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平价医疗法案是否在培养跨阶级的支持者?收入、党派立场以及追溯积极政策反馈效应的偶然性的建议。

Is the Affordable Care Act Cultivating a Cross-Class Constituency? Income, Partisanship, and a Proposal for Tracing the Contingent Nature of Positive Policy Feedback Effects.

机构信息

University of North Carolina at Charlotte.

出版信息

J Health Polit Policy Law. 2018 Feb 1;43(1):19-67. doi: 10.1215/03616878-4249805.

Abstract

Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far. On the other hand, partisanship conditions the relationship between income and beliefs about benefits likely to be derived from the ACA in the long run. In total, the results suggest that cross-class Democratic optimism about long-run benefits may enable the ACA to reap positive beneficiary feedbacks, but a large and bipartisan cross-class constituency appears unlikely. Drawing on these results, this article also makes theoretical contributions to the policy feedback literature by underscoring the need for research on prospections' power in policy feedbacks and proposing a strategy for researchers, policy makers, and public managers to identify where partisanship intervenes in the standard policy feedback logic model, and thereby to better assess how it fragments and conditions positive feedback effects in target populations.

摘要

社会保障和医疗保险在大众中享有强大的政治联盟,因为中产阶级美国人认为他们从这些项目中受益,并与低收入受益人为捍卫这些项目免受侵蚀而站在一起。本文通过汇集来自九个全国代表性调查的数据,研究《平价医疗法案》(ACA)是否正在培养类似的跨阶层选民群体。结果表明,与低收入美国人相比,中等收入美国人表示 ACA 迄今为止对他们个人有帮助的可能性较小。另一方面,党派关系影响了收入与对长期受益的看法之间的关系。总的来说,这些结果表明,跨阶层的民主党人对长期受益的乐观情绪可能使 ACA 能够获得积极的受益反馈,但不太可能出现一个庞大的跨党派的选民群体。本文通过强调需要研究预期在政策反馈中的作用,并提出研究人员、政策制定者和公共管理者的策略,以确定党派在标准政策反馈逻辑模型中的干预点,从而更好地评估它如何在目标人群中分裂和影响积极反馈效果,为政策反馈文献做出了理论贡献。

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