Faculty of Arts and Social Sciences

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Browsing Faculty of Arts and Social Sciences by browse.metadata.advisor "Adams, U. L."

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    The war over America’s Health Care: an application of the advocacy coalition framework to the Affordable Care Act
    (Stellenbosch : Stellenbosch University, 2023-03) Mofulatsi, Mofenyi Kgotso; Fourie, P. P.; Adams, U. L.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Political Science.
    ENGLISH ABSTRACT: Health care in the United States has been, and continues to be, a contentious issue since the beginning of the 20th century. European nations instituted their own social health insurance programmes in the late 19th and early 20th centuries; following suit, individuals and organisations in the US have sought to institute national health insurance that fits the American political and cultural contexts which are based on limited government and a free-market economy. However, powerful interest groups have stood in strong opposition to their efforts. Indeed, attempts to pass health reform and institute national health insurance were evident throughout the 20th century; but were often met with strong opposition and charged political rhetoric, labelling these efforts as fundamental betrayals of America’s values and beliefs. Though the US has to date only instituted public health insurance programmes specifically for senior citizens and the indigent population, the US continues to spend more on health care than any other industrialised nation; yet it produces poorer health care outcomes than peer nations do. The US has attempted to correct flaws in the system, but each attempt has been met with charged political rhetoric, questions surrounding government’s role in health care, and input from interest groups which have muddied the health reform waters. In view of this, the student attempted to understand who have played significant roles in the state of US health policy reform and how this has occurred. To answer this question, the study utilised the elements of the Advocacy Coalition Framework (ACF) to identify these actors and the resulting advocacy coalitions. The student followed a qualitative research approach and surveyed available literature on health reform to identify actors who have featured most prominently in the health reform debate during and after the implementation of the case study law: the Affordable Care Act (ACA); as well as to identify their beliefs. These actors coalesce around their beliefs to form advocacy coalitions, which compete with one another to translate these beliefs into policy. The research findings confirm the complexity and multi-faceted nature of the US health care policy-making arena. Identified actors and the resulting advocacy coalitions have actively competed to translate their beliefs into policy; however, their policy positions have been influenced by the political and societal contexts of the US. Actors either leveraged the political and societal contexts for their benefit or had to amend or limit their proposed policies to fit these contexts. Lobbying has continued to hold significant sway over health care policymaking, despite selected officials’ mandates, leaving interest groups in a privileged position in the policy process.