Chapter 2 Literature

Two major perspectives, attributed to Edmund Burke, purport to define the essential nature of representation in a democracy for legislators: delegates, who are supposed to mirror constituents’ opinions, and trustees, who are supposed to be introspective when it comes to delivering what is best for their constituents. Beyond normative concerns, which actually describes legislator behavior empirically? The literature has focused on areas where measurement is easier: on Congress, on states as a whole, and on generalized representation via responsiveness. We know very little about how well representation works on important, specific policies like health reform, and we know even less about dyadic representation at the legislator/district level.

2.1 Delegative Representation

Most of the work on this kind of representation has focused on Congress. The logic of the connection starts with Mayhew (1974) who argued the linchpin of legislator accountability is their concern for re-election. Yet empirical support for the strength of the electoral connection has been limited to more general voting behavior (Canes-Wrone, Brady, and Cogan 2002), as opposed to votes on specific issues where legislators appear to have lots of freedom to maneuver. Poole and Rosenthal (2007) finds little evidence that constituency need is a major determinant of legislator votes. One interesting counterexample is [Nyhan et al. (2012) which found that moderate Democrats voting in favor of the then-unpopular ACA suffered substantial losses at the polls, and maybe even enough to help flip Congress to Republican control in 2010.

Even at the congressional level, studies of representation have been hampered by the difficulty of measuring public opinion at the district level. Most studies proxy for district ideology using presidential vote (Levendusky, Pope, and Jackman 2008; Kernell 2009). More modern measures employ newer statistical estimators to model district opinion (Tausanovitch and Warshaw 2013; Kousser, Phillips, and Shor 2016), but these applications were with generalized measures of district ideology and not responses to specific issues.

What about the state level? States are much more likely to be dominated by a single party, and information on activity in state capitols is very poor, especially given the near-destruction of traditional newspaper state political coverage. Compounding the lack of information is the nationalization of state elections in recent years. National factors like presidential popularity and generic party approval have increasingly dominated state factors (Hopkins 2018). This raises the concern about how well the electoral connection can work at the state level if constituents vote on national rather than state level issues.

Most work has been done on responsiveness of generalized policy outputs, aggregating over all the different policies that states produce, with general findings of responsiveness (Erikson, Wright, and McIver 1993; Caughey and Warshaw 2017). Less work has focused on state representation at the policy level, but the major findings suggest responsiveness but relatively little congruence (J. R. Lax and Phillips 2009; J. Lax and Phillips 2009).

More to the point, very little is known about the influence of constituents on their state legislators. What little we know suggests a limited role for the public in legislator decisions. State legislative elections are very uncompetitive. In 2016, about 42% of general election contests and 79% of primary election contests were uncontested even nominally: that is, only a single name appeared on the ballot. Incumbents that do face opponents rarely lose (except in wave elections like 2014). At the same time, the public is barely aware of which party controls the state legislature in general, much less the name of their own representative, and legislators lose very little when they are out of step of their districts in general (Rogers 2017).

As with Congress, the difficulties of measurement plague district level studies of representation. We presidential vote by legislative district, data only available for 2012 and 2016 via crowdsourcing by the Daily Kos. Generalized ideology measures from [Tausanovitch and Warshaw (2013) are also available, but these aggregate over an entire decade and do not address individual policies. Finally, state legislators themselves have consistently inaccurate images of public opinion in their own district (Broockman and Skovron 2017). They are nearly as blind as their constituents.

2.2 Trustee Representation

As with delegative representation, nearly all the work on trustee-type representation at the legislator level have been done in the congressional context. There, the contrast with the ``trustee’’ variables of partisanship, ideology, and interests at the legislator level could not be more striking. Party (Lee 2009, 2016) and ideology (Poole and Rosenthal 2007) are the strongest known influences on congressional behavior. The parties are polarizing rapidly (Barber and McCarty 2015) and the same district can elect a Democrat or a Republican and experience vast differences in representation (McCarty, Poole, and Rosenthal 2009).

State level work on representation in the health policy area almost always cites partisanship as the most important predictor of progress in ACA implementation (Rigby and Haselswerdt 2013; L. R. Jacobs and Callaghan 2013; Jones, Bradley, and Oberlander 2014; Barrilleaux and Rainey 2014; Haeder and Weimer 2015; T. Callaghan and Jacobs 2016; T. H. Callaghan and Jacobs 2017). Ideological divisions within state Republican parties between a more extreme Tea party faction and a more moderate business-oriented faction has been cited as explaining variation in expanding Medicaid (Hertel-Fernandez, Skocpol, and Lynch 2016).

What we know about the influence of party and ideology on specific policy outputs at the state legislator level is relatively limited. In general terms, state legislative parties are polarizing (Shor and McCarty 2011; Shor 2020). Moderate, heterogeneous districts elect extreme Republicans and Democrats (McCarty et al. 2018) In terms of specific policy, my own work addresses this on a small set of health policies and roll call votes (Shor 2018).

2.3 Interest Representation

Interest groups are an important part of the American political system and their influence is well know to operate through campaign finance and especially lobbying channels (R. L. Hall and Wayman 1990; Evans 1996). Campaign finance is now a much more important channel, especially in the states, because of the decision and many state laws which essentially have no limits on donations.

State health policy has long attracted the attention of scholars interested in illuminating the role of interests in the policymaking process (Lowery et al. 2008; Gray, Lowery, and Benz 2013). A newer literature focusing on the implementation of the Affordable Care Act at the state level continues this tradition. For example, T. Callaghan and Jacobs (2016) document the influence of business interests in retarding ACA implementation, and public interest advocates in pushing it forward. Rose (2015) cites the role of resource-starved hospitals in particular on Medicaid expansion. Yet these influences can not be measured at the individual level. Bill-level measures give us more detail, like those in Garlick (2016) who finds that business lobbying pressure moderates polarization on individual bills while public interest advocacy amplifies it.

States are also the site for the unmatched influence of the conservative Koch network groups: the American Legislative Exchange Council, Americans for Prosperity, and the State Policy Network. These work together to provide expertise and resources to the resource-starved efforts of mostly amateur and part-time legislators. These three organizations have built an infrastructure over decades, and not at all matched by the disjointed, less comprehensive, and far more nascent efforts on the left (Hertel-Fernandez 2016). These operate explicitly at the legislator level, providing model bills and other resources directly to individual members, especially backbenchers without institutional resources (Hertel-Fernandez 2014).

Physicians have a very special role in the setting of health policy. More than any other group, they are trusted by members of the public when it comes to making health policy choices (Patashnik, Gerber, and Dowling 2017). Yet physicians have long had a strong professional and ideological bias against health reform that has doomed previous reforms over American history (Starr 2008, 2013). At the same time as possessing the public’s trust, physicians are educated, wealthy, geographically dispersed, and unusually politically active (Bonica et al. 2017).

But what do physicians believe? New measures have been introduced directly measuring the ideology of physicians based on party registration (Bonica, Rosenthal, and Rothman 2014, 2015) and campaign finance donations (Bonica 2017; Bonica et al. 2017). These attest to the vast geographic heterogeneity in physician policy preferences. While new studies find geographic sorting by ideology is limited (Mummolo and Nall 2017), this does not appear to be the case for physicians given their incomes and their ability to find work across the country (and the quasi-randomization induced by the residential matching program after medical school) (Bonica et al. 2017). Physicians have sorted into distinct geographic areas (within and across states), and this naturally raises the possibility that this sorting has political and policy consequences.

2.4 Issue Ownership

Not all issues are the same. Pioneering work by Petrocik (1996); Petrocik, Benoit, and Hansen (2003) and others have shown how one or the other major parties have advantages over certain issues in the eyes of the public. The public perceives that the parties prioritize certain issues over others, and these priorities are enduring over time (Pope and Woon 2009; Egan 2013). The connection to representation is that parties are responsive on issues they own than on those they don’t. Health as a category is considered owned by Democrats so this should imply that Republicans are actually more responsive to public opinion on this issue.

The issue ownership literature has not investigated spatial heterogeneity in issue ownership, partly because the focus has been exclusively on national politics. It may be that Democrats own health care in some states, but not all. Voters in South Carolina or Utah might see Republicans as owning the issue, especially as Democrats are nowhere near the policymaking reins in either state. Furthermore, it could be the case that ``health’’ is simply too big a catchall category to adequately describe voters’ opinion. Perhaps Republicans own tort reform in the very same state that Democrats own Medicaid expansion or prescription drug pricing.

References

Barber, Michael, and Nolan M McCarty. 2015. “Causes and Consequences of Polarization.” In Solutions to Political Polarization in America, edited by Nathaniel Persily. Cambridge University Press.
Barrilleaux, Charles, and Carlisle Rainey. 2014. “The Politics of Need Examining Governors’ Decisions to Oppose the ‘Obamacare’ Medicaid Expansion.” State Politics & Policy Quarterly 14 (4): 437–60.
———. 2017. “Database on Ideology, Money in Politics, and Elections (DIME).”
Bonica, Adam, Howard Rosenthal, and David J Rothman. 2014. “The Political Polarization of Physicians in the United States: An Analysis of Campaign Contributions to Federal Elections, 1991 Through 2012.” JAMA Internal Medicine 174 (8): 1308–17.
———. 2015. “The Political Alignment of US Physicians: An Update Including Campaign Contributions to the Congressional Midterm Elections in 2014.” JAMA Internal Medicine 175 (7): 1236–37.
Bonica, Adam, Howard Rosenthal, David J. Rothman, and Kristy Blackwood. 2017. “Political Ideology and Sorting: The Mobility of Physicians.”
Broockman, David E, and Christopher Skovron. 2017. “Conservative Bias in Perceptions of Public Opinion Among American Political Elites.”
Callaghan, Timothy H, and Lawrence R Jacobs. 2017. “The Future of Health Care Reform: What Is Driving Enrollment?” Journal of Health Politics, Policy and Law 42 (2): 215–46.
Callaghan, Timothy, and Lawrence R Jacobs. 2016. “Interest Group Conflict over Medicaid Expansion: The Surprising Impact of Public Advocates.” American Journal of Public Health 106 (2): 308–13.
Canes-Wrone, Brandice, David W. Brady, and John F. Cogan. 2002. “Out of Step, Out of Office: Electoral Accountability and House Members’ Voting.” American Political Science Review 96 (1): 127–40.
Caughey, Devin, and Christopher Warshaw. 2017. “Policy Preferences and Policy Change: Dynamic Responsiveness in the American States, 1936–2014.” American Political Science Review. Forthcoming.
Egan, Patrick J. 2013. Partisan Priorities: How Issue Ownership Drives and Distorts American Politics. Cambridge University Press.
Erikson, Robert S., Gerald C. Wright, and John P. McIver. 1993. Statehouse Democracy: Public Opinion and Policy in the American States. New York: Cambridge.
Evans, Diana. 1996. “Before the Roll Call: Interest Group Lobbying and Public Policy Outcomes in House Committees.” Political Research Quarterly 49 (2): 287–304.
Garlick, Alexander. 2016. “Interest Groups, Lobbying and Polarization in the United States.” PhD thesis, University of Pennsylvania.
Gray, Virginia, David Lowery, and Jennifer K Benz. 2013. Interest Groups and Health Care Reform Across the United States. Georgetown University Press.
Haeder, Simon F, and David L Weimer. 2015. “You Can’t Make Me Do It, but i Could Be Persuaded: A Federalism Perspective on the Affordable Care Act.” Journal of Health Politics, Policy and Law, 2882219.
Hall, Richard L, and Frank W Wayman. 1990. “Buying Time: Moneyed Interests and the Mobilization of Bias in Congressional Committees.” American Political Science Review 84 (3): 797–820.
Hertel-Fernandez, Alexander. 2014. “Who Passes Business’s ‘Model Bills?’ Policy Capacity and Corporate Influence in US State Politics.” Perspectives on Politics 12 (3): 582–602.
———. 2016. “Explaining Liberal Policy Woes in the States: The Role of Donors.” PS: Political Science & Politics 49 (3): 461–65.
Hertel-Fernandez, Alexander, Theda Skocpol, and Daniel Lynch. 2016. “Business Associations, Conservative Networks, and the Ongoing Republican War over Medicaid Expansion.” Journal of Health Politics, Policy and Law 41 (2): 239–86.
Hopkins, Daniel J. 2018. The Increasingly United States. University of Chicago Press.
Jacobs, Lawrence R, and Timothy Callaghan. 2013. “Why States Expand Medicaid: Party, Resources, and History.” Journal of Health Politics, Policy and Law 38 (5): 1023–50.
Jones, David K, Katharine WV Bradley, and Jonathan Oberlander. 2014. “Pascal’s Wager: Health Insurance Exchanges, Obamacare, and the Republican Dilemma.” Journal of Health Politics, Policy and Law 39 (1): 97–137.
Kernell, Georgia. 2009. “Giving Order to Districts: Estimating Voter Distributions with National Election Returns.” Political Analysis 17 (3): 215–35.
Kousser, Thad, Justin H. Phillips, and Boris Shor. 2016. “Reform and Representation: Assessing California’s Top-Two Primary and Redistricting Commission.” Political Science Research and Methods. https://doi.org/https://doi.org/10.1017/psrm.2016.43.
Lax, Jeffrey R., and Justin H. Phillips. 2009. “How Should We Estimate Public Opinion in the States?” American Journal of Political Science 53 (1): 107–21.
Lax, Jeffrey, and Justin Phillips. 2009. “Gay Rights in the States: Public Opinion and Policy Responsiveness.” American Political Science Review 103 (03): 367–86. https://doi.org/10.1017/S0003055409990050.
Lee, Frances E. 2009. Beyond Ideology. University of Chicago Press.
———. 2016. Insecure Majorities: Congress and the Perpetual Campaign. University of Chicago Press.
Levendusky, Matthew S., Jeremy C. Pope, and Simon D. Jackman. 2008. “Measuring District-Level Partisanship with Implications for the Analysis of U.S. Elections.” The Journal of Politics 70 (03): 736–53. https://doi.org/10.1017/S0022381608080729.
Lowery, David, Virginia Gray, Jennifer Benz, Mary Deason, Justin Kirkland, and Jennifer Sykes. 2008. “Understanding the Relationship Between Health PACs and Health Lobbying in the American States.” Publius: The Journal of Federalism 39 (1): 70–94.
Mayhew, David R. 1974. Congress: The Electoral Connection. New Haven: Yale University Press.
McCarty, Nolan, Keith T. Poole, and Howard Rosenthal. 2009. “Does Gerrymandering Cause Polarization?” American Journal of Political Science 53 (3): 666–80.
McCarty, Nolan, Jonathan Rodden, Boris Shor, Christopher Tausanovitch, and Christopher Warshaw. 2018. “Geography, Uncertainty, and Polarization.” Political Science Research and Methods, May.
Mummolo, Jonathan, and Clayton Nall. 2017. “Why Partisans Do Not Sort: The Constraints on Political Segregation.” The Journal of Politics 79 (1): 45–59.
Nyhan, Brendan, Eric McGhee, John Sides, Seth Masket, and Steven Greene. 2012. “One Vote Out of Step?: The Effects of Salient Roll Call Votes in the 2010 Election.” American Politics Research 20 (10). https://doi.org/10.1177/1532673X11433768.
Patashnik, Eric M, Alan S Gerber, and Conor M Dowling. 2017. Unhealthy Politics: The Battle over Evidence-Based Medicine. Princeton University Press.
Petrocik, John R. 1996. “Issue Ownership in Presidential Elections, with a 1980 Case Study.” American Journal of Political Science, 825–50.
Petrocik, John R, William L Benoit, and Glenn J Hansen. 2003. “Issue Ownership and Presidential Campaigning, 1952–2000.” Political Science Quarterly 118 (4): 599–626.
Poole, Keith T., and Howard Rosenthal. 2007. Ideology and Congress. Transaction Publishers.
Pope, Jeremy C, and Jonathan Woon. 2009. “Measuring Changes in American Party Reputations, 1939-2004.” Political Research Quarterly 62 (4): 653–61.
Rigby, Elizabeth, and Jake Haselswerdt. 2013. “Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges.” Publius: The Journal of Federalism 43 (3): 368–91.
———. 2017. “Electoral Accountability for State Legislative Roll Calls and Ideological Representation.” American Political Science Review 111 (3): 555–71.
Rose, Shanna. 2015. “Opting in, Opting Out: The Politics of State Medicaid Expansion.” The Forum 13 (1): 63–82.
Shor, Boris. 2018. “Ideology, Party and Opinion: Explaining Individual Legislator ACA Implementation Votes in the States.” State Politics and Policy Quarterly. https://doi.org/https://doi.org/10.1177%2F1532440018786734.
———. 2020. “Two Decades of Polarization in American State Legislatures.”
Shor, Boris, and Nolan McCarty. 2011. “The Ideological Mapping of American Legislatures.” American Political Science Review 105 (3): 530–51.
Starr, Paul. 2008. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. Basic books.
———. 2013. Remedy and Reaction: The Peculiar American Struggle over Health Care Reform. Yale University Press.
Tausanovitch, Chris, and Christopher Warshaw. 2013. “Measuring Constituent Policy Preferences in Congress, State Legislatures, and Cities.” Journal of Politics 75 (2): 330–42.