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Interest Groups and Health Care Reform across the United States

Virginia Gray, David Lowery, and Jennifer K. Benz

Publication Year: 2013

Universal health care was on the national political agenda for nearly a hundred years until a comprehensive (but not universal) health care reform bill supported by President Obama passed in 2010. The most common explanation for the failure of past reform efforts is that special interests were continually able to block reform by lobbying lawmakers. Yet, beginning in the 1970s, accelerating with the failure of the Clinton health care plan, and continuing through the passage of the Affordable Care Act in 2010, health policy reform was alive and well at the state level.

Interest Groups and Health Care Reform across the United States assesses the impact of interest groups to determine if collectively they are capable of shaping policy in their own interests or whether they influence policy only at the margins. What can this tell us about the true power of interest groups in this policy arena? The fact that state governments took action in health policy in spite of opposing interests, where the national government could not, offers a compelling puzzle that will be of special interest to scholars and students of public policy, health policy, and state politics.

Published by: Georgetown University Press

Series: American Governance and Public Policy series


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p. 1-1

Title Page, Copyright

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pp. 2-7


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pp. vii-9

List of Tables and Figures

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pp. ix-x

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Preface and Acknowledgments

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pp. xi-13

This research was launched by an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation to Virginia Gray and David Lowery (ID# 047727) in 2003. We were intrigued by the repeated attempts of state governments to offer universal coverage to their citizens and by the backlash against managed care that was manifested in many state regulations, yet at the national level policymakers were still chastened by the ...

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Introduction: Interests and Health Policy

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pp. 1-4

This book is about the politics of interest representation. It is also about health care policy and politics in the American states. But it is first and foremost a book about interest representation. Simply put, there is a deep and profound debate among both academics and citizens about the role interest organizations play in the public policy process (Lowery and Gray 2004b). On the one hand, the press routinely recycles stories of undue influence of ...

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1 Health Care and Organized Interests in the United States

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pp. 5-40

Universal health care coverage was on the national political agenda for nearly a hundred years, from the platform of Teddy Roosevelt’s Bull Moose Party in 1912, to President Franklin Roosevelt’s consideration in the 1930s, to the long string of presidents who introduced major reform bills to expand access—starting with Harry Truman in the 1940s, to Lyndon Johnson, who got Medicare and Medicaid adopted in 1965; continuing with Richard ...

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2 The Theory and Structure of Health Interest Communities in the States

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pp. 41-59

Politicians, media commentators, and scholars alike long have been con-cerned about the role of organized interests in public policy. Of particular concern is the seeming dominance of business over citizens and not-for-profit groups. In spite of this concern about the balance of different types of interest organizations in the population as a whole, the conversation in much of the media is about individual interest organizations. How is a given firm or associ-...

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3 State Pharmacy Assistance Programs as Innovations

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pp. 60-92

At the end of 2003 President George W. Bush and the Republican Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA), the largest increase in social spending since the Great Society, which was estimated to cost at least $400 billion over ten years. The law began as an effort to add prescription drug coverage to Medicare, a problem that had been recognized for the previous thirty-eight years, and an issue ...

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4 The Politics of Managing Managed Care

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pp. 93-122

The rise and fall of managed care is one of the most significant stories associated with the politics of health care during the last fifty years. Managed care began from local efforts associated with rural cooperatives in the 1920s and expanded during World War II through the efforts of the in-dustrialist Henry Kaiser. By the late 1960s it had become the preferred option of consumer advocates because of its emphasis on preventive care. At roughly ...

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5 Universal Health Care in the States

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pp. 123-159

During the 1990s the states and the federal government addressed many of the same health care issues—universal coverage, regulation of man-aged care, and prescription drug coverage for seniors. But, as we have seen, the outcome was often different, with health reforms being enacted later or not at all at the federal level. In chapter 3 we saw that by 2004, thirty-four states had passed some kind of pharmaceutical assistance law, using state funds to pay ...

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6 Conclusion: Lessons Learned and Opportunities for Influence in the ACA Policy Environment

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pp. 160-178

In this final chapter we summarize our key findings about the role of inter-est groups in state health reform, comparing the three different reforms we have highlighted in this book. As noted in the introduction, this book is primarily one about the influence of organized interests with secondary em-phases, albeit vital to a research design capable of addressing the first issue, on health policy and state policymaking. Thus, our conclusions bear on all three ...

Appendix 2.1: Descriptions of Health InterestOrganization Subguilds

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pp. 179-182

Appendix 2.2: States Ranked by HealthInterest Group Density

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pp. 183-184

Appendix 2.3: Density by Subguild,Raw Numbers in 1998

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pp. 185-186

Appendix 2.4: Data Source for PoliticalAction Committees

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pp. 187-188

Appendix 3.1: List of Data Sources

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pp. 189-191

Appendix 3.2: Estimation of Annual InterestGroup Measures Using the ESA Model

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pp. 192-193

Appendix 4.1: Data Sources ofDependent Variables

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pp. 194-195

Appendix 4.2: Managed Care RegulationDescriptive Statistics

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pp. 196-197

Appendix 4.3: Definitions and Sources ofIndependent Variables

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pp. 198-199

Appendix 5.1: Sources of Dependent Variables

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pp. 200-201

Appendix 5.2:Sources of Independent Variables

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pp. 202-206


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pp. 207-226


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pp. 227-236

E-ISBN-13: 9781589019904
E-ISBN-10: 1589019903
Print-ISBN-13: 9781589019898

Page Count: 248
Illustrations: 18 figures, 16 tables
Publication Year: 2013

Series Title: American Governance and Public Policy series