CONTEXT:In June 2022, the Dobbs decision rescinded abortion rights in the US. Did this mobilize women's healthcare providers, whose jobs and patients' health were impacted? We measure mobilization in two ways: 1. Engagement in a physician-led get-out-the-vote (GOTV) drive; and 2. Turnout in the 2022 midterms. METHODS:Using a novel dataset of 6,205 physicians involved in a healthcare-based GOTV campaign and voter file data, we utilize linear probability models, t-tests, and parametric regression discontinuity analysis to show that women's healthcare providers were more politically engaged than physicians in other specialties. FINDINGS:In 2022, the percentage of GOTV participants specializing in women's health increased by 50% and the share of women's health provider participating in the GOTV program spiked by 4.8-6.7 percentage points (p < 0.05). Regarding turnout, 6.4% of women's health providers were first-time midterm voters, compared to 5.7% for other physicians. Overall, women's health providers were 3.3 percentage points more likely to vote (p < 0.05) in the first post-Dobbs election than other physicians. Among Democratic physicians, women's health providers were 6.3 percentage points more likely to vote than others. CONCLUSIONS:Our findings have implications for mobilization research and GOTV strategies by highlighting that individuals directly impacted by policy changes are motivated to engage politically.

Policy Points Researchers investigate how recent elections in the United States have influenced mental health, especially among political- and policy-based election losers. The previous two presidential elections worsened the self-reported mental health of Americans on average. Likely partisan election losers and those who had the most to lose in terms of health policy were even more likely to have their mental health affected by the results of elections. As American politics has become increasingly polarized and the perceived stakes of elections have loomed larger in recent years, elections have become a source of worsening mental health for Americans. CONTEXT:Politics is increasingly important to many Americans. Yet little is known about how the increasing centrality of politics affects Americans' mental health. This work aimed to evaluate how recent polarized elections have influenced Americans' mental health. METHODS:To investigate this question, we compared online search interest in politically related mental health issues and self-reported mental health data. Analyses explored changes before and after election days in 2020 and 2024. The two outcome variables were aggregate Google search interest in politics-related mental health issues and individual responses to the following item from the Behavioral Risk Factor Surveillance System (BRFSS): ''Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? With BRFSS, we compared differential changes for likely Democrats and Republicans using multiple proxy measures and for those with health policy interest in the election. FINDINGS:The 2020 and 2024 presidential elections substantially increased interest in politics-related mental health issues online. The 2020 election led to just under 0.2 additional days of poor mental health (P < .05), and the 2024 election led to just under 0.5 additional days of poorer mental health (P < .05). Likely losing partisans and those who stood to lose out from Trump's reelection in terms of health policy were found to drive most of this relationship, with just under 1 full additional day of poorer mental health for each group. CONCLUSIONS:The stakes of elections in this polarized era of American politics are worsening the mental health of Americans. Additional resources may be necessary to allow therapists and clinicians to navigate additional care-seeking surrounding and following elections.

Scholars have long associated rural residency with gun ownership and conservative gun-related attitudes in the United States. However, less is known about the roots and long-term stability of this relationship. Are individuals who are raised in more rural communities more likely to own firearms even when they move away? Do individuals socialized in rural communities maintain a long-term cultural attachment to guns and distinctive firearms policy attitudes? Scholars disagree about whether current rural residency and childhood rural cultural socialization are independently related to rural gun politics. This article explores for the first time the relative roles of rural childhood socialization, contemporary rural residency, and rural cultural attachments in patterns of gun ownership and firearms policy attitudes. The authors use original survey data as well as the American National Elections Study to explore these questions. They find that individuals socialized in rural communities maintain their attachment to firearms and hold relatively more conservative firearms policy attitudes over their lifespan, even after moving away from rural areas. Rural cultural childhood socialization has an independent influence on the long-run politics of guns.

Policy Points Rural communities have more limited access to medical care and worse health outcomes. Existing federal and state policies largely fall short in addressing rural access disparities. Rural health woes require increased government funding for providers and the embrace of alternative health delivery mechanisms, as well as expanded public-private/nonprofit partnerships to overcome access barriers. CONTEXT:Rural and urban areas have diverged significantly in health care access and health outcomes over the last four decades. Federal and state policies have played important roles in shaping these trends. METHODS:I qualitatively review previous and existing federal and state policies that have shaped contemporary rural-urban health disparities. I review academic literature on recent policy enactments that have shown promise for alleviating some rural health struggles as well as scholarship on how the politics of rural health have stymied better policymaking. FINDINGS:Large scale federal investments (e.g., the Hill-Burton Act) were required to bring modern health care to rural communities in the first place, but inadequate and nonuniversal policies enacted since the 1970s and the increasing corporatization of health care over the last decades have led to withering rural health care access. The recent "One Big Beautiful Bill Act" will likely make these matters worse. Policies that have expanded telehealth and mobile health access, as well as subsidized rural transportation services and changes to public payer reimbursement policies, have provided some optimism. However, the broader politics of rural health limit policy opportunities. CONCLUSION:Rural health has suffered, in part, due to state and federal policy failures. While some incremental changes have certainly shown evidence of potential improvements, a more radical policy agenda may be needed to maintain or improve health care access in rural communities. There is mixed-to-negative evidence regarding whether the political environment will allow for sufficient policy improvements.

How does the threat of adverse policy change influence affected individuals? To answer this question, we explore the responses of gun owners following salient mass shootings and after the election of Democratic presidents. We gather and merge data on the timing and location of mass shootings (2006–2020) and data on the timing of gun purchase background checks from (2006–2020). We exploit the exogenous timing of elections and the resulting determination of future partisan control of the White House over three closely contested presidential elections as well as the timing of mass shootings under a Democratic versus Republican administration. Using regression discontinuity designs, we find that the election and re-election of Barack Obama led to increases in gun sales of 70–210 per 100,000, while the election of Trump was not related to similar increases. Further, we find that salient mass shootings led to substantially higher gun sales during times with Democratic presidents.

PURPOSE:Distance to health service providers is related to increased mortality risk and decreased service utilization. However, existing studies of distance to services often rely either on aggregated measures of distance or small samples of survey respondents. Nationwide individual data from 200 million Americans are used to assess various demographic groups' distances to open acute hospitals. METHODS:We gathered the exact location of every open acute hospital from the UNC Cecil G. Sheps Center and the Department of Health and Human Services. We merged this information with data on 200 million voters from the L2 voter file for 2020. We calculate each registered voters' distance to the nearest open hospital in kilometers by demographic, region, and state Medicaid expansion status. RESULTS:The average American adult is 5 miles from the nearest hospital. Native Americans and rural White Americans face the longest distances to medical services. Lower-income adults face longer distances than higher-income adults. Those over 65 are roughly 10% farther away in comparison to those 18-40. Registered Republicans are 30% farther than registered Democrats. Recent hospital closures in states that have yet to expand Medicaid have contributed to all of these disparities. CONCLUSIONS:Lower-income and older Americans, groups that tend to have worse health overall, face the longest travel distances to hospitals-perhaps contributing to income and age-based health disparities. Native Americans and rural whites, who themselves experience considerable health hardship, also have significant travel burdens to receive hospital care. Registered Republicans have longer travels to emergency care than Democrats, adding to recent research on partisan health disparities.

Political observers have asserted that Democrats have stopped campaigning for rural votes. Despite this refrain, little quantitative evidence has assessed its veracity. We also do not understand the broader electoral implications of these potential geographic changes in party organizing. To explore these questions, we merge two novel data sources on county party organizational capacity with county-level election data and survey data from the CES. Since 2016, the Democratic Party has failed to declare a party chair in about 20% of rural counties and did not field a candidate for Congress in nearly the same, while Republicans filled all but 4% of rural chairships and contested every rural seat. With broader data from Texas, we show even larger percentages of rural counties have uncontested State Senate and House seats. These changes are associated with decreased Democratic vote share in statewide races, turnout, and campaign contact. We estimate that the Democratic Party loses some of the rural vote in statewide elections by failing to organize and compete for it.

Who do citizens hold responsible for outcomes and experiences? Hundreds of rural hospitals have closed or significantly reduced their capacity since just 2010, leaving much of the rural U.S. without access to emergency health care. I use data on rural hospital closures from 2008 to 2020 to explore where and why hospital closures occurred as well as who–if anyone–rural voters held responsible for local closures. Despite closures being over twice as likely to occur in the Republican-controlled states that did not expand Medicaid, closures were associated with reduced support for federal Democrats and the Affordable Care Act following local closures. I show that rural voters who lost hospitals were roughly 5–10 percentage points more likely to vote Republican in subsequent presidential elections. If anything state Republicans seemed to benefit in rural areas from rejecting Medicaid and resulting rural health woes following the passage of the ACA. These results have important implications for population health and political accountability in the U.S.

Despite a long history of physician service in the U.S. Congress, scholars have not yet provided a systematic study of physician members of Congress (PMCs) behavior once elected. Using publicly available data, the authors built a database of all PMCs, including years served, gender, and party affiliation since 1921, merging these data with information on PMC lawmaking activities since 1973. We show that, relative to other members, PMCs are substantially more likely to sponsor and have their health policies passed relative to other members. Further, PMCs are 66% more legislatively effective on health policy matters relative to other members. We show that these health policy effectiveness gains are isolated to health policy making and are not driven by committee assignments or ideological moderation. This work expands on the literatures related to the descriptive and substantive representation of occupational and economic class groupings as well as lawmaking effectiveness.

Abstract Who is this rural voter pundits and politicians are so captivated by? In their important new book, Nicholas Jacobs and Daniel Shea shed light on this important question, offering many new and nuanced insights on The Rural Voter in America. Providing novel and rich survey data on rural Americans from across the entire U.S. Jacobs and Shea dispel harmful stereotypes of rural people and clarify misperceptions often held by those unfamiliar with rural communities, all while providing the most in-depth exploration of rural public opinion to date. The Rural Voter is an essential read for any one wishing to wrestle with the politics of rural communities.

Abstract Federalism allows state politicians opportunities to undermine or support for federal policies. As a result, voters often have varied impressions of the same federal programmes. To test how this dynamic affects voting behaviour, I gather data on the severity of the opioid epidemic from 2006–2016. I exploit discontinuities between states that expanded Medicaid and those that did not to gain causal leverage over whether expansion affected the severity of the epidemic and whether these policy effects affected policy feedback. I show that the decision to expand Medicaid reduced the severity of the opioid epidemic. I also show that expanding Medicaid and subsequent reductions in the severity of the opioid epidemic increased support for the Democratic Party. The results imply that the Republican Party performed better in places where voters did not have access to Medicaid expansion and where the epidemic worsened, demonstrating an unintended consequence of federalism on policy feedback.

AbstractHow do changes in Election Day polling place locations affect voter turnout? We study the behavior of more than 2 million eligible voters across three closely-contested presidential elections (2008–2016) in the swing state of North Carolina. Leveraging within-voter variation in polling place location change over time, we demonstrate that polling place changes reduce Election Day voting on average statewide. However, this effect is almost completely offset by substitution into early voting, suggesting that voters, on average, respond to a change in their polling place by choosing to vote early. While there is heterogeneity in these effects by the distance of the polling place change and the race of the affected voter, the fully offsetting substitution into early voting still obtains. We theorize this is because voters whose polling places change location receive notification mailers, offsetting search costs and priming them to think about the election before election day, driving early voting.

Do local election administrators change precincts and Election Day polling place locations to target voters based on their partisanship or race? We systematically evaluate whether decisions consistent with targeting occur using the near universe of eligible voters, polling place locations, and precinct boundaries across three presidential elections in the closely contested state of North Carolina. We find no evidence that local administrators allocate precincts and polling places in a manner consistent with partisan manipulation for electoral gain. Some counties appear to differentially target opposition party voters with these changes, but the county-level variation we document is likely due to random variation rather than deliberate manipulation. There is also little evidence that the removal of minority voter protections inShelby County v. Holderimpacted polling place placement. If partisan-motivated precinct or polling place decisions occur in North Carolina, they are seemingly more idiosyncratic than pervasive.

Although the majority of research on revolving-door lobbyists centers on the influence they exercise during their postgovernment careers, relatively little attention is given to whether future career concerns affect the behaviors of revolving-door lobbyists while they still work in government. We argue that the revolving-door incentivizes congressional staffers to showcase their legislative skills to the lobbying market in ways that affect policymaking in Congress. Using comprehensive data on congressional staffers, we find that employing staffers who later become lobbyists is associated with higher legislative productivity for members of Congress, especially in staffers’ final terms in Congress. It also is associated with increases in a member’s bill sponsorship in the areas of health and commerce, the topics most frequently addressed by clients in the lobbying industry, as well as granting more access to lobbying firms. These results provide the systematic empirical evidence of pre-exit effects of the revolving-door among congressional staff.

Can "urban-centric" local television news coverage of the COVID-19 pandemic affect the behavior of rural residents with lived experiences so different from their "local" news coverage? Leveraging quasi-random geographic variation in media markets for 771 matched rural counties, we show that rural residents are more likely to practice social distancing if they live in a media market that is more impacted by COVID-19. Individual-level survey responses from residents of these counties confirm county-level behavioral differences and help attribute the differences we identify to differences in local television news coverage-self-reported differences only exist among respondents who prefer watching local news, and there are no differences in media usage or consumption across media markets. Although important for showing the ability of local television news to affect behavior despite urban-rural differences, the media-related effects we identify are at most half the size of the differences related to partisan differences.

While the majority of research on revolving-door lobbyists centers around the disproportionate amount of influence they exhibit during their post-government careers, relatively little attention is given to questions of whether future career concerns affect the behaviors of revolving-door lobbyists while they are still working in the government. Using comprehensive data about congressional staffers, we find that hiring staff who become lobbyists in the future is associated with higher Legislative Effectiveness Scores. We find that congressional offices sponsor more legislation in the areas of health and commerce, but less in law and crime, social welfare, and government operations after hiring staffers who later became lobbyists. We also find that hiring a future revolving-door staffer is associated with granting more access to lobbying firms. All of these results are most consistently observed for lower-level personal staff. ∗We are grateful for comments from Scott Ainsworth, James Curry, participants at Graham Symposium at Vanderbilt University, panelists at the 2017 Midwest Political Science Association Annual Meeting, and seminar participants at Columbia University American Politics Workshop. We also thank Craig Volden and Alan Wiseman for sharing the Legislative Effectiveness Score data with us. †Ph.D. Student, Department of Political Science, Vanderbilt University, Nashville, TN 37203. Email: michael.e.shepherd@vanderbilt.edu ‡Assistant Professor, Wilf Family Department of Politics, New York University, New York, NY 10012. Email: hyou@nyu.edu