Journal of Health Politics Policy and Law最新文献

Context: Despite early skepticism about Medicaid's ability to withstand retrenchment as a program of "welfare medicine," it has proved remarkably durable. Existing analyses explain durability with a policy feedbacks perspective - how program provisions affect the subsequent political environment and policymaking options. This article updates earlier feedback accounts to the ACA era.

Methods: Examines extant findings on policy feedbacks in Medicaid at the elite and mass levels since the implementation of the Affordable Care Act of 2010.

Findings: Mass feedbacks have been modest. Medicaid expansion under the ACA only slightly increased beneficiary political participation, if at all. Medicaid attitudes among beneficiaries and the larger public have become somewhat more supportive. Elite-level feedbacks are the most powerful, with the federal contribution, increased for expansion populations under the ACA, inexorably shaping state incentives. However, continued rejection of Medicaid expansion and attempts to add conditions to Medicaid eligibility in Republican-led states with large shares of Black residents demonstrate that federalism, race, and the program's welfare medicine image continue to threaten the program.

Conclusion: Medicaid survives as the nation's largest health insurance program by enrollment, and is deeply woven into the health care system, but remains chronically vulnerable and variable across states despite robust aggregate enrollment and spending.

Context: As inequality grows, politically powerful healthcare institutions - namely Medicaid and health systems - are increasingly assuming social policy roles, particularly solutions to housing and homelessness. Medicaid and health systems regularly interact with persons experiencing homelessness who are high utilizers of emergency health-services, and experience frequent loss of/inability to access Medicaid services, resulting from homelessness. This research examines Medicaid and health system responses to homelessness, why they may work to address homelessness, and the mechanisms by which this occurs.

Methods: Primary data were collected from Medicaid policies and the 100 largest health systems and national survey data from local homeless policy systems to assess scope, and measure mechanisms and factors influencing decision-making.

Findings: Nearly one-third of states have Medicaid Waivers targeting homelessness and over half of the 100 largest health systems have homeless mitigation programs. Most Medicaid Waivers use local homeless policy structures as implementing entities. A plurality of health systems rationalize program existence based on the failure of existing structures.

Conclusions: Entrenched healthcare institutions may bolster local homeless policy governance mechanisms and policy efficacy. Reliance on health systems as alternative structures, and implementing entities in Medicaid Waivers, may risk shifting homeless policy governance and retrenchment of existing systems.

Context: Conventional wisdom suggests that people with a collectivist tradition tend to comply more with the government's regulatory and even coercive disease-prevention policies. Besides this socio-cultural element, political partisanship is also an important aspect relating to people's willingness to cooperate with the government. This study aims to examine the relationships between these two factors and three dimensions of vaccination policy attitudes: common responsibility to take the vaccine, the government's vaccine mandate, and indignation over anti-vaxxers.

Methods: Using the data from a nationally representative cross-sectional survey conducted in 2022 in Taiwan, this study applies multiple linear OLS regression to examine the relationships between vaccination policy attitudes and Confucian collectivism and political partisanship.

Findings: Confucian collectivism and political partisanship aligning with the ruling party are associated with supportive vaccination policy attitudes. For those who do not align with the ruling party, the negative attitudes toward the vaccination policy appear in different dimensions according to the party they lean to.

Conclusions: Confucian collectivism is prevalent in Taiwan and is related to public attitudes toward vaccination policy. This association is independent of political partisanship. Public health authorities should consider the socio-cultural context and political atmosphere for the effectiveness of disease-prevention measures.

Context: Most of the 11 million undocumented immigrants living in the United States are excluded from government healthcare programs. Yet, healthcare inequities pose significant dangers to all members of society during a pandemic. This project explores to what extent undocumented immigrants, in the context of a pandemic, can be seen as deserving of access to government healthcare programs.

Methods: The first survey experiment explores whether work ethic can affect perceptions of undocumented immigrants as deserving of government healthcare programs. The second survey experiment tests to what extent appeals to fairness and self-interest, during a pandemic, shape healthcare deservingness attitudes.

Findings: The results show that respondents view undocumented immigrants as less deserving of healthcare than citizens, even when undocumented immigrants have a solid work history. The second survey experiment, however, shows that appeals to fairness and self-interest trigger substantial increases in support for undocumented immigrants, both among Republicans and Democrats.

Conclusions: The results suggest that while undocumented immigrants are seen as less deserving of access, appeals to fairness and self-interest can trigger increased support.

Context: In the United States, fetal development markers, including "viability" and the point when a fetus can "feel pain", have permeated the social imaginary of abortion, affecting public support and the legality and availability of care, but the extent to which they describe and orient the experience of abortion at later gestations is unclear.

Methods: Using interviews with 30 cisgender women in the U.S. who obtained an abortion after 24 weeks of pregnancy, we investigate whether and how notions of fetal viability and/or pain operated in their lived experiences of pregnancy and abortion.

Findings: By respondents' accounts, fetal development-based laws restricting abortion based in purported points of fetal development operated as gestational limits, privileged the viability and pain status of the fetus over that of the prospective neonate, and failed to account for the viability and pain of the pregnant person.

Conclusions: The discursive practice of centering fetal development in regulating abortion access makes denial of abortion care because of the status of the fetus conceptually available-even at the point of fertilization-and naturalizes the erasure of the subjectivity of women and others who can become pregnant.

Context: Little is known about the political, institutional, and social contexts contributing to a decline in food and beverage industry power and influence over fiscal (soda taxes) and regulatory (sales/advertising restrictions and food labels) policy. This article addresses this issue by exploring why Mexico and Chile eventually saw such a decline in the food and beverage industry's influence whereas Brazil was not as successful. I argue that in Mexico and Chile, these outcomes are explained by shifts in presidential, congressional, and bureaucratic interests in pursuing policies that went against industry preferences.

Methods: This article took a qualitative methodological approach to comparative historical research.

Findings: Policymakers' interest in pursuing stronger food and beverage regulations were shaped by economic and public health concerns, new electoral contexts, epidemiological information, and normative beliefs. In Mexico, the infiltration of nutrition researchers within government facilitated this process. In contrast, Brazil's government was divided about pursuing regulatory policies, with presidents favoring partnerships with industry to implement a popular anti-hunger program; industry's power endured there with limited progress in policy reforms.

Conclusion: Governments can eventually overcome industry power and policy influence, but it depends on a whole government commitment to reform.

Context: Media messaging matters for public opinion and policy, and analyzing patterns of campaign strategy can provide important windows into policy priorities.

Methods: The authors used content analysis supplemented with keyword-based text analysis to assess the volume, proportion, and distribution of media attention to race-related issues in comparison to gender-related issues during the general election period of the 2022 midterm campaigns for federal office in the United States.

Findings: Race-related mentions in campaign advertising were overwhelmingly focused on crime and law and order, with very little attention to racism, racial injustice, and the structural barriers that lead to widespread inequities. In stark contrast to mentions of gender, racial appeals were less identity focused and were competitively contested between the parties in their messaging, but they were much more likely to be led by Republicans.

Conclusions: The results suggest that discussions of race and gender were highly polarized, with consequences for public understanding of and belief in disparities and policies important to population health.