IDEAS home Printed from https://ideas.repec.org/a/bla/ajecsc/v84y2025i5p729-736.html

Direct Democracy With Teeth: The Political Economy of Washington Initiative 678

Author

Listed:
  • Conor Norris

Abstract

Scope of practice laws restrict mid‐level professionals, like dental hygienists, from practicing independently. In 1997, Washington voters considered Initiative 678, which would have allowed dental hygienists to offer cleanings without dentist oversight, aiming to increase dental access. Due to a statewide advertising campaign by the dental professional association, the initiative failed. This paper examines county‐level support for Initiative 678. I find evidence that counties with lower dental care utilization, fewer residents with fluoridated water, and worse oral health predicted greater support for the initiative. These results are consistent with voters' interests shaping voting patterns, despite special interests influencing the outcome.

Suggested Citation

  • Conor Norris, 2025. "Direct Democracy With Teeth: The Political Economy of Washington Initiative 678," American Journal of Economics and Sociology, Wiley Blackwell, vol. 84(5), pages 729-736, November.
    • Handle: RePEc:bla:ajecsc:v:84:y:2025:i:5:p:729-736
    DOI: 10.1111/ajes.12628
    as

    Download full text from publisher

    File URL: https://doi.org/10.1111/ajes.12628
    Download Restriction: no
    File URL: https://libkey.io/10.1111/ajes.12628?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Wing, Coady & Marier, Allison, 2014. "Effects of occupational regulations on the cost of dental services: Evidence from dental insurance claims," Journal of Health Economics, Elsevier, vol. 34(C), pages 131-143.
    2. Joshua Hall & Shree Baba Pokharel, 2017. "Does the Median Voter or Special Interests Determine State Highway Expenditures? Recent Evidence," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 45(1), pages 59-69, March.
    3. Kleiner, Morris M & Kudrle, Robert T, 2000. "Does Regulation Affect Economic Outcomes? The Case of Dentistry," Journal of Law and Economics, University of Chicago Press, vol. 43(2), pages 547-582, October.
    4. Congleton, Roger D & Bennett, Randall W, 1995. "On the Political Economy of State Highway Expenditures: Some Evidence of the Relative Performance of Alternative Public Choice Models," Public Choice, Springer, vol. 84(1-2), pages 1-24, July.
    5. Joshua C. Hall & Serkan Karadas, 2018. "Tuition increases Geaux away? Evidence from voting on Louisiana’s amendment 2," Applied Economics Letters, Taylor & Francis Journals, vol. 25(13), pages 924-927, July.
    6. Levi Russell & Josh Hall, 2022. "The political economy of state right to farm amendments: evidence from Missouri," Economics and Business Letters, Oviedo University Press, vol. 11(3), pages 93-97.
    7. Joshua C. Hall & Jeremy Horpedahl & E. Frank Stephenson, 2021. "Collective Action Problems and Direct Democracy: An Analysis of Georgia’s 2010 Trauma Care Funding Amendment," Economies, MDPI, vol. 9(2), pages 1-9, April.
    8. G–khan R. Karahan & William F. Shughart II, 2004. "Under Two Flags: Symbolic Voting in the State of Mississippi," Public Choice, Springer, vol. 118(1_2), pages 105-124, January.
    9. John G. Matsusaka, 2005. "Direct Democracy Works," Journal of Economic Perspectives, American Economic Association, vol. 19(2), pages 185-206, Spring.
    10. repec:jpe:journl:768 is not listed on IDEAS
    11. Candon Johnson & Joshua Hall, 2019. "The Public Choice of Public Stadium Financing: Evidence from San Diego Referenda," Economies, MDPI, vol. 7(1), pages 1-9, March.
    12. Larry Schroeder & David Sjoquist, 1978. "The rational voter: an analysis of two Atlanta referenda on rapid transit," Public Choice, Springer, vol. 33(3), pages 27-44, January.
    13. Rodney D. Fort & Jon B. Christianson, 1981. "Determinants of Public Services Provision in Rural Communities: Evidence from Voting on Hospital Referenda," American Journal of Agricultural Economics, Agricultural and Applied Economics Association, vol. 63(2), pages 228-236.
    14. Benjamin J. McMichael, 2017. "The Demand for Healthcare Regulation: The Effect of Political Spending on Occupational Licensing Laws," Southern Economic Journal, John Wiley & Sons, vol. 84(1), pages 297-316, July.
    15. Kahn, Matthew E & Matsusaka, John G, 1997. "Demand for Environmental Goods: Evidence from Voting Patterns on California Initiatives," Journal of Law and Economics, University of Chicago Press, vol. 40(1), pages 137-173, April.
    16. repec:jpe:journl:1501 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Joshua C. Hall & Jeremy Horpedahl & E. Frank Stephenson, 2021. "Collective Action Problems and Direct Democracy: An Analysis of Georgia’s 2010 Trauma Care Funding Amendment," Economies, MDPI, vol. 9(2), pages 1-9, April.
    2. Xia, Xing, 2021. "Barrier to Entry or Signal of Quality? The Effects of Occupational Licensing on Minority Dental Assistants," Labour Economics, Elsevier, vol. 71(C).
    3. Noghanibehambari, Hamid & Bagheri, Hesamaldin & Toranji, Mostafa & Vu, Hoa & Tavassoli, Nasrin, 2025. "Womb to wisdom: Early-life exposure to midwifery laws and later-life disability," Social Science & Medicine, Elsevier, vol. 372(C).
    4. Kerianne Lawson & Joshua C. Hall, 2023. "Who should be behind the wheel? A study of Oregon's Measure 88," Economics Bulletin, AccessEcon, vol. 43(4), pages 1797-1801.
    5. Matthew J. Holian & Matthew E. Kahn, 2014. "Household Demand for Low Carbon Public Policies: Evidence from California," NBER Working Papers 19965, National Bureau of Economic Research, Inc.
    6. Ilya Kukaev & Edward J. Timmons, 2026. "Is occupational licensing a barrier to self-employment?," Journal of Regulatory Economics, Springer, vol. 69(1), pages 1-32, December.
    7. Guo, Jiapei & Kilby, Angela E. & Marks, Mindy S., 2024. "The impact of scope-of-practice restrictions on access to medical care," Journal of Health Economics, Elsevier, vol. 94(C).
    8. Hoda Nouri, 2025. "Determinants of voting behavior on healthcare policy: Analysis of Oregon Measure 111," Economics Bulletin, AccessEcon, vol. 45(3), pages 1134-1141.
    9. Matthew E. Kahn & Kyle Barron, 2015. "The Political Economy of State and Local Investment in Pre-K Programs," NBER Working Papers 21208, National Bureau of Economic Research, Inc.
    10. Noghanibehambari, Hamid & Fletcher, Jason, 2023. "Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws," Journal of Health Economics, Elsevier, vol. 92(C).
    11. Michael R. Richards & Coady Wing, 2019. "Recruiting and retaining dental labor in federal facilities: Harder than pulling teeth?," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1356-1369, November.
    12. Peter T. Leeson & Henry A. Thompson, 2023. "Public choice and public health," Public Choice, Springer, vol. 195(1), pages 5-41, April.
    13. Yelowitz, Aaron & Ingram, Samuel J., 2021. "How Does Occupational Licensing Affect Entry into the Medical Field? An Examination of EMTs," IZA Discussion Papers 14071, IZA Network @ LISER.
    14. Bruce Morley, 2023. "The Effects of Direct Democracy on Stock Market Risk and Returns: An Event Study from Switzerland," Risks, MDPI, vol. 11(2), pages 1-13, January.
    15. Masayuki MORIKAWA, 2017. "Occupational Licenses and Labor Market Outcomes," Discussion papers 17078, Research Institute of Economy, Trade and Industry (RIETI).
    16. Aaron Yelowitz & Samuel J. Ingram, 2024. "How does occupational licensing affect entry into the medical field? An examination of emergency medical technicians," Southern Economic Journal, John Wiley & Sons, vol. 91(1), pages 38-61, July.
    17. Jie Chen & Chad D. Meyerhoefer & Edward J. Timmons, 2024. "The effects of dental hygienist autonomy on dental care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1726-1747, August.
    18. Lang, Corey & Pearson-Merkowitz, Shanna, 2022. "Aggregate data yield biased estimates of voter preferences," Journal of Environmental Economics and Management, Elsevier, vol. 111(C).
    19. Shishir Shakya & Alicia Plemmons, 2020. "Does Scope of Practice Affect Mobility of Nurse Practitioners Serving Medicare Beneficiaries?," Journal of Labor Research, Springer, vol. 41(4), pages 421-434, December.
    20. Matthew J. Holian & Matthew E. Kahn, 2015. "Household Demand for Low Carbon Policies: Evidence from California," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 2(2), pages 205-234.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ajecsc:v:84:y:2025:i:5:p:729-736. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0002-9246 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.