Dissertation: Race and the Politics of Health Reform

Race and the Politics of Health Reform: A Historical-Sociological Analysis from the New Deal to the Affordable Care Act

My dissertation explores the historic struggle for national health insurance in the U.S. through a critical race lens. Offered as a race-neutral policy to expand access to health care, the landmark Patient Protection and Affordable Care Act (Affordable Care Act) enacted by Congress in 2010 exposed the continued influence of racial politics on social welfare policy.

A few researchers have examined the relationship between racial attitudes and opposition to the Affordable Care Act (‘Obamacare’). I summarized some these findings in my 2012 Huffington Post article, Race and the Fight Against Obamacare. But opposition to universal health care is much deeper than the current debate, and in fact if we go back in history we can locate the roots of oppositional refrains and tactics still being used today to constrain health care policy. As a result of political processes often shaped by racial and class biases,  we are still far from achieving a truly universal and equitable health care system.

Beginning with the racial politics of the New Deal and exclusion of national health insurance under Roosevelt’s social insurance programs— to the continued opposition, largely by southern legislators to the Affordable Care Act—my research seeks to increase the understanding of the extent to which race and racism have limited federal government involvement in health care. Why is this important? Because political events do not occur in a vacuum. Historical patterns create path dependencies or self-reinforcing dynamics that limit policymaking to choices made in the past. Moreover, politicians and opinion leaders can employ coded language to prime voters to respond to deeply held biases about race and gender, rather than the policy under consideration (Winter 2008). We know from examination of  the antigovernment rhetoric associated with calls for “welfare reform” in the 1980s and 1990s, government programs and their beneficiaries can become stigmatized and suffer from public backlash. Strong opposition to social policies can hinder efforts to address disparities in health, income, education, and other critical areas. Understanding the factors that underlie hostility and resistance to change can inform advocacy and policy efforts that seek to dismantle structural barriers to equity and improve conditions for vulnerable populations.