Dissertation Title:  "Ensuring the Health of Vulnerable Populations in the United States: Intersections of Politics and Public Policy"

This dissertation examines two major health policy issues in the United States: the nature of public attitudes about expanding health insurance coverage and the health-related challenges of vulnerable communities during major hurricane threats. Paper 1 uses national survey data to assess the relative influences of people’s political ideology and economic self-interest on public opinion about the 2007 reauthorization of the State Children’s Health Insurance Program (SCHIP) and universal health insurance. Data are from national surveys conducted during the 2007 SCHIP reauthorization debate and immediately after the 2008 presidential election. I compare the characteristics of public opinion regarding these two issues and find that ideological orientation and partisan identification had strong influences on Americans’ views about both policies, a common finding in studies of Americans’ views about policy issues. However, self-interest also had a considerable effect on older Americans’ views about these health insurance expansions, and the influence of self-interest among seniors appears to have had implications in the ongoing national debate about health reform as Medicare spending reductions have become a central topic of public discussion.

Paper 2 examines racial disparities in health-related difficulties during major hurricane threats in the Southern United States. I identify several specific problems that African Americans are more likely to face in these situations, and I assess which individual-level factors chiefly contribute to these disparities. The data for this investigation are from a 2007 survey of all coastal counties from North Carolina to Texas, including the areas affected by Hurricanes Katrina and Rita. The results demonstrate that evacuation behavior, receipt of safety information, chronic illness and disability, housing, and socioeconomic status all contributed to racial disparities. These findings should inform future emergency management policies and planning in order to mitigate these health threats among African American communities.

Paper 3 reexamines the effect of self-interest on public opinion about health policy issues and investigates the possibility that meager self-interest effects found in previous research may have resulted from the manner in which these studies have defined self-interest. The analysis also explores the potential moderating effects of the unique political and economic conditions of 2008 on the influence of self-interest. Data for this paper are from a survey of residents of Florida and Ohio, two swing states in which many residents felt the earlier effects of the most recent economic recession. The results indicate that multiple measures of self-interest, including a previously unused measure regarding difficulties paying medical bills, had statistically significant and sizeable effects on attitudes about universal health insurance. The new measure of self-interest and the economic and political environment of 2008 may explain these relatively unique findings.