Dissertation Title: "Religion, Parties, and Policymaking: Health Policy Debates in the United States and Brazil"
This dissertation examines the role of religion, political parties, and strategic alliances in three contemporary health policy debates in the United States and Brazil.
Paper 1 investigates the roots of opposition to the Affordable Care Act (ACA) among white Catholics and Protestants in the U.S., who, together, account for almost 60% of the electorate. Through a statistical analysis of national surveys, we examine the variation in views toward the law across denominational groups, and offer explanations for why these significant differences in views exist. The results show that, among white U.S. Christians, individual views toward abortion policy, and toward Blacks, differentially mediate opposition to the health care law for different denominational groups. These results suggest that groups that most vehemently oppose the law--Evangelical Protestants and devout Catholics--do so on grounds that are rooted in deeply held beliefs central to their group identity that will likely not be changed if the program is a technical success.
Paper 2 examines how political party in power affects the degree of private sector management in the Brazilian Unified Health System (SUS). Drawing on election results and health system data, we analyze how party in power affects the proportion of privately managed health care services in Brazilian municipalities over two election periods--2004 and 2008. We find that, overall, few consistent trends exist in health care privatization behavior by political parties. These findings show that although left political parties may posture in defense of the public SUS, these ideological policy positions do not necessarily translate into action.
Paper 3 explores the political determinants of policy responses to the surge in crack cocaine use in Brazil in recent years. Using qualitative evidence gathered from 40 in-depth interviews in 4 municipalities in the state of Minas Gerais, I examine how municipal politics influences the adoption of a state-run initiative creating public-private partnerships with faith-based treatment programs. Through process tracing, I find that 1) the entrenchment of an existing drug treatment arrangement in a municipality, and 2) strategic politician- stakeholder relationships can provide powerful explanations for how municipal-level acceptance of the state-level program may occur.