The Policy Consequences of Health Bias in Political Voice

• DOI: 10.1177/1065912919859434
• Date: 01 March 2021
• Published date: 01 March 2021
• Author: Julianna Pacheco
• Subject Matter: Articles

https://doi.org/10.1177/1065912919859434

Political Research Quarterly

2021, Vol. 74(1) 46 –58

© 2019 University of Utah

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DOI: 10.1177/1065912919859434

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Article

There is growing evidence that healthy citizens are more

likely to turn out than unhealthy citizens (e.g., Mattila

et al. 2013; Schur et al. 2002), that the link between health

and turnout develops in young adulthood (Ojeda and

Pacheco 2019), and that health and wealth are indepen-

dent inputs into the decision to vote (Pacheco and Fletcher

2015).1 Healthy citizens also tend to identify with the

Republican Party (Pacheco and Fletcher 2015; Schur and

Adya 2013), are less likely to think that social policy is

effective at improving public health (Robert and Booske

2011), and are less supportive of government involve-

ment in healthcare (Schur and Adya 2012). In short, there

is little doubt that “health and illness shape who we are

politically” (Carpenter 2012, 303).

At the same time, that research on the link between

health and political behavior at the individual level has

flourished, there have been little systematic analyses

regarding the political consequences of health inequalities

in political voice. It is reasonable to think that if healthy

people are more likely to turn out and have systematically

different policy preferences, as suggested by previous

research, then electoral results and the policies that are

enacted may have a “health bias.” Yet, without empirical

evidence looking directly at policies, it is difficult to make

assertions about how health inequalities in political voice

contribute to biases in the public policy process.

This paper tests the proposition that an electorate dis-

proportionately representative of healthy citizens pro-

duces biased policies that disproportionately disadvantage

unhealthy citizens. I do this using a unique dataset that

combines measures of “health bias” in voter turnout with

state spending on health and Medicaid from 1996 to 2012.

I find that state electorates that are disproportionately rep-

resentative of healthy citizens spend less money on health

and have less generous Medicaid programs. The negative

relationship between the degree of health bias in state

electorates and these inferences remain after various

robustness checks. These findings have important impli-

cations for democratic theory and policy responsiveness,

as well as how we understand variations in health policy

and population health across the American states.

Do Health Disparities in Turnout

Lead to a Bias in Public Policy?

Political equality and democratically responsive govern-

ment are cherished American values. Yet, political scien-

tists have known for a long time that participatory

inequalities are not randomly distributed, but systemati-

cally biased toward the more privileged citizens who are

highly educated and wealthy (e.g., Lijphart 1997). Even

more troubling is that class biases in the electorate have

significant political consequences. There is mounting

evidence that political officials are more responsive to the

859434PRQXXX10.1177/1065912919859434Political Research QuarterlyPacheco

research-article2019

1The University of Iowa, Iowa City, USA

Corresponding Author:

Julianna Pacheco, The University of Iowa, 326 Schaffer Hall, Iowa City,

IA 52242, USA.

Email: julianna-pacheco@uiowa.edu

The Policy Consequences of

Health Bias in Political Voice

Julianna Pacheco1

Abstract

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.

Keywords

health, political participation, voter turnout, health bias, representation