Journal of Health Politics Policy and Law最新文献

Context: Although the COVID-19 pandemic has affected all Americans, its effects have been unequally distributed across geographic areas. These variations in the pandemic's severity-and public perceptions thereof-likely have political consequences. This study examines the factors that shape perceptions of COVID-19 at the local level and assesses the consequences of these perceptions for public opinion and political behaviors.

Methods: The authors use questions from the 2020 Cooperative Election Study linked with county-level COVID-19 rates to examine predictors of respondents' perceptions of the pandemic's severity in their county, including demographic, political, and informational characteristics. The study also examines whether these perceptions are associated with public opinion and voter behavior.

Findings: Respondents' perceptions are correlated with case rates. Liberals and Democrats estimate the pandemic to be more severe than Republicans and conservatives do, as do CNN viewers compared to Fox News viewers. The study found only limited evidence of a relationship between perceptions of the pandemic in a respondent's county and political outcomes.

Conclusions: The results add to the accumulating evidence that both news media and political predispositions shape perceptions of COVID-19, and they raise important questions about whether and how the pandemic has shaped-and will continue to shape-political outcomes.

Context: Although community health centers (CHCs) arose in the 1960s as part of a Democratic policy push committed to social justice, subsequent support has been shaped by paradoxical politics wherein Republican and Democratic support for CHCs continually morphed in response to changes in the health policy landscape.

Methods: Drawing on the CHC literature and empirical examples from firsthand accounts and reporting, this article explains CHCs' curious historical development from 1965 to the present.

Findings: Both Republicans and Democrats have calibrated their support for CHCs in response to a broader set of political considerations, from antiwelfare policy commitments to aspirations of establishing a national health care plan.

Conclusions: CHCs have proven to be a politically malleable policy tool within the broader context of American health care policy. The COVID-19 pandemic raised new questions about CHCs' sustainability and future, but CHCs will continue to play a critical role in providing health care access to underserved populations. They also will continue to be an attractive bipartisan policy option within the larger framework of US health policy.

Context: Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust.

Methods: The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists.

Findings: Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists.

Conclusions: Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

Context: Nearly half of the adults in the United States have received an unexpected medical bill in recent years. While government, provider, and insurance policies related to unexpected medical expenses receive attention in the media, this study focuses on variation in public support.

Methods: The study employs two multifactor survey vignette experiments to detect how different features of common health care scenarios that result in costly medical expenses influence the public's sympathy for the patient, perceived fairness of the medical costs, and demand for government action.

Findings: The results point to out-of-pocket cost, severity of the treatment, and the patient's insurance situation as important for public opinion. The public is significantly more supportive of government action when the costs are high and out of the patient's control; in contrast, respondents are generally less sympathetic toward patients described as uninsured or who seek out more costly providers.

Conclusions: The findings underscore the sensitivity of health care attitudes to framing effects, which may occur when media choose how to cover health care costs. The results also point to a potential mismatch in legislation that narrowly addresses "surprise billing," with public support for government addressing disproportionate costs across a broader range of scenarios.

Housing is a fundamental right and a vital determinant of health. Health equity is not possible without widespread access to safe, affordable, high-quality housing. Local housing policy is a central conduit for advancing such ends. However, preemption of local law is a powerful institutional mechanism that state legislatures sometimes deploy to inhibit or nullify municipal efforts to address housing-based inequities. Local housing policies often have high stakes, are ideologically laden, and are politically salient. This makes them a clear target for preemptive action. Political science research to date has focused on broadly explaining the causes of preemption, with scant emphasis on its consequences and minimal attention to the implications for racial and economic equity. This article highlights the political repercussions of state preemption. Drawing on in-depth qualitative interviews, the article examines how local tenant organizations that work to build power within racially and economically marginalized communities perceive and respond to state preemption. The findings demonstrate how both the reality and the threat of state preemption prompt tenant organizations to adjust (and often minimize) their policy goals and to adapt their political strategies in ways that strain their capacity. By burdening local organizations that are crucial power resources in marginalized communities, state preemption of local housing policy risks entrenching inequity and eroding democracy.

Institutional narratives, appealing both to the intellect and the imagination, are powerful mechanisms of entrenchment. Drawing on close examination of legislative debates, interview transcripts, and official documents, this article analyzes institutional narratives of the British National Health Service (NHS) and American Medicare and Medicaid. These narratives take the form of epics, featuring founding heroes, adversaries, stewards, saviors, and other characters, and are retold on multiple occasions, and especially on anniversaries of the founding date. In the process, certain elements of history are remembered, and others forgotten. The myth of the NHS as a single national institution obscured much of the complexity and compromise that went into its founding and subsequent development, but preserved fidelity to its founding principles. In the United States, the dominant narrative belonged to Medicare, while Medicaid featured as an afterthought. In the case of the NHS, narrative entrenchment served to preserve universal access to comprehensive health care. In the case of American Medicare, entrenchment preserved the original mission of the institution but kept it from expanding to a broader swath of the population, even as its less-entrenched companion Medicaid provided a vehicle for coverage of an increasingly wide range of population groups. A distinct Medicaid narrative developed only after incremental expansion was well underway.

Context: In health care, licensing is pervasive. Restrictions on applicants with criminal records may have a disparate impact on historically marginalized groups. There is bipartisan interest in evaluating whether occupational licensing requirements are too strict.

Methods: The authors analyze how 12 representative states (California, Colorado, Connecticut, Delaware, Florida, Illinois, Missouri, New York, Ohio, Pennsylvania, South Dakota, and Texas) respond when people with criminal records apply for a license for five entry-level allied health professions (dental hygienist, occupational therapy assistant, physical therapy assistant, radiologic technologist, and respiratory therapist).

Findings: With one exception for one allied health profession, all states require their licensing boards to consider past serious criminal convictions. A majority of states require the conviction to be substantially related to the scope of professional duties for it to provide a basis for disqualification. Most states make it difficult for applicants with criminal records to determine whether they may obtain a license.

Conclusions: State licensing boards have considerable discretion in handling applicants with a criminal record. The trend is toward fewer restrictions, but more could be done to increase the transparency of state licensing board guidelines, practices, and procedures-particularly in the states that still rely on a "good moral character" test.

Context: Segregation has been linked to unequal life chances. Individuals from marginalized communities experience more crime, higher levels of poverty, poorer health, and less civic engagement. In addition, segregated metropolitan regions have been found to display inequality in access to basic services. This article builds on these findings by linking segregation to infection and deaths from COVID-19.

Methods: Using census data matched to COVID infection and death statistics at the county level, this article offers a theoretical basis for the researchers' choice of segregation measures and predictions for different racial groups. It analyzes the relationship between two dimensions of segregation-racial isolation and racial unevenness-and COVID outcomes for different racial and ethnic groups.

Findings: In counties where Black and Latino residents lived in more racially isolated neighborhoods, they were much more likely to contract COVID-19. This pattern was exacerbated in counties with a high proportion of frontline workers. In addition, racial segregation increased COVID-19 death rates for Black, Latino, and white residents.

Conclusions: These findings suggest that devastating outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies. This knowledge should be used to inform public health planning.