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I n March 2010 President Barack Obama signed the most comprehensive health care reform in the United States since the enactment of Medicare and Medicaid forty-five years earlier. In order to increase coverage to the uninsured and control rising health care costs, among other things, this reform brings comprehensive change to some aspects of America’s complex public–private health insurance system and revises other parts in a more incremental manner. The heated nature of the debate surrounding this key legislation and the compromises necessary for the president and the Democratic majorities in Congress to enact a reform in the first place showed once again how the politics of policy change is both risky and complicated , especially when it involves dealing with powerful vested interests and a nervous public. This in turn illustrates the need for scholars and other commentators on public affairs to have a proper understanding of the dynamics of the process of policy change. What motivates political actors and policymakers to pursue a reform agenda? And what are the opportunities and challenges they face? To help deepen understanding of these processes, this book explores the politics of policy change in the United States through a systematic comparison of three major policy areas and policy episodes: the 1996 welfare reform, the 2003 Medicare reform, and the 2005 failed attempt to privatize Social Security. These three cases had quite distinct immediate outcomes. First, there was a sharp, conservative reform of welfare as the Aid to Families with Dependent Children program, initially established in the 1930s, was ended and replaced by a new program called Temporary Assistance to Needy Families (with an emphasis on “Temporary”). Second, during the George W. Bush years, legislation was enacted to reform Medicare but, as a social policy reform, this was less radical and more ideologically ambiguous. This is true because the introduction of a prescription drug benefit for seniors was accompanied by a series of less publicized but potentially significant conservative minded changes. Finally, the attempt to reform Social Security ended in dismal legislative failure. Despite these different outcomes, the three cases share common themes, particularly with regard to the importance of ideas and their interaction with other causal factors such as issue ownership and institutional legacies. Placing our discussion of the three episodes and their aftermath in the context of these factors allows us to develop an empirically grounded and integrated analytical framework that should help others to better grasp the politics of policy change in the field of social policy and well beyond. In putting forward this framework, this book explicitly contributes to the debate about the nature and the sources of policy change in advanced industrial Preface societies associated with the work of scholars such as Jacob Hacker and Kathleen Thelen. Yet, because our book is deliberately written in a clear and accessible manner, we hope that informed, nonacademic readers interested in federal social policy reform in the United States will find our empirical analysis and our general remarks about policy change insightful. The development of the federal welfare state is and will remain a major issue in the politics of the United States, and we strongly believe that systematically comparing specific yet important policy areas is an important way to further explore what Paul Pierson famously called “the new politics of the welfare state.” As we show, much has changed in social policy since the Clinton years, and our framework, we believe, offers a compelling way to explain both incremental and sharp policy changes that have taken place in the federal welfare state since 1993. Although our book focuses on the Bill Clinton and the George W. Bush years, our analysis of the three policy episodes listed earlier leads to remarks about more recent developments, including the 2010 health insurance reform. Overall, our book should help the reader better understand and explain major social policy developments in contemporary federal politics. This project began in 2005, when Daniel Béland met series coeditor Gerry Boychuk at the annual American Political Science Association meeting in Washington, DC. Gerry mentioned the possibility of writing a book on US social policy for his series, something that Daniel found very exciting. Immediately after the meeting, he contacted his friend and long-time collaborator, Alex Waddan, to see whether they could collaborate on this project. Alex had already published extensively on welfare reform and Daniel had just published a book on the history and politics of Social Security, so they decided to compare the two...

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