Dissertations, Theses, and Capstone Projects

Date of Degree

6-2025

Document Type

Master's Thesis

Degree Name

Master of Arts

Program

Political Science

Advisor

Keena Lipsitz

Subject Categories

Health Policy | Medicine and Health Sciences | Other Medicine and Health Sciences | Other Political Science | Political Science | Public Policy

Keywords

Health Policy, Medicare, Medicaid, Path Dependency, Affordable Care Act

Abstract

This study examines the impact of path dependency on health reform efforts in the United States, specifically analyzing how past policy decisions constrain subsequent reform possibilities. Utilizing the theoretical framework of historical institutionalism, the study investigates two significant cases—the passage of Medicare and Medicaid in 1965 and the The Patient Protection and Affordable Care Act (ACA) in 2010—to illustrate how successful healthcare reforms embed institutional arrangements that limit future policy innovation. Through a comparative case study approach grounded in legislative records, historical texts, and scholarly analyses, the research highlights that major healthcare reforms in the U.S. have consistently been structured around political feasibility rather than systemic transformation. The study finds that the institutional choices made during these critical junctures—such as the segmented structure of Medicare, the federal-state partnership model of Medicaid, and the ACA’s reliance on private insurance markets—have created entrenched systems resistant to expansive reform. This study contributes to the understanding of health policy development by demonstrating that even legislative successes carry inherent limitations, reinforcing incrementalism and complicating future efforts toward universal healthcare coverage. Policymakers and reform advocates must therefore consider the enduring constraints imposed by historical institutional arrangements when designing and promoting health reforms.

Download

Share

COinS