National Health Care and Presidential Conviction, Savviness, and Popularity: An Analysis of Presidential Identity and Health Care Legislative Outcomes in the United States from 1977-2020

Does presidential popularity guarantee legislative success? How does it impact the enactment of progressive nationalized health care legislation? The answer to the first question appears, at varying degrees, to be yes. The answer to the second is still contested. Demand for state-sponsored health insurance from the working class has been constant since the late nineteenth century, yet policy change has been largely unresponsive. This thesis explores the factors that stunt presidential attempts to expand, reform, or repeal national health care programs. First, I will compare the presidential rhetoric of each president of interest, in order to assess the extent to which spoken references to health care correlate with the success or failure of the administration’s health care goals. Second, this thesis seeks to establish that presidential savviness, with respect to pre-presidential professional experiences and health care prioritization, affects each president’s path to securing health care reform. Lastly, I will analyze the extent to which public opinion on presidential favorability has an impact on the outcomes of health care legislation introduced in Congress. To examine these questions, I first analyze presidential remarks—including Inaugural and State of the Union Addresses, party nomination acceptance speeches, legislation signing statements, and public addresses—to assign Conviction Scores to each president of interest. Through constructing two word banks composed of health care vernacular, the scores will allow for a quantitative comparison between each president with respect to their verbal conviction toward passing national health care reform. Next, I conduct a qualitative analysis of each president’s pre-presidential professional experiences and savviness in taking advantage of policy windows, to delve into the nuances of each administration’s struggles with health care. Lastly, employ a simple linear regression in RStudio comparing the outcomes of over 31,000 pieces of health care legislation with each president’s approval ratings throughout their tenure in office. I find that, when accounting for congressional composition and isolating individual presidencies, health care legislation has a higher likelihood of passing at times of higher presidential popularity, but that there does not appear to be a significant relationship between approval ratings and legislative outcomes writ large