Research Overview

My research on health reform examines the politics and implementation of major coverage expansions in the United States, with particular focus on the Affordable Care Act and earlier state-federal health programs. This work analyzes state responses to federal health reform initiatives through multiple lenses, including partisan politics, federalism, path dependence, and the role of organized interests. By placing the ACA in historical context alongside earlier grant-in-aid programs—from the Sheppard-Towner Act of 1921 through Medicaid's creation in 1965—my research reveals enduring patterns in how states respond to federal health initiatives and how these programs evolve over time.

A central focus examines state decision-making regarding ACA implementation, including Medicaid expansion, insurance marketplace creation, and Pre-existing Condition Insurance Plan programs. Through qualitative and quantitative analyses, I document how partisanship significantly influences state choices, yet I also find that states respond to federal incentives and accommodation in predictable ways. My work identifies recurring characteristics of state-federal grant programs: slow and uneven implementation, wide variation across states, federal accommodation of state resistance, incomplete take-up by eligible individuals, and programs serving as both stepping-stones for further expansion and wedges for political conflict.

My research also examines public opinion formation around health reform and how policy feedback effects shape attitudes. Using large-scale survey data, I investigate how information about specific ACA provisions affects support among different populations, including older Americans and their perceptions of Medicare-related benefits. I analyze how Medicaid expansion influenced public attitudes toward the ACA, examining whether experiencing policy benefits translates into increased support. Additionally, my work explores the role of intense policy demanders—organized interests deeply invested in policy outcomes—in shaping post-reform politics and maintaining support despite sustained opposition. This body of research contributes to broader understanding of how major social policies are enacted, implemented, and sustained in America's federalist system.