About

Eric M. Patashnik is the Julis-Rabinowitz Professor of Public Policy and Professor of Political Science at Brown University, where he also serves as the Director of the A. Alfred Taubman Center for American Politics and Policy. He is a Nonresident Senior Fellow at the Brookings Institution and a fellow of the National Academy of Public Administration. Patashnik has held faculty positions at the University of Virginia, UCLA, and Yale University. His research focuses on the politics of policymaking, health policy, fiscal politics, policy reform, implementation, and the welfare state. He has authored and edited several books, including 'Countermobilization: Policy Feedback and Backlash in a Polarized Age' (2023), 'Unhealthy Politics: The Battle over Evidence-Based Medicine' (2017), 'Reforms at Risk' (2008), and 'Putting Trust in the US Budget' (2000). His articles have been published in leading journals such as Perspectives on Politics, Journal of Politics, and Health Affairs. Patashnik has received awards including the Louis Brownlow Book Award and the Don K. Price Book Award. He has served as president of the Public Policy Section of the American Political Science Association, editor of the Journal of Health Politics, Policy and Law, and held various administrative roles at Brown and the University of Virginia. He earned his Ph.D. from the University of California, Berkeley.

Research topics

• Political Science
• Business
• Law
• Psychology
• Sociology
• Economics
• Computer Science
• Public economics
• Nursing
• Medicine
• Chemistry
• Accounting
• Public administration

Selected publications

• After Defeat: Conservative Postenactment Opposition to the ACA in Historical-Institutional Perspective

  UNC Libraries · 2025-09-06

  articleOpen accessSenior author

  Since the enactment of the Affordable Care Act (ACA) in 2010, conservatives have sought to undermine the law's entrenchment. While they have failed in their ambitious quest to repeal the ACA, opponents have succeeded in overturning one major provision (the individual mandate penalty), narrowing the law's reach, complicating its implementation, and fomenting doubts about its political sustainability. This essay places the postenactment battle over the ACA in historical-institutional perspective by juxtaposing the strategic choices that conservatives have made to limit the role of the federal government in the core social welfare areas of pensions and health since the New Deal. Our central argument is that conservatives' varying strategies of postenactment opposition, resistance, and accommodation for Social Security, Medicare, Medicaid, and the ACA have been shaped by shifts in conservative ideology, changes in control of institutional resources, and the nature of policy feedback. Attention to these contextual factors helps explain why ACA opponents viewed the law as a threat despite its moderate policy design, why opposition did not subside after the law's enactment, and how conservatives managed to keep the conflict going across multiple election cycles.

  PublisherDOI

• Introduction: Medicaid at 60

  Journal of Health Politics Policy and Law · 2024-09-27

  article1st authorCorresponding
  PublisherDOI

• Affluence and the Demand-side for Policy Improvements: Exploring Elite Beliefs About Vulnerability to Societal Problems

  The Forum · 2024-04-01

  articleSenior author

  Abstract An important stylized fact about American government is that many societal problems persist despite expert recognition that better outcomes are technically feasible. What explains the weakness of the political demand for more effective public policies? This study investigates one factor that may contribute to the attenuated demand for policy improvements: namely, the belief among many affluent citizens that they are personally insulated from societal problems. Drawing on a national public opinion survey, we show that affluent Americans believe their resources and ability to activate powerful social networks affords them a measure of personal insulation from key problems in areas such as education, healthcare and neighborhood safety. We also find that the affluent express a more optimistic view than other respondents of the average citizen’s financial situation and capacity to manage problems in several domains. Taken together, our results have important implications for understanding how highly influential Americans think about public policy in an era of inequality.

  PublisherDOI

• Countermobilization

  2023-01-01 · 34 citations

  book1st authorCorresponding
  PublisherDOI

• Polarization, the Pandemic, and Public Trust in Health System Actors

  Journal of Health Politics Policy and Law · 2023 · 14 citations

  Senior authorCorresponding
  • Political Science
  • Political Science
  • Business

  CONTEXT: Public opinion on the performance of health system actors is polarized today, but it remains unclear which actors enjoy the most or the least trust among Democrats and Republicans, whether the COVID-19 pandemic has influenced how people view their own physicians, and whether doctors have retained the ability to influence public beliefs about policy issues. METHODS: The authors conducted two national surveys in 2022 and 2023 to examine these questions. FINDINGS: Democrats rated the performance of medical research scientists and public health experts during the pandemic more highly than did Republicans and independents. About three in ten Republicans said the pandemic decreased their trust in their personal doctors. Nonetheless, most Americans reported confidence in physicians. The authors replicated the findings of Gerber and colleagues (2014) to demonstrate that respondents continued to have more positive views of doctors than other professionals and that public opinion was responsive to cues from a doctors' group. CONCLUSIONS: What polarizes Democrats and Republicans today is not the question of whether medical scientists and public health experts are competent but whether the advice offered by these actors is in the public interest and should guide policy makers' decisions. Democrats strongly believe the answer to these questions is yes, while Republicans exhibit skepticism.

  PublisherOA PDFDOI

• Introduction: Entrenchment and Health Equity

  Journal of Health Politics Policy and Law · 2022-09-27

  article1st authorCorresponding

  Introduction| September 27 2022 Introduction: Entrenchment and Health Equity Eric M. Patashnik Eric M. Patashnik Brown University Eric M. Patashnik is Julis-Rabinowitz Professor of Public Policy, professor of political science, and chair of the Department of Political Science at Brown University. Patashnik is also a nonresident senior fellow at the Brookings Institution and a fellow of the National Academy of Public Administration. Patashnik is the author and editor of several books including Unhealthy Politics: The Battle over Evidence-Based Medicine (with Alan Gerber and Conor Dowling, Princeton University Press, 2017) and Reforms at Risk: What Happens After Major Policy Changes Are Enacted (Princeton University Press, 2008). He has served as president of the Public Policy Section of the American Political Science Association and is a former editor of Journal of Health Politics, Policy and Law.eric_patashnik@brown.edu Search for other works by this author on: This Site Google J Health Polit Policy Law 10234128. https://doi.org/10.1215/03616878-10234128 Cite Icon Cite Share Icon Share Facebook Twitter LinkedIn MailTo Permissions Search Site Citation Eric M. Patashnik; Introduction: Entrenchment and Health Equity. J Health Polit Policy Law 2022; 10234128. doi: https://doi.org/10.1215/03616878-10234128 Download citation file: Zotero Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search Books & JournalsAll JournalsJournal of Health Politics, Policy and Law Search Advanced Search The text of this article is only available as a PDF. Copyright © 2022 by Duke University Press2022 Article PDF first page preview Close Modal Issue Section: Introduction You do not currently have access to this content.

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• Entrenchment and Health Equity: Lessons for Advocates, Policy Makers, and Researchers

  Journal of Health Politics Policy and Law · 2022-09-27

  article1st authorCorresponding

  In his book Entrenchment, Paul Starr (2019: xii) writes: A society's entrenched features—the foundational features that are hardest to change—shape what kind of society it is. They establish its moral and political character and influence its economic performance. They have often arisen through great struggles and may later become the subject of high-stakes conflict. Whether we want to preserve those entrenched realities or entrench new ones, we need to understand entrenchment itself.Examining the implications of entrenchment for health equity and policy is the focus of this special issue. Though the six articles presented here range widely in their substantive foci, they circle around a number of core questions. Why should advocates, policy makers, and scholars care about entrenchment? How is entrenchment politics shaping the prospects for robust government action to promote population health and better outcomes for marginalized communities? What reforms must be successfully embedded if government is to possess the capacity to meet the challenges of the 21st century? Finally, what strategies can advocates and policy makers use to reduce the burdens of pathological forms of entrenchment on society? In this brief concluding article, I draw out five key lessons of the articles.Entrenchment is a matter of degree, not kind (Starr 2019: 3). But this special issue focuses on those laws, policies, or norms that are both significant and very difficult to alter. These constitutive features of society have profound effects on the distribution of public goods, such as access to health care services, public education, and clean air.As Jessica Trounstine and Sidra Goldman-Meller argue in their article, patterns of residential segregation are among the most important entrenched features of American social and political life. For more than a century, white Americans have used a variety of formal and informal mechanisms to create and maintain segregated neighborhoods. Even after courts ruled racially explicit zoning to be unconstitutional, policies that are ostensibly racially neutral, such as growth controls, restrictions on multifamily housing, and mortgage lending patterns, have perpetuated inherited patterns of segregation. An extensive body of research shows that residential segregation is linked to negative outcomes for marginalized communities, including poor health outcomes and a lack of access to public services. Trounstine and Goldman-Meller focus on the relationship between segregation and racial disparities in COVID-19 outcomes. They show empirically that COVID-19 infection rates were higher in counties where racial minorities live in more isolated neighborhoods, and that the spread of COVID was even worse in segregated areas with high proportions of front-line workers. Their findings suggest that the “devasting outcomes of the coronavirus pandemic were linked to a long history of racial marginalization and entrenched discrimination produced by structural inequalities embedded in our geographies.” While additional research is needed to determine whether these results are causal, their findings have important implications for policy makers, advocates, and researchers who seek to understand and mitigate inequities in the health care system.When a group can find common ground with its rivals, it is likely to accept that conflicts will be settled by ordinary politics. When ideological disagreement grows, however, groups gain an incentive to make their policies as irreversible as possible through entrenchment, especially when groups believe their power may decline in the future (Starr 2019: 187). One area where polarized battles over entrenchment are playing out today is state preemption of local housing policies. Some legislatures are removing the authority of more liberal or progressive cities to enact local policies intended to address housing inequities, such as rent control and inclusionary zoning. Based on participant observation and in-depth interviews with tenant organizations, Jamila Michener shows that state preemption of housing policy often has a detrimental impact on grassroots democracy. Preemption can limit the menu of policy options, make it more difficult for advocacy organizations to build power, and constrain the ability of marginalized communities to shape the outcomes that directly affect their lives.As Michener acknowledges, there is nothing intrinsic in state preemption that requires it to amplify inequities. States can also use preemption to constrain the power of special interests and limit the authority of localities to enact discriminatory or inegalitarian policies. For example, the California Housing Crisis Act of 2019 curtails the ability of local governments to delay new housing approvals or enact moratoriums on new housing construction. The key issue is whether preemption-based entrenchment is used to make policy more responsive to the public and marginalized groups—or more responsive to elites and powerful interests. As Michener writes, “Whether entrenchment via preemption offers democratic promise or peril is contingent. That is why scholars must assess preemption in relation to specific policy domains, contexts, and institutions.”While markets are often thought to arise spontaneously, the reality is that markets are institutions. Property rights, the rules governing which products are allowed to be bought and sold, and many other aspects of market exchange are structured by public policy (Vogel 2018). Regulations are often necessary to make markets function efficiently, especially when markets are subject to imperfect information and high uncertainty, as is true with respect to the provision and financing of medical care (Arrow 1963). Yet the regulations that govern contemporary markets are shaped by the decisions of legislators, bureaucrats, and judges, and thus arise from power struggles. As a result, market regulations may not always advance the public interest or respond to the needs of vulnerable constituencies. Whether market rules promote consumer welfare, innovation, and other desirable goals, or simply entrench the power of privileged interests, requires close scrutiny.Amy Kapczynski argues that the pharmaceutical industry uses its entrenched power to amass large profits in the United States, despite concerns that drugs are unaffordable for many patients and too often fail to produce medical benefits commensurate with their costs. One of the key mechanisms of entrenchment she identifies is “property power,” including the right to exercise exclusive control over various types of information through intellectual property and trade secrecy protections. While the Food and Drug Administration (FDA) remains one of the most powerful regulatory agencies in the world, its gatekeeping power to determine which products drug companies can market has diminished over time. The FDA is increasingly approving drugs on the basis of surrogate endpoints and less rigorous trial designs, in response to pressure from the industry, industry-supported patient groups, and conservative think tanks.To be sure, the pharmaceutical industry's power is not unlimited. It suffered a historic defeat in the Inflation Reduction Act of 2022. For the first time, Congress gave Medicare the authority to negotiate drug prices—a step the industry fiercely opposed. But the price negotiation authority in the final bill is much narrower “than earlier versions, which would have extended negotiations to more drugs and included private insurance plans. The bill would enable only Medicare to negotiate prices beginning in 2026, initially for just 10 drugs” (Allen 2022). As Kapczynski notes, the pharmaceutical industry has not accepted that this defeat is a permanent one and is threatening to use litigation and other tactics to block the law's implementation. It remains to be seen whether the recent relatively modest Medicare reform will endure and build momentum for the passage of stronger drug price control measures in future years—or instead serve as a symbol of Congress's inability to break through the industry's entrenched power.Market rules also govern who is permitted to provide health care services. It is common for governments to bar people with criminal records from entering professions that require an occupational license, including not only medicine but also allied health professions. While such restrictions are an understandable way to protect the interests of patients, they can have a disparate impact on workers from minority groups, who are more likely to have had contract with the criminal justice system. In their article, Jing Liu and David A. Hyman examine how 12 states handle applicants with criminal records for five health-related jobs: dental hygienist, occupational therapy assistant, physical therapy assistant, radiologic technologist, and respiratory therapist. They find that most states treat criminal convictions as a basis for disqualification. Of greater concern, some states frame licensing restrictions in “ambiguous and expansive terms, such as limiting entry to those of ‘good moral character.’” Liu and Hyman argue that the lack of clarity about who is eligible for a license generates uncertainty and likely deters people with criminal records from pursuing career opportunities for which they may be suited, reinforcing racial inequities in the labor market. The implication is not that all occupational licensing rules should be eliminated, but rather that such regulations can have both positive and negative consequences, which policy makers should weigh carefully.There are several district mechanisms of entrenchment. The most familiar involve designing institutions to channel subsequent change, creating facts on the ground and generating increasing returns and political lock-in (Starr 2019). But entrenchment can also involve the embedding of collective beliefs. As Starr (4) argues: “A test for the entrenchment of a belief system is whether it continues to prevail despite contradictory evidence, dissonant experience, and social pressure for revision.” Several of the authors in this special issue explore how embedded beliefs anchor social practices and impose barriers to fundamental change. For example, Kapczynski argues that the pharmaceutical industry's clout in Washington reflects not only its material power but also a long-standing belief that the pharmaceutical industry will reduce drug innovation if government seeks to lower drug prices. Whether this argument remains persuasive to policy makers and the public will be tested in the coming years as the pharmaceutical industry seeks to reverse the recent Medicare drug pricing reform before the government's new negotiation authority is consolidated.At times, the embedded beliefs that channel policy change take the form of “institutional narratives.” As Carolyn Tuohy argues, institutional narratives “constitute the core discourse through which the understanding of purpose within institutions is developed, conveyed, and internalized by members of the institution over time.” Using legislative debates, interviews, and other sources to trace the narratives associated with the British National Health Service (NHS) and the Medicare and Medicaid programs in the United States from the founding of each institution, Tuohy demonstrates that the ideas and values embedded in narratives help account for the persistence of the single-payer structure of the NHS as well as for the divergent trajectories of Medicare and Medicaid. The broader lesson is that policy makers and advocates who seek to build durable programs should focus not only on the harnessing of material interests but also on the cultivation of narratives to imbue programs with cultural integrity and meaning.A pathological form of entrenchment arises when the policy status quo is widely recognized as being dysfunctional yet is nonetheless very resistant to change. In his article, Paul Starr analyzes the causes and remedies of such “policy traps.” Starr argues that policies can generate massive costs for society and be inferior to technically feasible alternatives yet still generate sufficient political support to endure over the long run. While the persistence of policy traps might appear puzzling, Starr argues that the normal operation of democratic politics does not guarantee that needed reforms will be adopted. Institutional veto points can block large-scale change. In addition, concentrated interests hold advantages over diffuse publics, the electoral system contains biases that may give more weight to some constituencies than others, and citizens may resist change for ideological or other reasons, even when they believe the status quo is broken.But the situation is far from hopeless. Starr argues that reformers can use four generic strategies for overcoming policy traps: Schumpeterian innovation (leveraging new technology or organizational forms to bring about institutional change), globally oriented innovation (importing other nations' policies or using international negotiations to effect change), institutional conversion (repurposing or scaling up existing structures), and social creativity (introducing new institutions in government or civil society). Starr explains how each of these generic strategies works, and he applies his insights to three policy traps: our dependence on fossil fuels (a major contributor to global warming), the internet economy (which has generated online monopoly power and threatens democratic values), and the US health care system (which has high costs and inferior performance).Starr's penetrating analysis offers several broad lessons for reformers. First, reformers need to have a viable theory of social and political change. It is not sufficient to identify a policy trap or even to articulate a reform goal. Reformers need to understand how to get from where they are to where they want to go. Second, reformers need to be flexible, pragmatic, and problem-focused. Rather than organizing around a specific solution, which may prove inadequate as conditions change, it is better to keep the focus on the underlying social pathologies. Starr's analysis shows that there are multiple strategies for breaking through policy traps. Under some circumstances, economic incentives may do the heavy lifting, but in other cases we will need to rely on technological shifts, cross-national learning, or the recasting of existing institutions. Rather than privileging one strategy from the outset, it will often be more productive to maintain an open mind about where breakthrough solutions will come from. In addition, reformers should recognize that change can be a self-reinforcing process. Small changes can build momentum for larger ones by establishing precedents, altering the menu of solutions, and creating a new politics. Reformers should strive to craft generative reforms that serve as a springboard for further progress.Third, reformers should aim not only to build a coalition for positive change but also to weaken and fragment defenders of the status quo. The recent adoption of a fee on fugitive methane emissions (contained in the Inflation Reduction Act) illustrates this idea. Oil and gas producers vary enormously in the amount of methane emissions they generate (Gordon 2021). While some of the largest industry players oppose the methane tax, others companies have indicated they can live with the proposal, in part because they have already taken steps to reduce their emissions (Ferek and Morenne 2022). In sum, the methane tax is making it harder for defenders of the fossil fuel status quo to maintain a unified position. The more policy makers can split apart fossil fuel interests, the less likely there will be an industrywide backlash against efforts to mitigate climate change.Finally, reformers need long time horizons. We will be dealing with policy traps in the areas of health care, climate change, and the internet for the foreseeable future. Reformers need to be in the fight for the long haul, especially because concentrated interests that are defeated in one round of policy making can return to fight again in the next (Patashnik 2008).

  PublisherDOI

• Backlash Politics in America's Disunited and Polarized State

  Studies in American Political Development · 2022-08-04 · 16 citations

  articleOpen access1st authorCorresponding

  Abstract The policy feedback literature developed in an era in which the level of polarization and the intensity of party competition were far lower than today. These background conditions narrowed the scope of many policy debates and facilitated the consolidation of programmatic expansions after their enactment. As a result, the feedback literature emphasized the ways that new policies build supportive constituencies and become entrenched. While the core insight that policies can generate major political repercussions remains solid, American political development (APD) scholars should pay greater attention to the role of negative feedback processes and backlash politics in an era of disunity. Based on a review of New York Times articles mentioning policy backlash between 1960 and 2019, I show that the 2010s was a period of heightened countermobilization. Backlash forces have diffused from civil rights into many other arenas—including health, trade, and immigration—due to partisan polarization, conflicts over cultural shifts, and the negative feedback from activist government itself.

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• How Voters Use Contextual Information to Reward and Punish: Credit Claiming, Legislative Performance, and Democratic Accountability

  Harvard Dataverse · 2021-01-19

  datasetOpen access1st authorCorresponding

  Some studies have found that constituents do not evaluate legislators more favorably for claiming credit for delivering large grants than for claiming credit for delivering tiny ones. It remains unclear, however, whether the lack of sensitivity to the amount of money claimed reflects innumeracy or the difficulty that many people have understanding the size of a government expenditure in the abstract. We perform a survey experiment in which we give respondents information about both the absolute and relative size of projects. We find that subjects evaluate legislators significantly more favorably for claiming credit for relatively large projects. Our results suggest that subjects are responsive to the magnitudes in claims of accomplishment, but only when provided a benchmark. We also find evidence of an asymmetric effect; subjects are more inclined to punish legislators for delivering grants of below average size than to reward them for delivering grants of above average size

  PublisherDOI

• Conclusion:

  University Press of Kansas eBooks · 2021-04-21

  book-chapter1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Alan S. Gerber

  Yale University

  45 shared

• Conor M. Dowling

  32 shared

• Justin Peck

  Wesleyan University

  7 shared

• David Doherty

  Loyola University Chicago

  6 shared

• Julian E. Zelizer

  5 shared

• Ann Carlson

  National PKU Alliance

  3 shared

• Colleen M. Grogan

  University of Chicago

  3 shared

• Mackenzie Lockhart

  Yale University

  2 shared

Labs

• Taubman Center for American Politics and PolicyPI

Awards & honors

• Louis Brownlow Book Award of the National Academy of Public…
• Don K. Price Book Award of the American Political Science As…
• APSA's Outstanding Public Engagement Award (2025)