the years of 2008 and 2015. I find that greater access to clinics is strongly associated with reductions in cases of sexually transmitted diseases, HIV diagnoses, the teen birth rate, and reliance upon emergency room as opposed to outpatient care. The results suggest that investment in these services have public health consequences including but extending far beyond the domain of abortion, such that responsiveness to pro-life sentiment in the states may come with adverse health and economic consequences.
Click here for draft. Comments and complaints welcome.
Book review of Dynamics of Bureaucracy in the US Government, by Samuel Workman (Perspectives on Politics)
Policy Brief for Evidence in Governance and Politics (EGAP) Program at Columbia, summarizing Arceneaux et al (2012)
Policy Brief for Evidence in Governance and Politics (EGAP) Program at Columbia, summarizing Barr et al (2014)
Who is the most vulnerable to the health insurance practice of coverage denials, and how does this insurance practice deepen health and economic inequities across race and class lines? I argue that this insurance practice -- including but extending beyond the growing reliance on prior authorization -- harms marginalized populations because of the health literacy demands that health insurance-related administrative burdens place on patients. Coverage denials are all the more prevalent in recent years as the United States has continued to witness the growth of managed care, even in health care realms typically managed by the government (Medicare Advantage, managed Medicaid), and relatedly a shift in concerns from cost containment to profit maximization. To examine this health policy problem, I conduct an original nationwide survey of 1,340 U.S. adults and supplement the nationwide survey with 110 semi-structured interviews with patients, physicians, health care advocates, health care lawyers, and health insurance executives. Combining quantitative analysis with patient and physician storytelling, I highlight not only patient vulnerabilities to this practice but both patients' and physicians' administrative burdens of appeal, and the longer-term destabilizing nature of this insurance practice as patients are left to postpone medical care and other purchasing. The findings shed light on the value of policy reforms that can help to mitigate these adverse impacts on marginalized populations.
"Rationing by Inconvenience: How Insurance Coverage Denials Induce Administrative Burdens." Journal of Health Politics, Policy, and Law
How does the practice of health coverage denials keep care out of reach for American patients through the imposition of unevenly distributed administrative burdens? While there has been increased conversation about the extent of wrongful coverage denials and prior authorization administration in the context of Medicare Advantage, little work has examined the impact of these denials across patients enrolled in public and private insurance. I argue that the process of appealing insurers’ denials has the effect of imposing administrative burdens on patients in ways that are not equitable, and which have the effect of deepening the divide between those with meaningful access to health coverage and those for whom benefits are kept out of reach. Drawing on an original nationwide survey of 1,340 United States adults, I find support for the myriad ways in which denials can drive patients to experience administrative burden that more affluent and healthier patients are better equipped to navigate. The paper highlights the informational barriers to appeal, and the ways in which this bureaucracy deepens health divides along class lines.
"Damages Denied: The Impact of ERISA's Statutory Design on Patients' Access to Care" (working paper under review)
Despite being written primarily as a pension law, the Employment Retirement Income Security Act (ERISA) of 1974 has come to apply to the majority of employer-sponsored health plans in the United States. However, despite its health care salience in self-insured plans, it has a key statutory design feature that limits patients’ ability to access their prescribed care: it precludes damages recovery for those who have been denied health coverage, an insurance practice that is pervasive and increasing. What’s more, the law does not even necessarily guarantee the awarding of attorney’s fees if successful. A consequence is that patients from marginalized groups will be less willing to incur the costs of litigating to secure coverage for their prescribed care. The absence of litigation incentives creates perverse incentives for insurers because it makes it all the more unlikely that patients will be able to obtain legal representation, such that insurers may deny with impunity. Drawing on extant literature on path dependence and on ERISA’s history and implementation, legislative history of Congress's health care reform efforts, original data on ERISA-related litigation and bill introductions, and interviews with key legislative and executive staffers, this paper evaluates this statutory design’s persistence across moments of health care reform including the 1993-1994 health care reform efforts, the Patients’ Bill of Rights, and the Affordable Care Act, and the ways in which this can not only limit patients’ rights upon a coverage denial but reduces health insurer accountability in a manner that can perpetuate the denials themselves.
"Congressional Assertions of the Spending Power: Institutional Conflict and Regulatory Authority." 2016. Journal of Law, Economics, and Organization 32(2): 272-305.
This study seeks to answer a crucial and unexplored question about American regulatory law and policy: How do majority coalitions in Congress use the spending power to circumvent intra-branch conflict and judicial constraints against regulating by finding alternate avenues to regulate states and private actors? This study provides the first large-scale empirical evidence of congressional use of the spending power to assert implementation authority in the face of constraints against more direct legislating. It is through this process of conditioning funds upon regulatory compliance that Congress works toward ideal policy outcomes without inciting institutional conflict with the other branches or from the opposing party. I base my conditional spending analysis on data on statutory specificity and congressional delegation from the 80th to the 110th Congresses provided by Sean Farhang, and include additional measures of institutional conflict. The above argument is supported by the empirical analysis.
Here is the paper. Data are available upon request.
"Divided Government and the Fragmentation of American Law" (with Sean Farhang). 2016. American Journal of Political Science 60(2): 401-17.
We investigate institutional explanations for Congress’s choice to fragment statutory frameworks for policy implementation. We argue that divided party government, which fuels legislative-executive conflict over control of the bureaucracy, motivates Congress to fragment implementation power as a strategy to enhance its control over implementation. We develop a novel measure of fragmentation in policy implementation, collect data on it over the period 1947 to 2008, and test hypotheses linking separation of powers structures to legislative design of fragmented implementation power. We find that divided party government is powerfully associated with fragmentation in policy implementation, and that this association contributed to the long-run growth of fragmentation in the post-war U.S. We further find that legislative coalitions are more likely to fragment implementation power in the face of greater uncertainty about remaining in the majority.
The paper can be found here. The replication files can be found here.
"Systematic Review and Meta-Analysis of Depression, Anxiety, and Suicidal Ideation Among Ph.D. Students." 2021. Scientific Reports.
University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I2 = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I2 = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed.
The paper can be found here.
"Re-Setting the Agenda: Estimating Congressional Responses to Fire Alarms in the DC Circuit Court of Appeals" (Invited to revise and resubmit to Political Science Quarterly.)
Evaluating the effects of bureaucratic policymaking requires a systematic way to evaluate the policies that emerge over time. Such a measure would allow us to understand the substantive policy effects of agencies' implementation choices over time. This paper raises the following core question: To what extent, and under what conditions, do congressional coalitions respond to interest group fire alarms raised through the DC Circuit by statutorily amending administrative capacity? I argue that agency losses through DC Circuit litigation should raise signals to Congress that the agency has drifted in its implementation behavior, and spur it to amend legislation to better constrain the agency's latitude. I evaluate this in the context of the Environmental Protection Agency from 1973 to 2010 using a rich new dataset comprising the 2,000 statutory amendments to the legislation under the jurisdiction of the EPA, each of which is hand-coded to determine the magnitude of the congressional revision, as well as the DC Circuit cases in which the agency was the defendant. I find robust support for the claim that agency losses are associated with subsequent statutory constraints on the agency, but do not find strong support for the claim that executive branch vulnerability is predictive of congressional interventions.
Here is a current version of the paper.
"When Do Agencies Have Agency? The Limits of Compliance in the EPA" (Invited to revise and resumbit to Political Science Quarterly)
This paper raises a question that is little-discussed yet central to lawmaking and policy implementation in the American separation-of-powers system: Under what institutional conditions is Congress unable to induce compliance with legislative dictates in contemporary statutory implementation? Unlike a number of existing delegation models, the paper holds that variation in institutional conflict and oversight of agencies fundamentally reshape agencies' latitude as active policymakers. I answer this question in the context of the Environmental Protection Agency from 1973-2010 using an extensive original dataset on noncompliance using the hand-coding of several thousand congressional bill introductions and several hundred DC Circuit court cases. I use these data to test the separation-of-powers theories concerning the effects of legislative-executive conflict and legislative division on agencies' regulatory compliance, as well as the effect of third-party oversight through litigation. The study provides the first systematic empirical analysis of the extent to which Congress is unable to successfully induce compliance when delegating, providing support for the core inter-branch conflict hypotheses.
Here is a current version of the paper. Data are available upon request.
"Inter-Agency Learning in United States Regulatory Policymaking" (preliminary paper draft, do not cite)
While a number of scholars have evaluated the strategies driving congressional decisions to delegate regulatory authority to administrative agencies, the literature has been largely restricted to evaluating the relationship between Congress and its administrative agent. I argue that this presents an incomplete picture of implementation given that it is typically carried out by multiple administrative actors that interact in multiple contexts and that share political principals. Such arrangements for overlapping jurisdiction and interagency organizations provide opportunities for agencies to learn from one another about the constraints of the political environment within which they are operating. This paper provides a preliminary examination of the extent to which administrative agencies can learn from other agencies the preferences of shared political principals and use that information to reshape their regulatory strategies. Using original data on Court of Appeals litigation directed at administrative agencies from the 93rd to the 113th Congress, as well as congressional delegation to administrative agencies within the text of the Statutes at Large, I provide preliminary evidence that when an agency observes a closely-linked agency facing legal constraints, it reshapes its own regulatory strategy so as to provoke less costly litigation. The results pave the way toward further, more in-depth examination of the spillover effects of bureaucratic punishment and the ways in which this inter-agency learning takes place over time.
Here is a current version of the paper, which is very much a work in progress. Comments and complaints welcome.
"Selection Bias and Ideal Point Estimation on the United States Supreme Court" (under review)
This paper addresses a long-standing limitation of analyses of Supreme Court ideology, which is the fact that the Court's docket is discretionary and thus renders the pool of votes a highly non-random sample. While many scholars rely on ideology measures that rely on information drawn from justices' votes, I argue that the political conditions in which the Court operates has the capacity to fundamentally reshape the Court's incentives to take on certain types of cases (e.g., those of higher or lower salience), the votes on which we observe. I evaluate the effects of inter-branch partisan conflict and public mood in shaping the Court's propensity to devote attention to particular policies and find that while some policies appear to be insulated from these influences, a non-trivial number of policies do appear to be strongly affected by the political environment in which the Court is operating. Evaluating the wide variation in justices' voting behavior across different issue areas, I go on to simulate dockets of cases and demonstrate that with different compositions of cases, we can recover a wide range of ideal points for the justices. The political influences at the cert stage thus induce bias in our inferences about Supreme Court justices' ideology and their relation to the other branches in the American separation-of-powers system.
Here is a current version of the paper.
"Party and Authorship on the U.S. Court of Appeals" (with Sean Farhang and Greg Wawro)
The paper builds upon recent work evaluating opinion assignment and authorship on the U.S.Court of Appeals. Using a large dataset Court of Appeals cases pooling all areas of law, as well as models focused on criminal and labor policy, we find that, in some areas, Democratic judges are more likely to author opinions when cases are decided in a liberal direction, and Republicans are more likely to author opinions decided in a conservative direction. We further find that this partisan authorship pattern is not driven by assigning judges disproportionately self-assigning, or assigning to co-partisans. Instead, it appears to result from a consensual assignment norm under which judges seek out opinions they wish to write. We also find that assigning judges disproportionately self-assign.
"Democratic Responsiveness in State Policy Implementation" (with Doug Spencer)
While a burgeoning literature has evaluated responsiveness to state and district-level opinion in estimating members' votes -- that is, choices pertaining to policy adoption -- we know precious little about how these policies ultimately are carried into effect. We utilize multi-level regression with post-stratification (MRP) to estimate state-level opinion on abortion policy, and evaluate the extent to which shifts in opinion translate into changes in the strength of enforcement in the states, thus providing new insights into responsiveness not simply at the voting, but also at the implementation stage of policymaking. We examine the areas of criminal justice, hate crimes, abortion policy, and healthcare spending. Focusing first on abortion policy, we find that shifts in pro-life sentiment are significantly associated with reductions in access to abortion providers.
"When Duel Incentives Become Dueling: Public Health Consequences of Responsiveness to Pro-Life Sentiment" (under review)
Those elected into office are tasked with the dual responsibilities of representing public preferences as well as taking a leadership role in defense of the public health and safety of their electorate. What are the consequences when public opinion is in tension with public health interests? Looking within the context of women's health, over which there has been extensive federal and state-level activism resulting in numerous state-level constraints on access, I address the public health consequences of Planned Parenthood clinic access in the states between the years of 2008 and 2015. I find that greater access to clinics is strongly associated with reductions in cases of sexually transmitted diseases, HIV diagnoses, the teen birth rate, and reliance upon emergency room as opposed to outpatient care. The results suggest that investment in these services have public health consequences including but extending far beyond the domain of abortion, such that responsiveness to pro-life sentiment in the states may come with adverse health and economic consequences.
Click here for draft. Comments and complaints welcome.
Book review of Dynamics of Bureaucracy in the US Government, by Samuel Workman (Perspectives on Politics)
Policy Brief for Evidence in Governance and Politics (EGAP) Program at Columbia, summarizing Arceneaux et al (2012)
Policy Brief for Evidence in Governance and Politics (EGAP) Program at Columbia, summarizing Barr et al (2014)