Stakeholder participationinpolicymaking: Evidence from medicare fee schedule revisions

To what extent do the material stakes of specific policies motivate political participation by affected interests? We address this question by examining physician participation in the annual process governing revisions to Medicare fee schedules. This setting permits us to identify the relevant universe of affected actors and to construct a novel measure of the annual financial consequences of proposed policy changes that varies idiosyncratically at the individual level. Employing text analysis to identify who participates in the notice-and-comment process between proposed and final rules, we find that while few providers comment, the odds of participation vary dramatically as a function of a rule’s impact, with anticipated losses motivating comments substantially more than gains. This relationship persists in both individually tailored and mass comments and is largely independent of the behavior of physician specialty societies. Evidence of the effect of these stakes on campaign contribution behavior is more modest.