From a new paper in Health management, Policy and Innovation, by Aaron Chatterji, Siona Listokin, and Jason Snyder:
Studies of health policy often assume that politicians will enact laws based on the preferences of their constituents in order to maximize their reelection prospects. This paper analyzes the determinants of voting in the 111th Congress on the Affordable Health Care for America Act. We find that the percentage of uninsured constituents in a Congressional district has no impact on voting. This result is robust to including a host of demographic control variables. We find that President Obama’s popularity in the district is significantly correlated with support for the bill and explains approximately 50% of the variation in voting. Finally, we find little evidence that campaign contributions are correlated with voting when controlling for the other variables in the model. These findings call into question much of the conventional wisdom about how legislators vote on health policy.
It seems to me that future analyses of the non-group insurance market (exchanges) must control for political factors or risk missing what is now obvious.