Deadlock: A political economy perspective on the Massachusetts health policy reform experience

The issue of health care reform has persisted on both the state and national political agenda for decades. State involvement in health policy reform has grown considerably since the enactment of Medicaid in 1965 and the states have increasingly served as "laboratories of democracy" testing different health reform initiatives and approaches. Massachusetts has been identified in numerous instances as a pioneer among those states experimenting with reform, particularly with respect to its efforts to promote comprehensive health coverage. In a sense, the Massachusetts experience has positioned this state at the vanguard of the national health reform debate. Since the failure of its first attempt to provide universal insurance coverage in the late 1980s, efforts to reform the state's health care system have persisted, routinely surfacing on the state political agenda.;Using a political economy framework, this dissertation analyzes four discrete policy reform episodes in Massachusetts over a two decade period beginning in the late 1980s and concluding in 2008. Based on in-depth interviews and a review of archival documents and news reports, this study illustrates how the course of reform has been influenced by such issues as the allocation for public and private responsibilities for health care coverage and cost control, the evolution and functioning of the employer based health insurance system, and the role played by dominant structural interests of the health care industry. In addition, attention is given to the way that political rhetoric and previous policy action or inaction have shaped reform opportunities at any point in time.;The completion of this study comes at an interesting time, as the nation recently elected a president dedicated to health care reform. In that context, the 2006 Massachusetts model may be considered as a useful template for constructing a reform plan. This study provides insight into the process that shaped its development and the factors that enabled its passage.