Journal of Health Politics Policy and Law最新文献

Context: In the U.S. federal system, states have adopted a wide array of opioid-related policies over the past thirty years to address the ongoing overdose crisis. The underlying factors driving this variation remain unclear. Understanding what influences states to adopt more comprehensive policies-and whether they prioritize harm reduction or opioid use disorder (OUD) treatment-has important implications for public health strategy and policymaking.

Methods: This study develops state-level indexes using dozens of policy indicators to measure the comprehensiveness of opioid-related policies across two dimensions: harm reduction and treatment. Feature rank analysis and multilevel mixed effects regression are employed to assess the influence of various political, epidemiological, and socioeconomic factors.

Findings: We find that decreases in conservative citizen ideology, increases in the severity of the overdose crisis, and increases in states' economic resources are the most consistent factors influencing adoptions of more comprehensive policies. These factors shaped not only the overall robustness of state responses but also the emphasis on specific policy dimensions.

Conclusions: The study highlights key drivers behind the variation in state-level opioid policy comprehensiveness, offering a clearer picture of how political and contextual factors influence public health policymaking. These insights can guide future research on state-level health policy adoption.

Context: In the US, the tradeoff between incentivizing innovation and providing affordable medicines is managed by government regulation. New medicines are provided a lucrative period of exclusivity that is followed by competitive entry and lower prices. For small molecule drugs, generic competition is now common, whereas for most biologics, biosimilars are unavailable and the regulations governing competition are relatively new.

Methods: We compared the nominal patent term (time between originator/brand entry and the latest patent expiration date) and effective market life (time between originator/brand entry and biosimilar/generic entry) of the 15 biologics and 141 small molecules experiencing competitive entry during 2015-2025. We also examined how litigation outcomes affected these periods.

Findings: Despite having a much longer nominal patent term, the effective market life of biologics was similar to small molecule drugs in recent years. Biosimilars were more likely to be launched during active patent litigation whereas generics were more likely to be launched after settlements.

Conclusions: Although biosimilars are still relatively rare, the patent litigation structure does not appear to be slowing competitive entry for biologics relative to small molecule drugs. Biosimilar competition may become more common as biologics advance in their life cycle and the regulations are brought to bear.

Healthcare cost benchmark programs have emerged as states seek to curb healthcare cost growth. States feel the adverse effects of rising healthcare expenditures acutely through Medicaid, employee health benefit programs, and the growing burden of benefit costs on private sector employers. Beginning with Massachusetts in 2013, eight states have established benchmarks through executive action or legislation. These programs set cost-growth benchmarks and collect data to compare spending trends to the benchmarks at multiple levels, from statewide performance to individual providers and insurers. Many states employ a graduated strategy to promote compliance with benchmarks, ranging from public reporting of provider and insurer performance to imposing sanctions for persistent growth above targets. The effectiveness of these initiatives is not yet clear, in part because most programs are relatively new and early trends were obscured by the pandemic. Several factors suggest that benchmark programs may ultimately achieve meaningful, sustainable impact, including mounting cost pressures, broad support for transparency, and phased enforcement approaches. However, entrenched interests, the need for ongoing investment in program infrastructure, and the inherent complexity of healthcare cost containment present significant challenges.

Context: Scholars have long shown that policies outside healthcare-like labor market, housing, and social assistance-affect health. Health in All Policies (HiAP) is a collaborative policy approach that integrates health into these sectors. Most research on HiAP adoption focuses on a few well-known cases, highlighting the importance of policy learning and political dynamics. This article updates this knowledge by analyzing the Netherlands alongside Finland and England, asking: How can we understand HiAP adoption in the Netherlands?

Methods: We studied the Dutch case using primary and secondary sources and compared it to Finland and England as shadow cases based on existing analyses in secondary sources.

Findings: Policy learning is necessary but not sufficient for HiAP adoption. In the Netherlands, adoption was not partisan, yet still political. The political salience of health inequality was the key factor driving HiAP adoption in the Netherlands and played this decisive yet less visible role in the shadow cases as well.

Conclusions: The Dutch case shows that HiAP can be a product of coalitional strategies outside legislative politics and respond to those coalitions' formulations of problems. Both policy learning and political salience are important, but it is their interaction that best explains whether HiAP is adopted.

The enactment of the One Big Beautiful Bill Act (OBBBA) in July 2025 has introduced rigorous Medicaid work requirements, sparking projections of significant coverage losses for millions of low-income Americans. This essay examines the administrative and political dynamics that will determine whether states can mitigate this enrollment erosion. The Congressional Budget Office estimates that eligibility provisions, particularly work mandates for the Affordable Care Act's expansion population, will account for the majority of projected federal savings. We identify five primary "coping strategies" states may utilize to stanch declines, including expanding ex parte (automatic) determinations, limiting "look-back" periods for work history, and aggressively documenting "medically frail" exemptions. Implementation is expected to follow a pattern of partisan federalism, where Democratic-led states prioritize take-up practices to maintain coverage, while Republican jurisdictions may adopt policies-such as frequent eligibility reviews and monthly premiums-that exacerbate declines. Ultimately, the Trump administration's approach to federal compliance, financial support for systems development, and the approval of restrictive waivers will be pivotal in shaping the law's long-term impact on the Medicaid safety net.

Context: Racial inequality remains a central, entrenched characteristic of American health and health care, and racial discourse strongly shapes health politics and policy. Despite this, discussions of race and health are rare in a core site of health policymaking-the presidency-though this varies across historical periods and political parties. This study examines the prevalence and nature of racial discourse in 90 years of presidential health speeches, from Roosevelt to Biden, addressing, in particular, a debate about whether racial discourse rose or fell after the Civil Rights Era.

Methods: Quantitative content analysis and qualitative analysis of 1,359 presidential health speeches from Roosevelt to Biden.

Findings: Attention to race was higher among Democrats than Republicans. It rose sharply during the Civil Rights Era and the COVID-19 pandemic but fell during the intervening period, with most presidents discussing race and health less than same-party Civil Rights Era benchmarks, Johnson and Nixon. The qualitative analysis shows that presidents of both parties mainly engaged in positive (though sometimes paternalistic) racial discourse, but often combined it with universalist or technical language, perhaps meant to reduce White backlash.

Conclusions: The study speaks to debates about the prominence, nature and causes of racial discourse in policy-making and shows how presidents balance racial particularism and universalism.

The United States is currently experiencing democratic backsliding. In this commentary, I consider how this backsliding impairs the mental health of Americans. Surprisingly, the literature on democratic backsliding has little to say about its impact on mental health, and the literature on mental health has little to say about the role of democratic backsliding. I draw on anecdotes, news stories, polls, and real-world events from Trump's second term to theorize about a potential connection. I highlight three ways that democratic backsliding might give rise to feelings of depression, anxiety, and to a lesser extent post-traumatic stress disorder. I then discuss how this mental toll may be felt unequally across citizens and may create a feedback loop that gives rise to more democratic backsliding. I conclude by urging scholars to build on these ideas as we collectively seek to develop and refine our understanding of this important topic.

Female sterilization occupies a paradoxical place in reproductive policy. When chosen freely, it is a safe and effective contraceptive method, yet has also been deployed as a tool of coercion and state control. This dual legacy makes the United States, where sterilization remains more common than other high-income democracies, an important case for examining how public accountability and policy design shape permanent contraceptive use. From a theoretical perspective, highly visible, accountability-driven interventions such as the 1974 Relf v. Weinberger case might be expected to generate larger behavioral changes than less visible administrative reforms, though prior scholarship offers mixed expectations about the relative influence of legal visibility versus economic incentives. To test these competing expectations, we analyze a harmonized panel of contraceptive surveys from 190 nations (1965-2010) and apply the synthetic-control method. We examine the behavioral impact of Relf as a democratic accountability event and contrast it with a later unrelated administrative change in U.S. hospital reimbursement policy in the 1990s. We find that the public outrage and litigation following Relf produced formal consent safeguards but were associated with limited changes in the national sterilization rates. In contrast, the 1990s payment reforms, aimed at cost containment, were associated with a sustained national decline. Together, these contrasting impacts suggest that reforms driven by court decisions and financial architecture may influence entrenched policies through different, potentially complementary, channels. Taken together, the findings affirm the important role of administrative levers alongside legislative activism, levers often overlooked in reproductive rights debates despite their capacity to reshape clinical practice.

Scholars have long associated rural residency with gun ownership and conservative gun attitudes in the U.S. However, less is known about the roots and long-term stability of this relationship. Are individuals who are raised in more rural communities more likely to own weapons even when they move away? Do individuals socialized in rural communities maintain a long-term cultural attachment to guns and distinctive firearms policy attitudes? Scholars disagree about whether current rural residency versus childhood rural cultural socialization are independently related to rural gun politics. Here, we explore for the first time the relative roles of rural childhood socialization, contemporary rural residency, and rural cultural attachments to patterns of gun ownership and firearms policy attitudes. We utilize original survey data as well as the American National Elections Study to explore these questions. We find that individuals socialized in rural communities maintain their attachment to firearms and hold relatively more conservative firearms policy attitudes over their lifespan, even after moving away from rural areas. Rural cultural childhood socialization has an independent influence on the long-run politics of guns.

The One Big Beautiful Bill Act of 2025 extends the 2017 federal tax cuts, with most benefits going to the top of the income spectrum while cutting social programs for lower- and middle-income households including Medicaid, Medicare, provisions of the Affordable Care Act, and SNAP. An open question is whether Republican candidates will suffer electoral punishment as a result, or whether the cuts are hidden enough for the GOP to escape electoral retribution. The OBBBA uses strategic policy design to cut social policy spending in submerged, invisible ways by taking advantage of delegation to states and to private insurers and by increasing administrative burden rather than making overt eligibility or benefit reductions. An examination of previous social policy retrenchment efforts suggests that the OBBBA has more in common with the 1996 welfare reform, which retrenched through heightened administrative burdens and real declines in funding, than it does with more overt and unsuccessful retrenchment attempts, such as cuts to Social Security in the 1980s and the 2017 ACA repeal and replace effort, whose visibility resulted in policymaker backtracking and electoral retribution. Hidden policy designs can defang opposition, diminishing democratic voice.