The Political Economy of Health Care: State Policy Liberalism and the Distribution and Diversity of the U.S. Health Care Workforce, 1960–2019

Abstract

A burgeoning literature links state policies to health care access/use, yet little research has explored whether state policies relate to the distribution of health care itself. Drawing on census microdata and state policy data from 1960 to 2019, I investigate whether state policy liberalism shapes workforce availability and diversity. First, I find that states in New England and the Middle Atlantic have persistently benefited from larger workforces compared to those in the East South Central and Pacific, with Black and foreign-born workers disproportionately represented in “workforce disadvantaged” states. Second, I show that an increase in policy liberalism is associated with reductions in states’ total health care, physician, and nursing workforces; Black and foreign-born physician and nursing workforces; and foreign-born medical assistant/health aide workforces. Taking a political economy approach toward understanding the (mal)distribution of U.S. health care sheds light on a “two-tiered” system that both reflects and reifies existing geographic inequities in population health.