Do Policies Shape Mass Politics? The Impact of Medicare Reform on Senior Citizens' Attitudes and Political Participation

2003年的《医疗保险现代化法案》是自1965年颁布以来针对老年人的医疗保险医疗保健计划的最大规模扩展。 这项立法为老年人引入了一项新的处方药福利，并在很大程度上改变了医疗保险计划的设计。 本项目将研究这些设计变化对老年人的态度和政治活动的影响。 政治学的一个新的分支研究“政策反馈效应”，即公共政策如何塑造公众的利益和政治行为。 这一分支研究公共政策的后果、目标、规模和范围以及管理如何影响服务对象群体和广大民众的态度和政治行为。 这些态度和行为反过来又会影响随后的政策制定过程。虽然值得称赞，但现有的研究大多基于一次性的横截面调查，这限制了可以得出的关于公共政策对个人态度和行为的影响的结论。 本研究克服了这一缺点，小组研究经历了重大变化的程序设计：老年人和2003年的医疗保险现代化法案（MMA）。 该项目将把调查人员在2005年12月执行综合管理评估前夕进行的基线调查变成一个小组调查。 也就是说，基线调查中的同一个人将在实施后大约15个月和27个月再次接受调查，以评估他们的态度和行为是否以及如何随着医疗保险的新设计而改变。 具体而言，本研究将研究是否注册在MMA的一个或两个市场导向的方面改变有关医疗保险的政治活动的可能性，无论是增加老年人的政治参与，因为他们推动改善MMA，或减少它，如果他们认为，政府在他们的医疗保健的作用减少，感觉政治参与不再是一个相关的路径对他们的影响。 本研究还将探讨是否在这些新的方面的医疗保险的注册影响的政治效能感，老年群体意识，对政府的取向，投票选择，以及对两个政党的看法，无论是在一般和作为决策者的医疗保险。该项目不仅提出了一个重大的进展，为学术文献的政策反馈效应，但它也将有助于未来对美国最大的公共项目之一的辩论。 通过研究老年人在医疗保险这一高度重要的改革下的表现，这项研究将有助于立法者和其他政策参与者继续改革该计划，并解决这一弱势群体的需求。

The Medicare Modernization Act of 2003 is the largest expansion of the Medicare health care program for senior citizens since its enactment in 1965. The legislation introduces a new prescription drug benefit for senior citizens and changes the design of the Medicare program in significant ways. This project will examine the effects of these design changes upon senior citizens' attitudes and political activity. A new branch of research in political science explores "policy feedback effects," or the ways in which public policies shape the interests and political behavior of the public. This branch of research examines how the consequences, the targets, the size and scope, and the administration of public policies may shape the attitudes and political behavior of both client groups and the larger population. These attitudes and behaviors, in turn, influence subsequent policymaking processes. While laudable, existing studies are based mostly on one-time-only cross-sectional surveys, which limit the conclusions that can be drawn about the effects of public policies upon individuals' attitudes and behaviors. This study overcomes this shortcoming with a panel study of a group experiencing significant change in program design: senior citizens and the Medicare Modernization Act of 2003 (MMA). This project will turn a baseline survey that the investigators conducted in December 2005, on the eve of MMA implementation, into a panel. That is, the same individuals from the baseline survey will be surveyed again, roughly 15 and 27 months after implementation, to assess if and how their attitudes and behaviors have changed with the new design of Medicare. Specifically, this research will study whether enrollment in one or both market-oriented aspects of the MMA changes the likelihood of political activity concerning Medicare, either increasing seniors' political participation as they push to improve the MMA, or decreasing it, if they perceive that the role of government in their health care is diminished and feel political participation no longer a relevant path of influence for them. The research will also examine whether or not enrollment in these new aspects of Medicare influences feelings of political efficacy, elderly group consciousness, orientations toward government, vote choice, and regard for the two political parties, both in general and as decision-makers on Medicare.This project not only presents a significant advance for the scholarly literature on policy feedback effects, but it will also contribute to future debates on one of the largest public programs in the United States. By examining how senior citizens have fared under this highly consequential reform of Medicare, this study will help lawmakers and other policy actors as they continue to reform the program and address the needs of this vulnerable population.