Female & black legislators more likely than others to prioritize children's health

07/14/04

ANN ARBOR, Mich. -- When it comes to new proposals to protect children's health at the state level, women and African Americans serving in legislatures are far more likely than other legislators to put forth new bills -- but the issue doesn't appear to rank high on legislatures' overall priority list, a new study finds.

In an exhaustive analysis of more than 9,800 bills introduced in three states over a two-year period, researchers from the University of Michigan Health System, the U-M C.S. Mott Children's Hospital and the U-M Ford School of Public Policy find that a tiny percentage -- two-thirds of one percent -- pertained to children's health.

That's only 11 percent of all health bills, even though children's medical issues often involve important preventive measures, as well as bills related to the Medicaid and State Children's Health Insurance Program (SCHIP) services that make up a large part of state budgets. The paper is in the July-August issue of Ambulatory Pediatrics.

Women legislators were more than twice as likely as their male counterparts to sponsor child health bills. Their proposals made up 37 percent of all child health bills while their total number of proposals made up 16 percent of all bills introduced.

Members of the Black Caucus in each state legislature also were more likely than non-Caucus legislators to put forth children's health legislation. There was no significant difference between legislators of the two major political parties.

But when the researchers looked at the bills introduced by senior legislators of any gender or race who had risen to committee chair positions, they found an opposite trend: a far lower percentage of bills introduced by chairs pertained to child health when compared with the bills introduced by non-chairs.

And when they looked at what child health bills actually passed in the legislature and and received the governor's signature, the only factor that seemed to matter was the overall pattern of bill passage in the particular state where the bill was introduced. States that enacted more legislation overall were more likely to enact proposed legislation related to children's health.

"States have a great deal of power in children's health issues, including discretion over the Medicaid and SCHIP health programs for disadvantaged and disabled children, and we wanted to look at just how legislation on these matters develops," says lead author Matthew Davis, M.D., M.A.P.P. "Children's health care may not be as expensive as other priorities facing legislatures, but there is great opportunity to protect children through state action. Still, it appears this issue receives low priority."

Davis, an assistant professor of both pediatrics and public policy, led the project with Ford School graduate student Amy Upston, M.P.P.

Together, they pored over and classified thousands of bills from 1997 and 1998 from the state legislatures of Michigan, Colorado and Louisiana, downloaded from state legislation web sites.

Their study built on previous work by other researchers that found women legislators are more likely to put forth bills regarding health in general, and African-American legislators are more likely to introduce bills related to welfare and education policy. But no study had looked at child health bills.

Overall, Davis and Upston found that health bills of any kind comprised 6.2 percent of all bills introduced in three states, and that health bills were among the top five categories of bills introduced in Colorado and Michigan. But in every state, child health bills were a small percentage of all health bills. In all, of the 9,833 bills studied, 65 were classified as pertaining to child health.

Those bills addressed issues ranging from expansion of Medicaid and SCHIP, to mandating coverage for a minimum hospital stay after birth, to requiring health insurers to cover certain vaccines. Lead poisoning screening, help for pregnant smokers, and bans on distribution of information on abortion and contraception at school health centers were also proposed.

Davis notes that many of the bills pertained to Medicaid and SCHIP, both of which are co-financed by the federal government and states but whose administration is largely left up to states. Nationally, about 50 percent of Medicaid enrollees are children, but they account for only about 16 percent of Medicaid costs.

Many of these bills never made it into law, but may have been introduced by legislators to "signal" to their constituents that they were advocating a particular position, or to distinguish themselves from potential opponents.

Those bills that did make it all the way to law appear to have done so largely because of prevailing passage trends in the broader legislature. In Colorado, 72 percent of child health bills introduced were passed, but the state also had a high rate of passage for all bills, nearly 53 percent. By contrast, in Louisiana, 21 percent of child health bills became law, compared with 35 percent of all bills. And in Michigan, where only 4 percent of child health bills became law, the legislature at the time passed only 20 percent of all bills.

"All three of these states had a mix of parties in control of the legislature and the governor's office at the time of the study, which likely played a part in passage rates," Davis explains. "We hope to conduct another analysis from the current decade, to see if shifts in control, and in the racial and gender makeup of the legislature, make a difference in child health bill introduction and passage."

It will be interesting to see if the trends from the current study continue as more women and African-Americans are elected to state legislatures, and achieve greater seniority and a larger role in committee leadership, Davis adds. He hopes to continue the study and expand it to more states.

In fact, he notes, health issues that once may have allowed these candidates to distinguish themselves from election opponents might in fact decrease in importance as those opponents are increasingly likely to be female or African-American themselves.

The study was also performed using bills from relatively good economic times; it would be interesting to see how children's health policy has fared since the economic downturn, which has pressured many states to cut Medicaid and SCHIP spending.

"In general, legislators and those running for election recognize that initiatives for children's health are seen as positive by the electorate, and voters care about what legislators are doing to protect children's health and well-being," he says. "While the overall cost of children's health is modest and one might think the impact of cutting those benefits might not be great, it's those kids enrolled in state programs who are at greatest risk if they're uninsured or programs aren't in place to prevent disease or injury."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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