Dissertation Title:  "Political Determinants of Health Policy: The Roles of Public Opinion and Private Interests"

The political environment is a key factor in efforts to sustain and reform public programs serving low-income and elderly populations. These papers assess the political determinants of policy-making in the health-care arena by analyzing two potential sources of influence: public opinion and campaign contributions from interest groups and other stakeholders.

The first paper examines public attitudes toward Medicaid and welfare in the context of the 1995-1996 block-grant debates and concludes that Medicaid enjoys broader public support than does the welfare program. The data demonstrate that Medicaid’s role for the elderly and disabled and the absence of negative stereotypes about both the program’s incentives and the population it serves are key to its relative popularity. In addition, in contrast to much of the existing literature, the data analyzed here suggest that negative attitudes toward racial minorities do not affect public support for the welfare program.

The second paper analyzes the relative roles of personal ideology and self-interest in individuals’ health-policy preferences. The data suggest that ideology is a much stronger predictor than self-interest of perceptions of the leading health-policy challenges facing the country and how they should be addressed. In addition, ideology appears to play less of a role in the context of Medicare reform than with respect to the problem of the uninsured.

The third paper provides an overview of campaign contributions from the health-care sector over the period spanning 1989-2002, along with a more in-depth analysis of contributions from the pharmaceutical industry during the ongoing Medicare prescription drug coverage debate. The data suggest that drug companies increase their contributions dramatically when threatened by potential legislative changes. In addition, although industry donors appear to allocate their contributions strategically—targeting generally sympathetic candidates and Members of Congress on Committees with jurisdiction over the Medicare program—these patterns do not shift along with the level of overall contributions as a function of the policy agenda.