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

Massachusetts Institute Of Technology, Cambridge MA

Investigators

Abstract

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.