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“Rights without Access”: The Political Context of Inequality in Health Care Coverage in the U.S. States

Published online by Cambridge University Press:  25 January 2021

Ling Zhu  and
Jennifer H. Clark
Ling Zhu*
Affiliation:
University of Houston, Houston, TX, USA
Jennifer H. Clark
Affiliation:
University of Houston, Houston, TX, USA
*
Ling Zhu, Department of Political Science, University of Houston, 436 PGH Hall, Houston, TX 77204, USA. Email: lzhu4@central.uh.edu
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Abstract

The question of how the American political process shapes inequality remains unsettled. While recent studies break ground by linking inequality to political institutions, much of this work focuses on national-level income inequality. The literature is lacking in its examination of inequality in other issue areas at the subnational level. This research explores how partisanship in government affects subnational-level inequality in health care coverage in the context of racial diversity. Using a new Gini-coefficient measure of inequality in health insurance coverage, we find a negative relationship between the seat share of Democratic representatives and inequality in health care coverage but only in states with racially diverse populations. Moreover, Democratic-controlled state legislatures mitigate the negative impact of racial diversity on inequality in health care coverage. These results highlight the importance of examining the partisan foundation of health care inequality in the context of racial diversity.

Keywords

inequalityhealth insurance coverageparty governmentstate politics
Type
Research Article
Information
State Politics & Policy Quarterly , Volume 15 , Issue 2 , June 2015 , pp. 239 - 262
Copyright
The Author(s) 2015

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References

Alt, James E., and Lowry, Robert C.. 1994. “Divided Government, Fiscal Institutions, and Budget Deficits: Evidence from the States.” American Political Science Review 88 (4): 811–28..CrossRefGoogle Scholar
Atkinson, Anthony B. 1970. “On the Measurement of Inequality.” Journal of Economic Theory 2 (3): 244–63..CrossRefGoogle Scholar
Avery, James M., and Peffley, Mark. 2005. “Voter Registration Requirements, Voter Turnout, and Welfare Eligibility Policy: Class Bias Matters.” State Politics & Policy Quarterly 5:47–67.CrossRefGoogle Scholar
Baltagi, Badi H. 2008. Econometric Analysis of Panel Data. 4th ed. West Sussex, UK: John Wiley.Google Scholar
Barrilleaux, Charles, and Davis, Belinda Creel. 2003. “Explaining State Variation in Levels and Change in the Distribution of Income in the United States, 1978-1990.” American Politics Research 31 (3): 280–300..CrossRefGoogle Scholar
Barrilleaux, Charles, and Bernick, Ethan. 2003. “Deservingness, Discretion, and the State Politics of Welfare Spending, 1990-96.” State Politics & Policy Quarterly 3 (1): 1–22..CrossRefGoogle Scholar
Bartels, Larry M. 2008. Unequal Democracy: The Political Economy of the New Gilded Age. Princeton: Princeton University Press.Google Scholar
Berry, William D., Ringquist, Evan J., Fording, Richard C., and Hanson, Russell L.. 1998. “Measuring Citizen and Government Ideology in the American States, 1960-93.” American Journal of Political Science 42 (1): 327–48..CrossRefGoogle Scholar
Berry, William D., Golder, Matt, and Milton, Daniel. 2012. “Improving Tests of Theories Positing Interaction.” Journal of Politics 74 (3): 653–71..CrossRefGoogle Scholar
Blackorby, Charles, and Donaldson, David. 1978. “Measures of Relative Equality and Their Meaning in Terms of Social Welfare.” Journal of Economic Theory 18 (1): 59–80..CrossRefGoogle Scholar
Blumenthal, David. 1999. “Who Pays for Employer Sponsored Health Insurance? Evidence and Policy Implications.” Health Affairs 18 (6): 58–61..Google Scholar
Bradley, David, Huber, Evelyne, Moller, Stephanie, Nielsena, Francois, and Stephens, John. 2003. “Distribution and Redistribution in Post Industrial Democracies.” World Politics 55 (2): 193–228..CrossRefGoogle Scholar
Brambor, Thomas, Clarke, William Roberts, and Golder, Matt. 2006. “Understanding Interaction Models: Improving Empirical Analysis.” Political Analysis 14 (1): 63–82..CrossRefGoogle Scholar
Brown, Robert D. 1995. “Party Cleavages and Welfare Effort in the American States.” American Political Science Review 89 (1): 23–33..CrossRefGoogle Scholar
Carrasquillo, Olveen, Himmelstein, David U., Woolhandler, Steffie, and Bor, David H.. 1999. “Trends in Health Insurance Coverage, 1989-1997.” International Journal of Health Services 29:467–83.CrossRefGoogle ScholarPubMed
Cummins, Jeff. 2011. “Party Control, Policy Reforms, and the Impact on Health Insurance Coverage in the U.S. States.” Social Science Quarterly 92 (1): 247–67..CrossRefGoogle ScholarPubMed
Dahl, Robert A. 1971. Polyarchy: Participation and Opposition. New Haven: Yale University Press.Google Scholar
Davis, Karen. 1991. “Inequality and Access to Health Care.” The Milbank Quarterly 69 (2): 253–73..Google ScholarPubMed
DeNavas-Walt, Carmen, Proctor, Bernadette D., and Smith, Jessica C.. 2011. “Income, Poverty, and Health Insurance Coverage in the United States: 2010.” In The United States Census Bureau Current Population Reports. Washington DC: U.S. Government Printing Office, 60–239.Google Scholar
Enns, Peter K., Kelly, Nathan J., Morgan, Jana, Volscho, Thomas, and Witko, Christopher. 2014. “Conditional Status Quo Bias and Top Income Shares: How U.S. Political Institutions Have Benefited the Rich.” Journal of Politics 76 (2): 289–303..CrossRefGoogle Scholar
Erikson, Robert S., Wright, Gerald C., and McIver, John P.. 1993. Statehouse Democracy: Public Opinion and Policy in the American States. New York: Cambridge University Press.Google Scholar
Filindra, Alexandra. 2012. “Immigrant Social Policy in the American States: Race Politics and State TANF and Medicaid Eligibility Rules for Legal Permanent Residents.” State Politics & Policy Quarterly 13 (1): 26–48..CrossRefGoogle Scholar
Flavin, Patrick. 2012. “Income Inequality and Policy Representation in the American States.” American Politics Research 40 (1): 29–59..CrossRefGoogle Scholar
Fording, Richard C. 1997. “The Conditional Effect of Violence as a Political Tactic: Mass Insurgency, Welfare Generosity, and Electoral Context in the American States.” American Journal of Political Science 41 (1): 1–29..CrossRefGoogle Scholar
Garand, James C. 1985. “Partisan Change and Shifting Expenditure Priorities in the American States.” American Politics Quarterly 13 (4): 355–92..CrossRefGoogle Scholar
Gelman, Andrew, and Hill, Jennifer. 2006. Data Analysis Using Regression and Multilevel/Hierarchical Models. New York: Cambridge University Press.CrossRefGoogle Scholar
Gilens, Martin. 2005. “Inequality and Democratic Responsiveness.” Public Opinion Quarterly 69:778–96.CrossRefGoogle Scholar
Graubarde, Barry I., and Korn, Edward L.. 1996. “Modeling the Sampling Design in the Analysis of Heath Surveys.” Statistical Methods in Medical Research 5 (3): 263–81..Google Scholar
Gray, Virginia, Lowery, David, Mornogan, James, and Godwin, Erik. 2010. “Incrementing toward Nowhere: Universal Health Care Coverage in the States.” Publius: The Journal of Federalism 40 (1): 82–113..CrossRefGoogle Scholar
Grogan, Colleen M. 1994. “Political Economic Factors Influencing State Medicaid Policy.” Political Research Quarterly 47 (3): 589–622..CrossRefGoogle Scholar
Grogan, Colleen M., and Rigby, Elizabeth. 2008. “Federalism, Partisan Politics, and Shifting Support for State Flexibility: The Case of the U.S. State Children's Health Insurance Program.” Publius: The Journal of Federalism 39:47–69.CrossRefGoogle Scholar
Hacker, Jacob S. 2004. “Privatizing Risk without Privatizing the Welfare State: The Hidden Politics of Social Policy Retrenchment in the United States.” American Political Science Review 98 (2): 243–60..CrossRefGoogle Scholar
Hacker, Jacob S. 2006. The Great Risk Shift. New York: Oxford University Press.Google Scholar
Hao, Lingxin, and Naiman, Daniel Q.. 2010. Assessing Inequality. Thousand Oaks: Sage.CrossRefGoogle Scholar
Hawes, Daniel P., and Rocha, Rene R.. 2011. “Culture, Capital, and Diversity: Assessing the Determinants of Civic and Economic Equity in the American States.” Political Research Quarterly 64 (4): 924–37..CrossRefGoogle Scholar
Heckelman, Jac C., and Dougherty, Keith L.. 2010. “Majority Rules versus Supermajority Rules: Their Effects on Narrow and Broad Texas.” Public Finance Review 38 (6): 738–61..CrossRefGoogle Scholar
Hero, Rodney E. 1998. Faces of Inequality: Social Diversity in American Politics. New York: Oxford University Press.Google Scholar
Hero, Rodney E., and Tolbert, Caroline. 1996. “A Racial/Ethnic Interpretation of Politics and Policy in the States of the U.S.” American Journal of Political Science 40:851–71.CrossRefGoogle Scholar
Hill, Kim Quaile, Leighley, Jan, and Hinton-Anderson, Angela. 1995. “Lower-Class Mobilization and Policy Linkage in the U.S. States.” American Journal of Political Science 39 (1): 75–86..CrossRefGoogle Scholar
Hill, Kim Quaile, and Leighley, Jan. 1992. “The Policy Consequences of Class Bias in State Electorates.” American Journal of Political Science 36 (2): 351–65..CrossRefGoogle Scholar
Hochschild, Jennifer, and Weaver, Vesla. 2007. Politics of Racial Classification and the Politics of Racial Inequality. In Remaking America Democracy and Public Policy in an Age of Inequality, eds. Soss, Joe, Hacker, Jacob S., and Mettler, Suzanne. New York: Russell Sage. 159–82.Google Scholar
Holahan, John. 2010. “The 2007-09 Recession and Health Insurance Coverage.” Health Affairs 30:145–52.Google ScholarPubMed
Jacobs, Lawrence R., and Skocpol, Theda, eds. 2007. Inequality and American Democracy: What We Know and What We Need to Learn. New York: Russell Sage.Google Scholar
Jacobs, Lawrence R., and Callaghan, Timothy. 2013. “Why States Expand Medicaid: Party, Resources, and History.” Journal of Health Politics, Policy and Law 38 (5): 1023–50..CrossRefGoogle ScholarPubMed
Johnson, Martin. 2001. “The Impact of Social Diversity and Racial Attitudes on Social Welfare Policy.” State Politics & Policy Quarterly 1 (1): 27–49..CrossRefGoogle Scholar
Kail, Ben Lennox, Quadagno, Jill, and Dixon, Marc. 2009. “Can States Lead the Way to Universal Coverage? The Effect of Health Care Reform on the Uninsured.” Social Science Quarterly 90 (5): 1341–1360..CrossRefGoogle Scholar
Kakawani, Nanak, Wagstaff, Adam, and Doorslaer, Eddy van. 1997. “Socioeconomic Inequalities in Health: Measurement, Computation, and Statistical Inference.” Health Affairs 77 (1): 87–103..Google Scholar
Kelly, Nathan J. 2004. “Does Politics Really Matter? Policy and Government's Equalizing Influence in the United States.” American Politics Research 32 (3): 264–84..CrossRefGoogle Scholar
Kelly, Nathan J., and Witko, Christopher. 2012. “Federalism and American Inequality.” Journal of Politics 74 (2): 414–26..CrossRefGoogle Scholar
Key, V. O. Jr. (1949). Southern politics in State and Nation. New York: Vintage.Google Scholar
Klarner, Carl. 2003. “The Measurement of the Partisan Balance of State Government.” State Politics & Policy Quarterly 3 (3): 309–19..CrossRefGoogle Scholar
Kousser, Thad. 2002. “The Politics of Discretionary Medicaid Spending, 1980-1993.” Journal of Health Politics, Policy and Law 27 (4): 639–71..CrossRefGoogle ScholarPubMed
Krueger, Brain S., and Mueller, Paul D.. 2001. “Moderating Backlash: Racial Mobilization, Partisan Coalition, and Public Policy in the American States.” State Politics & Policy Quarterly 1 (2): 165–79..CrossRefGoogle Scholar
Langer, Laura. 2001. “The Consequences of State Economic Development Policies on Income Distribution in the American States, 1976-1994.” American Politics Research 29 (4): 392–415..CrossRefGoogle Scholar
Leighley, Jan E., and Nagler, Jonathan. 1992. “Individual and Systemic Influences on Turnout—Who Votes, 1984.” Journal of Politics 54 (3): 718–40..CrossRefGoogle Scholar
Macenback, John P., and Kunst, Anton. 1997. “Measuring the Magnitude of Socio-Economic Inequalities in Health: An Overview of Available Measures Illustrted with Two Examples from Europe.” Social Science & Medicine 44(6): 757–71.Google Scholar
Matsubayashi, Tetsuya, and Rocha, Rene R.. 2012. “Racial Diversity and Public Policy in the States.” Political Research Quarterly 65 (3): 602–16..CrossRefGoogle Scholar
McCarty, Nolan M., Poole, Keith T., and Rosenthal, Howard. 2006. Polarized America: The Dance of Ideology and Unequal Riches. Cambridge: MIT Press.Google Scholar
O'Donnell, Owen, Doorslaer, Eddy van, Wagstaff, Adam, and Lindelow, Magnus. 2005. Analyzing Health Equity Using Household Survey Data (WBI Learning Resource Series). Washington, DC: World Bank Institute.Google Scholar
Page, Benjamin I., and Jacobs, Lawrence R.. 2009. Class War? What Americans Really Think about Economic Inequality. Chicago: University of Chicago Press.CrossRefGoogle Scholar
Paul, Starrm. 2011. Remedy and Reaction: The Peculiar American Struggle over Health Care Reform. New Haven: Yale University Press.Google Scholar
Plotnick, Robert D., and Winters, Richard F.. 1985. “A Political Economic Theory of Income Redistribution.” American Political Science Review 79 (2): 458–73..CrossRefGoogle Scholar
Rigby, Elizabeth, and Wright, Gerald C.. 2013. “Political Parties and Representation of the Poor in the American States.” American Journal of Political Science 57 (3): 552–65..CrossRefGoogle Scholar
Schattschneider, E. E. 1942. Party Government. New York: Rinehart.Google Scholar
Schlozman, Kay Lehman, Verba, Sidney, and Brady, Henry E.. 2012. The Unheavenly Chorus: Unequal Political Voice and the Broken Promise of American Democracy. Princeton: Princeton University Press.CrossRefGoogle Scholar
Sergeant, Jamie C., and Firth, David. 2006. “Relative Index of Inequality: Definition, Estimation and Inference.” Biostatistics 7 (2): 213–24..Google ScholarPubMed
Soss, Joe, Hacker, Jacob S., and Mettler, Suzanne, eds. 2007. Remaking America Democracy and Public Policy in an Age of Inequality. New York: Russell Sage.Google Scholar
Soss, Joe, Fording, Richard C., and Schram, Sanford F.. 2008. “The Color of Devolution: Race, Federalism, and the Politics of Social Control.” American Journal of Political Science 52 (3): 536–53..CrossRefGoogle Scholar
Tolbert, Caroline, and Hero, Rodney E.. 2001. “Dealing with Diversity: Racial/Ethnic Context and Social Policy Change Dealing with Diversity: Racial/Ethnic Context and Social Policy Change.” Political Research Quarterly 54 (3): 571–604..CrossRefGoogle Scholar
van Doorslaer, Eddy, Masseria, Cristina, and Koolman, Xavier. 2006. “Inequalities in Access to Medical Care by Income in Developed Countries.” Canadian Medical Association Journal 174 (2): 177–83..CrossRefGoogle ScholarPubMed
Wright, Gerald C. 1976. “Racism and Welfare Policy in America.” Social Science Quarterly 57 (3): 718–30..Google Scholar
Zhu, Ling, and Johansen, Morgen S.. 2014. “Public Responsibility and Inequality in Health Insurance Coverage: An Examination of American State Health Care Systems.” Public Administration 92 (2): 422–39..CrossRefGoogle Scholar
Zhu, Ling. 2013. “Panel Data Analysis in Public Administration: Substantive and Statistical Considerations.” Journal of Public Administration Research and Theory 23 (2): 395–428..CrossRefGoogle Scholar