Although research on the link between health and political behavior at the individual level has flourished, there have been no systematic analyses regarding the policy consequences of health inequalities in political voice. Using a unique dataset that measures the health bias in voter turnout across the fifty states from 1996 to 2012, I find that state electorates that are disproportionately more representative of healthy citizens spend less on health and have less generous Medicaid programs. The negative relationship between the degree of health bias in state electorates and these outcomes remain after controlling for the degree of class bias in voter turnout. These findings have important implications for democratic theory and policy responsiveness, as well as our understanding of variations in population health and health policy across the American states.
AlvarezMichael R.LevinInesSinclairJ. Andrew. 2012. “Making Voting Easier: Convenience Voting in the 2008 Presidential Election.” Political Research Quarterly65:248–62.
2.
AngelRonaldGronfeinWilliam. 1988. “The Use of Subjective Information in Statistical Models.” American Sociological Review53:464–73.
3.
ArmstrongElizabeth M.CarpenterDaniel P.HojnackiMarie. 2006. “Whose Deaths Matter? Mortality, Advocacy, and Attention to Disease in the Mass Media.” Journal of Health Politics, Policy, and Law31 (4): 729–72.
4.
AveryJames M.PeffleyMark. 2005. “Voter Registration Requirements, Voter Turnout, and Welfare Eligibility Policy: Class Bias Matters.” State Politics & Policy Quarterly5 (1): 47–67.
5.
BaileyMichael A.RomMark Carl. 2004. “A Wider Race? Interstate Competition across Health and Welfare Programs.” Journal of Politics66 (2): 326–47.
6.
BeckNathanielKatzJonathan N.1995. “What to Do (and Not to Do) With Time-Series Cross-Section Data.” American Political Science Review89 (3): 634–47.
7.
BeckNathanielKatzJonathan N.2011. “Modeling Dynamics in Time-Series–Cross-Section Political Economy Data.” Annual Review of Political Science14:331–52.
8.
BenferEmily A.2009. “The ADA Amendments Act: An Overview of Recent Changes to the Americans with Disabilities Act.” Washington, DC: American Constitution Society for Law and Policy.
9.
BjornerJakob B.FayersP. M.IdlerE. L.2005. “Self-Rated Health.” In Assessing Quality of Life, edited by FayersPeterHaysRon, 309–23. Oxford: Oxford University Press.
10.
BoardmanJason D.2006. “Self-Rated Health among U.S. Adolescents.” Journal of Adolescent Health38:401–408.
11.
BradyHenry E.VerbaSidneySchlozmanKay Lehman. 1995. “Beyond SES: A Resource Model of Political Participation.” American Political Science Review89 (2): 271–94.
CarpenterDaniel. 2012. “Is Health Politics Different?” Annual Review of Political Science15:287–311.
14.
De BoefSuzannaKeeleLuke. 2008. “Taking Time Seriously.” American Journal of Political Science52 (1): 184–200.
15.
EnnsPeter K.KochJulianna. 2013. “Public Opinion in the U.S. States: 1956 to 2010.” State Politics and Policy Quarterly13 (3): 349–72.
16.
GelmanAndrewKingGaryLiuChuanhi. 1998. “Not Asked and Not Answered: Multiple Imputation for Multiple Surveys.”Journal of American Statistical Association93 (443): 846–57.
17.
GilensMartin. 2012. Affluence and Influence. New York: Russell Sage Foundation.
18.
GilensMartinPageBenjamin I.2014. “Testing Theories of American Politics: Elites, Interest Groups, and Average Citizens.” Perspectives on Politics12:564–81.
19.
GreenbergPaul E.KesslerRonald C.BirnbaumHoward G.LeongStephanie A.LoweSarah W.BerglundPatricia A.Corey-LislePatricia K.2003. “The Economic Burden of Depression in the United States: How Did It Change between 1990 and 2000?” Journal of Clinical Psychiatry64 (12): 1465–75.
20.
GriffinJohn D.NewmanBrian. 2005. “Are Voters Better Represented?” The Journal of Politics67 (4): 1206–27.
21.
GriffinJohn D.NewmanBrian. 2007. “The Unequal Representation of Latinos and Whites.” The Journal of Politics69 (4): 1032–46.
22.
HendersonMichaelHillygusD. Sunshine. 2011. “The Dynamics of Health Care Opinion, 2008-2010: Partisanship, Self-Interest, and Racial Resentment.” Journal of Health Politics, Policy, and Law36 (6): 945–60.
23.
HillKim QuaileLeighleyJan. 1992. “The Policy Consequences of Class Bias in State Electorates.” American Journal of Political Science36 (2): 351–65.
IdlerEllen L.BenyaminiYael. 1997. “Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies.” Journal of Health and Social Behavior38:21–37.
26.
JacobyWilliam G.SchneiderSaundra K.2009. “A New Measure of Policy Spending Priorities in the American States.” Political Analysis17:1–24.
27.
JohnsNicole E.CowlingKryciaGakidouEmmanuela. 2013. “The Wealth (and Health) of Nations: A Cross-Country Analysis of the Relation Between Wealth and Inequality in Disease Burden Estimation.” The Lancet381 (2): S66.
28.
JylhäMarja. 2009. “What Is Self-Rated Health and Why Does it Predict Mortality? Towards a Unified Conceptual Model.” Social Science & Medicine69:307–16.
29.
KawachiIchiro. 2000. “Income Inequality and Health.” In Social Epidemiology, edited by F. BerkmanLisaKawachiIchiro, 76–94. Oxford: Oxford University press.
30.
KingGaryHonakerJamesJosephAnneScheveKenneth. 2001. “Analyzing Incomplete Political Science Data: An Alternative Algorithm for Multiple Imputation.” American Political Science Review95 (1): 49–69.
31.
KlarnerCarl. 2003. “The Measurement of the Partisan Balance of State Government.” State Politics and Policy Quarterly3 (3): 309–19.
32.
KousserThad. 2002. “The Politics of Discretionary Medicaid Spending, 1980-1993.” Journal of Health Politics, Policy, and Law72 (4): 639–72.
33.
LantzPaula M.HouseJames S.LepkowskiJames M.RWilliamsDavidMeroRichard P.ChenJieming. 1998. “Socioeconomic Factors, Health Behaviors, and Mortality: Results from a Nationally Representative Prospective Study of US Adults.” Journal of American Medical Association279: 1703–08.
34.
LijphartArend. 1997. “Unequal Participation: Democracy’s Unresolved Dilemma.” American Political Science Review91:1–14.
35.
MatsubayashiTetsuyaRochaRene R.2012. “Racial Diversity and Public Policy in the States.”Political Research Quarterly65(3): 600-614.
36.
MatsusakaJohn G.2004. The Initiative Process, Public Policy, and American Democracy. Chicago: The University of Chicago Press.
37.
MattilaMikkoSoderlundPeterWassHannaRapeliLauri. 2013. “Healthy Voting: The Effect of Self-Reported Health on Turnout in 30 Countries.” Electoral Studies32(4): 886–91.
38.
McDonoughJohn E.RosmanBrianButtMehreenTuckerLindseyHoweLisa Kaplan. 2008. “Massachusetts Health Reform Implementation: Major Progress and Future Challenges.” Health Affairs27 (4): w285–97.
39.
McLendonMichael K.HearnJames C.DeatonRuss. 2006. “Called to Account: Analyzing the Origins and Spread of State Performance-Accountability Policies for Higher Education.” Education Evaluation and Policy Analysis28 (10): 1–24.
40.
NickellStephen. 1981. “Biases in Dynamic Models with Fixed Effects.” Econometrica: Journal of the Econometric Society49:1417–26.
41.
OberlanderJonathan. 2007. “Health Reform Interrupted: The Unraveling of the Oregon Health Plan.” Health Affairs26 (1): w96–105.
42.
OjedaChristopherPachecoJulianna. 2019. “Health and Voting in Young Adulthood.” The British Journal of Political Science49:1163–86. doi:10.1017/S0007123417000151
43.
PachecoJulianna. 2013. “The Thermostatic Model of Responsiveness in the American States.” State Politics and Policy Quarterly13 (3): 306–32.
44.
PachecoJuliannaMaltbyElizabeth. 2017. “The Role of Public Opinion–Does it Influence the Diffusion of ACA Decisions?”The Journal of Health Politics, Policy, and Law42 (2): 309–40.
45.
PachecoJuliannaBousheyGraeme. 2014. “Public Health and Agenda Setting: Determinants of State Attention to Tobacco and Vaccines.” Journal of Health Politics, Policy, and Law39 (3): 565–89.
46.
PachecoJuliannaFletcherJason. 2015. “Incorporating Health into Studies of Political Behavior: Evidence for Turnout and Partisanship.” Political Research Quarterly68 (1): 104–16.
47.
RahnWendy M.GollustSarah. 2015. “The Bodies Politic: Chronic Health Conditions and Participatory Inequalities.” Journal of Health Politics, Policy, and Law 40 (6): 1115–55.
48.
RigbyElizabethSpringerJ. Melanie. 2011. “Does Electoral Reform Increase (or Decrease) Political Equality?” Political Research Quarterly64 (2): 420–34.
49.
RigbyElizabethWrightGerald C.2011. “Whose Statehouse Democracy? Policy Responsiveness to Poor vs. Rich Constituents in Poor versus Rich States.” In Who Gets Represented? Edited by EnnsPeter K.WlezienChristopher, 189–222. New York: Russell Sage Foundation.
50.
RobertStephanie A.BooskeBridget C.2011. “US Opinions on Health Determinants and Social Policy as Health Policy.” American Journal of Public Health101:1655–63.
51.
SchlozmanKay LehmanVerbaSidneyBradyHenry E.2012. The Unheavenly Chorus: Unequal Political Voice and the Broken Promise of American Democracy. Princeton: Princeton University Press.
52.
SchurLisaAdyaMeera. 2012. “Sidelined or Mainstreamed? Political Participation and Attitudes of People with Disabilities in the United States.” Social Science Quarterly94:811–39.
53.
SchurLisaShieldsToddKruseDouglasSchrinerKay. 2002. “Enabling Democracy: Disability and Voter Turnout.” Political Research Quarterly55 (1): 167–90.
54.
ShipanCharlesVoldenCraig. 2006. “Bottom-Up Federalism: The Diffusion of Antismoking Policies from U.S. Cities to States.” American Journal of Political Science50 (4): 825–43.
55.
SommersBenjamin D.EpsteinArnold M.2010. “Medicaid Expansion—The Soft Underbelly of Health Care Reform?” New England Journal of Medicine363 (22): 2085–87.
56.
UraJoseph DanielEllisChristopher R.2008. “Income, Preferences, and the Dynamics of Policy Responsiveness.” PS: Political Science & Politics41 (4): 785–94.
57.
VerbaSidneySchlozmanKay LehmanBradyHenry E.1995. Voice and Equality: Civic Voluntarism in American Politics. Cambridge: Harvard University Press.
58.
VoldenCraig. 2006. “States as Policy Laboratories: Emulating Success in the Children’s Health Insurance Program.” American Journal of Political Science50 (2): 294–312.
59.
WichowskyAmber. 2012. “Competition, Party Dollars, and Income Bias in Voter Turnout, 1980–2008.” The Journal of Politics74 (2): 446–59.
60.
WilkinsonRichard G.1996. Unhealthy Societies: The Afflictions of Inequality. London: Routledge.
