Dissertation Title:  "Political Institutions, Participation and Media Evaluations: Influence on Health Care Policy"

This thesis is composed of three distinct papers. Paper one explores the potential for a sensitization effect in research evaluations. This refers to the methodological phenomenon of a pre-event interview sensitizing the respondent such that the post-event measure is different than it would have been without the pre-measure experience. I find evidence for a substantial sensitization effect for panel respondents in an evaluation of a two-hour NBC News special on health care reform. The panel respondents, interviewed both before and after the special, scored consistently higher on health care reform knowledge scales as compared to an independent sample interviewed only after the special, even after accounting for other factors that influence the scores. I conclude that those evaluating the impact of media events on an average audience would be well advised to use an alternative research design than only a panel sample.

Paper two explores whether variation across states' political institutions and culture help to explain variation in the health policies states adopt. Using quantitative analysis, I find that state resources, needs, and ideology help to explain variation in health policy outcomes, particularly whether states adopt comprehensive health care reform or consider single payer proposals. Political institutions and culture significantly help to explain the number of incremental health policies aimed at covering the uninsured or controlling costs and the number of mandated health insurance benefits states adopt. Overall, states with more liberal ideologies are more likely to engage in publicly visible comprehensive health reform strategies; whereas political institutions exert more influence on those policies decided away from the public sphere.

Paper three explores who the participants were in the 1993-94 national health care reform debate. I find evidence that those active on health care reform were more likely to have more education, to be male, African-American, self-identified conservatives, associated with the health care industry, and engaged in the health care issue. Those with a policy preference for an employer mandate were considerably less active in the health reform debate. Furthermore, the presence of a single payer ballot initiative in California did not disproportionately mobilize self-identified liberals. Overall, legislators heard messages disproportionately from those opposed to comprehensive reform as proposed by President Clinton.