Dissertation Title："Polarized Politics, Public Opinion, and Health Reform"

This dissertation addresses two major health policy issues that have been debated in recent years – expanding insurance coverage to uninsured individuals and providing prescription drug coverage to the Medicare population. The first two papers focus on public opinion, with a particular emphasis on Republicans and Democrats, because, in this era of polarized politics, policymakers have a strong incentive to pay attention to the opinions of their base constituents. The focus in the third paper is opinion among pharmacists who, as essential health care providers, offer an important perspective on how the Medicare prescription drug program is functioning. Collectively, the papers aim to inform policy makers by addressing the policy and political environment in which health reforms are debated and implemented.

Specifically, Paper 1 examines the individual mandate, a requirement for everyone to have insurance. Using national survey data, I find that the individual mandate lacks extensive public support. Policymakers who still choose to pursue the mandate for policy reasons can expand the base of support by incorporating it into a "shared responsibility" plan that also includes requirements for employers, government, and insurers.

In Paper 2, I use national public opinion data to examine public perceptions of health care quality and access for the uninsured, and find that there is no public consensus on this issue. Party identification, age, and family income are significant predictors of perceptions of health care access for the uninsured. In addition, people who perceive that the uninsured have greater difficulty accessing care are more likely to favor national health insurance, but this relationship is moderated by party affiliation.

Paper 3 employs an analysis of survey data and in-depth interviews to assess pharmacists’ perceptions of the Medicare prescription drug program (Part D). I find that pharmacists’ impressions of their administrative and financial burden under Part D, as well as how beneficiaries fare under the program, are significantly associated with pharmacists’ favorability toward it. Pharmacists working in independent pharmacies, rural areas, or pharmacies serving more Medicare beneficiaries perceive greater burden than those pharmacists working in chain-store pharmacies, urban areas, or in pharmacies that serve fewer Medicare customers, respectively.