The war over America’s Health Care: an application of the advocacy coalition framework to the Affordable Care Act

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dc.contributor.advisorFourie, P. P.en_ZA
dc.contributor.advisorAdams, U. L.en_ZA
dc.contributor.authorMofulatsi, Mofenyi Kgotsoen_ZA
dc.contributor.otherStellenbosch University. Faculty of Arts and Social Sciences. Dept. of Political Science.en_ZA
dc.date.accessioned2023-02-28T13:01:42Z
dc.date.accessioned2023-11-16T08:23:14Z
dc.date.available2023-02-28T13:01:42Z
dc.date.available2023-11-16T08:23:14Z
dc.date.issued2023-03
dc.descriptionThesis (MA)--Stellenbosch University, 2023.en_ZA
dc.description.abstractENGLISH 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. en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Gesondheidsorg in die Verenigde State was, en is steeds, ’n omstrede kwessie sedert die begin van die 20ste eeu. Europese nasies het in die laat 19de en vroeë 20ste eeue hul eie sosiale gesondheidsversekeringsprogramme ingestel; individue en organisasies in die VSA het daarna gepoog om nasionale gesondheidsversekering in te stel wat pas by die Amerikaanse politieke en kulturele kontekste gebaseer op beperkte regering en ’n vryemarkekonomie. Magtige belangegroepe het egter sterk teen hul pogings gestaan. Alhoewel pogings tot gesondheidshervorming en nasionale gesondheidsversekering deur die 20ste eeu duidelik was, het die pogings dikwels opposisie een gelaaide politieke retoriek teëgekom. Hierdie retoriek beskou so 'n hervorming as verraad van Amerika se fundementele waardes. Die VSA het tot dusver net openbare gesondheidsversekeringsprogramme spesifiek vir senior burgers en die hulpbehoewende bevolking ingestel, maar bestee steeds meer aan gesondheidsorg in vergelyking met enige ander geïndustrialiseerde nasie; tog lewer hul swakker gesondheidsorguitkomste as eweknielande. Die nasie het probeer om foute in die stelsel reg te stel, maar elke poging is ontmoet met gelaaide politieke retoriek, vrae oor die regering se rol in gesondheidsorg, en insette van belangegroepe wat die waters vir gesondheidshervorming vertroebel het. In die lig hiervan het die student gepoog om te verstaan wie ’n belangrike rol gespeel het in die toestand van die Amerikaanse gesondheidsbeleidshervorming en hoe dit plaasgevind het. Om hierdie vraag te beantwoord, het die studie elemente van die ACF gebruik om hierdie akteurs en hul gevolglike voorspraakkoalisies te identifiseer. Die student het ’n kwalitatiewe navorsingsbenadering gevolg en beskikbare literatuur oor gesondheidshervorming ondersoek om akteurs te identifiseer wat die prominentste in die gesondheidshervormingsdebat tydens en na die implementering van die gevallestudiewet verskyn het: die Wet op Bekostigbare Sorg (ACA); asook om hul oortuigings te identifiseer. Die komplekse en veelsydige aard van die arena waarin Amerikaanse gesondheidsorgbeleide bepaal word, word deur die navorsing bevestig. Die akteurs wat hier betrokke is vorm voorspraakkoalisies rondom hulle oortuigings, wat op hul beurt met mekaar kompeteer om politieke beleide te bepaal. Hulle standpunte is egter deur die sosio-politieke konteks van die VSA beïnvloed. Hulle het òf die konteks ten gunste van hul eie belange gebruik òf hulle moes hulle beleid voorstelle by hierdie konteks aanpas. Dus het lobbyiste steeds ’n beduidende invloed op gesondheidsorgbeleide, ten spyte van staatsamptenare se beloftes. Dit beteken dat belangegroepe steeds in ’n bevoorregte posisie is in terme van die beleidsproses. af_ZA
dc.description.versionMastersen_ZA
dc.format.extentxii, 131 pages
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/128689
dc.language.isoen en_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subject.lcshMedical care -- United Statesen_ZA
dc.subject.lcshHealth insurance -- United Statesen_ZA
dc.subject.lcshNational health insurance -- United Statesen_ZA
dc.subject.lcshUnited States. Patient Protection and Affordable Care Acten_ZA
dc.subject.nameUCTD
dc.titleThe war over America’s Health Care: an application of the advocacy coalition framework to the Affordable Care Acten_ZA
dc.typeThesisen_ZA
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