UC Irvine

This project uses state-level data to answer a variety of questions related to the provision of vital healthcare services as a right of citizenship in a wealthy democracy. I focus on spending for reproductive healthcare policy specifically, which also allows me to explore the tension between state policy as granting women rights to bodily autonomy and state policy as a tool for instilling racialized and gendered norms onto women’s bodies and behaviors. As such, this work as falling at the intersection of politics, health, and inequality and builds on a robust body of literature exploring variation in social protections in industrialized democracies.

In my first empirical chapter, I employ theories of welfare state development to the exploration of variation in Medicaid spending across the United States from 2006-2016. Through several time-series panel regression models, I find general support for functionalist arguments of welfare state development, though these findings are somewhat tempered by the race of those in need. My second chapter focuses on Medicaid spending for family planning services, specifically those related to contraception and sterilization. In this chapter I use OLS regression to compare state variation in spending, as derived from the Guttmacher Institute’s comprehensive survey of reproductive healthcare professionals, at three recent time points. Paying particular attention to the relationship between need for publicly supported contraceptives and spending generosity reveals that states with higher levels of need among White women tend to offer more generous spending, while those with higher need among Black women present the opposite. Similarly, my third chapter compares state policy on public spending for abortion services using two methods: traditional OLS regression and mixed-methods approach called qualitative comparative analysis (QCA).

Taken together, these three chapters support notions of a racialized and gendered welfare state in which state policy differentially mediates access to rights of citizenship. In doing so, this project offers three main contributions to the sociological literature. First, it expands upon the welfare state literature by applying traditional theories to a different form of welfare, reproductive healthcare. Second, it contributes to methodological debates surrounding best practices for small-N studies of comparative welfare states through its use of both regression and QCA. Third, it maintains the importance of applying an intersectional lens to studies of welfare state spending based on results that suggest differential policy responses depending on the race of those in need as well as via its focus on an inherently gendered form of spending, that for reproductive healthcare.