How States Supported Older Adults and Persons With Disabilities During COVID-19 Through the Medicaid Program

COVID-19 has presented challenges for older adults who receive Medicaid home and community-based services. The federal government has allowed states to seek approval for certain flexibilities to better serve this population, including increasing provider payment rates, allowing family members to be caregivers, and permitting case management entities to provide direct services. This study uses cross-sectional data to identify factors associated with states’ adopting these Medicaid flexibilities using multivariate methods. The results indicate that the factors associated with state adoption varied depending on the flexibility. The findings suggest that states increased provider payment rates in response to prevalence of COVID-19 within their state. As cases increase, states may come under pressure to increase provider rates further which may not be feasible because of budget constraints. The results also suggest that demand for and supply of services may be a factor in whether states allowed family members to be paid caregivers. States with a higher proportion of individuals aged 85 years and older were more likely to permit caregivers to be paid which may suggest that these states may not have enough providers to care for the population. Lastly, the results suggest that provider supply was associated with whether a state allowed case management entities to provide direct care services. States with fewer home health agencies were more likely to allow this flexibility. Based on these results, states may be pursuing available Medicaid flexibilities to address provider and workforce shortages which existed prior to COVID-19 but have been exacerbated by the pandemic.

State Adoption of Nursing Home Immunity From Legal Liability During the COVID-19 Pandemic

Twenty-eight states have provided nursing homes (NHs) with immunity from legal liability related to COVID-19. This study places these provisions in the context of prior actions protecting NHs from legal action and explores factors influencing the adoption of such immunity provisions across states. It uses cross-sectional data to examine patterns of policy adoption and to assess states’ likelihood of adopting immunity provisions using multivariate methods. Variables of interest include information on state political, socioeconomic, programmatic, and COVID-19-related characteristics as well as data on campaign contributions and lobbying activity at the state level. Factors significantly related to NH immunity provision adoption included measures of state fiscal health (unemployment), ideology (percent legislators Democrat), governing capacity (unified government), and NH characteristics (percent not-for-profit, hospital-based, and chain). Population density and Medicaid as a percentage of state general fund expenditures proved significant as well. Against these complex influences, organizations lobbying on behalf of NH residents and their families have found themselves ineffectual in creating avenues for accountability. Results indicate that enforcing accountability for NH deaths during the COVID-19 pandemic is a complex process, constrained by available policy tools and made more complicated by factors external to the NH environment that contributed to high death rates. Historically, the NH industry has been successful in avoiding consequences for poor quality care, a pattern that has persisted in that NHs have generally been successful in avoiding liability for negligence during the COVID-19 pandemic.

Mobilized Yet Contained: Popular Women, Feminisms, and Organizing around Venezuela’s 2012 Organic Labor Law

Venezuela’s state-led national-popular Bolivarian process opened up a new political field for feminism—an approach that was both institutional and popular, aiming to combine forces from above and from below and use state gender institutions to foment popular women’s organization. Yet this field was conflictual, containing contesting popular feminist projects with different implications for the gendered division of labor. Analysis of popular women’s organizing around Venezuela’s 2012 organic labor law shows that state adoption of feminism marked a gendered political opening for popularizing feminism while also presenting risks of state co-optation of popular women’s organizing. The state understood popular women’s organization and mobilization as central to the revolution, yet it generally attempted to limit their autonomy and organizing to challenge the gendered division of labor. El bolivarianismo nacional-popular liderado por el estado venezolano abrió un nuevo campo político para el feminismo: un enfoque que era tanto institucional como popular y cuyo objetivo era combinar fuerzas tanto de arriba como de abajo, así como utilizar las instituciones estatales de género para fomentar las organizaciones populares de mujeres. Sin embargo, este campo resultó conflictivo, y parte de su contenido impugnaba proyectos feministas populares con diferentes implicaciones para las divisiones de género en el trabajo. El análisis de la organización popular de las mujeres en torno a la ley orgánica del trabajo de Venezuela de 2012 muestra que la adopción estatal del feminismo marcó una apertura política de género con intenciones de popularizar el feminismo a la vez que presentaba el riesgo de que la organización popular de las mujeres fuera cooptada por el estado. El estado consideraba la organización y movilización popular de las mujeres como esenciales a la revolución. Sin embargo y hablando generalmente, se abocó a limitar su autonomía y organización cuando se trataba de desafiar las divisiones de género en el trabajo.

Why Studying State Voting Laws Is Not Enough

Early studies of the effects of voter laws on turnout often showed that early voting, absentee, and mail voting had limited impacts on voter turnout, with only same day registration consistently linked to higher turnout. Much of the previous research measured these laws in isolation (although most states have combinations of the laws), omitted measurement of election administration, did not account for possible selection bias in state adoption of the laws, focused on overall voter turnout rather than that for disadvantaged groups, and did not measure the effects of the laws on campaign mobilization strategies. Census data used in previous studies omitted variables (e.g., political interest and partisanship) known to influence voting decisions. Building on research from 2000s and 2010s, Chapter 3 emphasizes how causal inference research design and national voter files can lead to more precise estimations of the effects of convenience voting laws and election administration on voter turnout.

An Environmental Race to the Bottom? “No More Stringent” Laws in the American States

Many American states have adopted laws designed to prevent environmental agencies from regulating pollution emissions more stringently than is required by federal statute. This study leverages variation in the timing and breadth of state adoption of these “No More Stringent” (NMS) laws to examine the claim that interstate competition for mobile capital leads state governments to relax regulatory standards, resulting in an environmental race to the bottom. The results indicate that the diffusion of NMS laws is driven by two forms of interstate economic competition, a policy competition effect that operates primarily among contiguous neighbors and a cost competition effect that operates primarily among a broader set of economic peers. These findings provide new empirical support for the environmental race to the bottom argument, and suggest new challenges for the use of cooperative federalism arrangements that involve state implementation of federal programs.

Deterring Drunk Driving: Why Some States Go Further Than Others in Policy Innovation

Policy innovation and diffusion studies have, since 1990, generally focused on a specific policy over time. Yet, few studies have considered if and why states adopt related multiple policies—a package of reforms—in a policy area. Are more innovative states in DUI policy likely to adopt a comprehensive set of policies or use them as substitutes for each other? In this study, we assess how overall state innovativeness relates to the adoption of sixteen DUI (Driving Under the Influence) laws. We find that state innovativeness in traffic safety policies (but not overall policy innovativeness), organizational size, and professionalism of a state highway department increase the likelihood that a state will adopt a more comprehensive bundle of DUI laws. Furthermore, we also test whether institutional or competitive bandwagon effects are found across this policy area and demonstrate that national institutional bandwagon effects are an important factor related to the increased comprehensiveness of state adoption of DUI policies.

State Preemption of Local Authority: Explaining Patterns of State Adoption of Preemption Measures

State preemption of local policymaking has attracted increasing attention from scholars, public officials, and citizens, as states have prevented local governments from boosting the minimum wage, regulating firearms, and barring certain forms of discrimination, among other policies. Although scholars have examined the legal dimensions of state preemption and analyzed preemption in specific areas, we lack a comprehensive account of which states have adopted preemption laws and why some states are more active than others in adopting them. Using a dataset drawing on preemption legislation in seventeen policy areas, we test support for competing explanations for variation in adoption of state preemption measures. Our general conclusion is that political factors are more significant than institutional features in explaining state preemption activity. More specifically, and consistent with expectations, we find preemption measures are more likely to be adopted by Republican-controlled states. We also find that legislative professionalism, political culture, and home-rule status are correlated with the prevalence of preemption measures.