“Caregivers and Problem-Solvers:” A Quantitative and Qualitative Assessment of How U.S. State Legislators with Health Professional Backgrounds Influence Health Policy

Abstract

Previous scholarly work establishes that a lawmaker’s professional background impacts their legislative priorities and behaviors. However, in U.S. State Legislatures, the influence of health professional-lawmakers on health-related legislation over an extended period of time has not been established. This thesis sets out to: (1) determine the number of health professional-legislators, physician-legislators, and nurse-legislators serving in U.S. State Legislatures from 2005-2022, (2) quantitatively model the relationship between health-related professional backgrounds and the percentage of health-related legislation introduced at individual and state legislature levels, and (3) understand the motivations and impacts of health professional-legislators serving in 2024 through interviews. Between 2005 and 2022, there was a substantial increase in the number of health professional-legislators, physician-legislators, and nurse-legislators––with the first two groups having statistically significant increases. Furthermore, despite overlaps between the three groups, health professional-legislators, physician-legislators, and nurse-legislators exhibit differing trends in party affiliation as well as gender, racial, religious, and regional identities. At a micro/individual-level, being a health professional-legislator, physician-legislator, or nurse-legislator significantly increases the percentage of health-related bills that they sponsor. At a macro/legislature level, a higher percentage of health professional-legislators, physician-legislators, or nurse-legislators does not significantly correlate with an increased focus on health-related topics in legislation. Based on interviews, health professional-legislators feel as if they have an additional responsibility of identifying and fixing the unintentional impacts in health-related legislation by utilizing their expertise. Contributing to the current literature, these findings reinforce that professional experience affects a state legislator’s work. This assessment also suggests that health professional-legislators may improve the quality of health-related bills; because of these findings, six specific policy recommendations to recruit and retain more health professionals to the U.S. State Legislatures have been proposed.