The Politics of Health Reform: Observations of an APSA Congressional Fellow

28 Pages Posted: 13 Aug 2009 Last revised: 7 Oct 2009

Date Written: September 5, 2009


From my vantage point as an American Political Science Association Congressional Fellow working for a prominent moderate Democratic senator on a key committee, I observed the machinations of the supporters, opponents, and influencers of health reform legislation. This paper compares the strategy and tactics of health reformers in 2009 to similar efforts in 1993-94 and 1965. I argue that by appealing to moderate Republicans, especially on the Senate Finance Committee, and by negotiating the support of interest groups who could derail reform entirely, pro-reform politicians are maximizing their chances of success - yet their efforts may be insufficient to pass comprehensive reform. I walk through the process of writing the bill in an environment of powerful and persistent interest groups attempting to influence its content. I describe congressional reactions to pressure from interest groups and constituents as well as the role of Members' own preferences. I conclude that securing the support of a few moderate Republican senators and minimizing organized opposition is necessary to passing a bill.

Keywords: lobbying, health reform, Congressional politics, policymaking, health policy, interest groups

Suggested Citation

McKay, Amy Melissa, The Politics of Health Reform: Observations of an APSA Congressional Fellow (September 5, 2009). APSA 2009 Toronto Meeting Paper, Available at SSRN:

Amy Melissa McKay (Contact Author)

University of Exeter ( email )

Northcote House
The Queen's Drive
Exeter, Devon EX4 4QJ
United Kingdom

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